There were great break through in the studies on aplastic anemia in China during the past 20 years.The annual incidence of aplastic anemia in China was about 0.73 per one hundred thousand population.The risk factors,particularly virus infection,were associated with the onset of aplastic anemia. The pathogenesis of aplastic anemia was recognized as that the marrow failure was resulted mainly by autoimmunic T cell attack through lymphokine induced apoptosis.Aplastic anemia,an autoimmunic marrow failure rather than marrow failure syndromes,should be diagnosed based on marrow failure,T cell over function and exclusion of other similar diseases.Long enough intensive immunosuppressive therapy combined with hemopoietic stimulating factors was proven to be effective on aplastic anemia which might be cured.

Idiopathic bone marrow failure anemia(BMF),a group of severe hematopoietic diseases including acquired aplastic anemia,pure red cell aplasia,immune related pancytopenia,immune related anemia,paroxysmal nocturnal hemogobinurea,myelodysplastic syndromes and idiopathic cytopenia of undetermined significances,is quite easy to be misdiagnosed clinically.The proper diagnoses of these diseases should be made on the complete and detailed information about the patient's symptoms and signs,results of regular blood tests,bone marrow morphology examination and investigations on the pathogenesis of BMF,and response to the tentative therapy if it is necessary.High curative rate of these diseases will be achieved with prompt and long enough therapies for supporting patient's life,blocking the pathogenic process and stimulating hematopoiesis.

Aplastic anemia(AA)is a life-threatening blood disease.The British guideline and Chinese experts' experiences indicate that it is related to the abnormality of cellular immunity.Diagnosis by adequate exclusion,strict indication for stem cell transplantation and more immunosuppression plus hematopoietic stimulating therapies should be paid more attention in the treatment of this disease.

Abnormal epigenetics play important roles in the pathogenesis of myelodysplastic syndromes (MDS). DNA hypermeth-ylation is the most common epigenetic abnormality in MDS. Demethylating DNA hypermethylation may improve the quality of life of MDS patients and prolong their overall survival. Azacitidine and decitabine are the demethylating drugs approved for MDS treatment. These drugs showed clinical effects on all subgroups of MDS patients.

[Abstrct] Based on field studying at University of California, Los Angeles (UCLA),discussing with the teacher and student representatives and reviewing related literatures, we found that the suc-cessful experience of PBL at UCLA were small group teaching, the use of different sources of tutor, serious case preparation, and good hardware support. The major difficulties of PBL at UCLA were high teaching costs, unstable teacher group and high hardware requirements. Because of the cultural differ-ences between East and West, Chinese students are not good at active learning, so we recommended gradually carrying out PBL teaching in our country, making more PBL skills training to teachers and students, strengthening the hardware construction, seeking school administrative support, and giving timely repair according to the feedback of scientific research.

Anemia is one of the most common complication and a negative prognostic factor of lymphoid neoplasma.Different cases with lymphoid neoplasma associated anemia(LNAA)have various pathogenesis such as hemorrhagic anemia, anemia of chronic disease,autoimmune hemolytic anemia and treatment related anemia, though they all have the same symptoms. So different regimens are given to different patients according to their pathogenesis of LNAA.

Myelodysplastic syndrome (MDS) comprises a heterogeneous group of malignant disorders.The diagnosis of MDS has always been the focus of attention of hematologists all over the world.From the FAB classification to 2008 WHO classification,the diagnosis of MDS has changed from completely morphological diagnosis to multi-parameter diagnosis.Nowadays,the diagnosis of MDS should involve multiple parameters concerning morphology,histochemistry,cytogenetics and immunology.

Objective To analyse the occurrence and prognosis related factors of renal dysfunction in patients with multiple myeloma(MM).Methods During Janaury 1991 and Janaury 2007 seventy-four cases of MM in Department of Hematology,Gernal Hospital of Tianjin Medical University were enrolled in this study.The occurrence,the risk factors and prognosis were analyzed.Results The incidence of renal dysfunction(RD)in MM was 56.8%.Age,hypertention,hemoglobin,serum ALB,GLO,calcium,phosphonium,?2-MG,the percentage of plasma and immature plasma cells in bone marrow,Durie-Salmon stage and type of MM were associated with the incidence to RD with MM by monovariam analysis.Hypertention,serum ALB and ?2-MG were associated with the incidence of RD with MM by multivariant analysis.ALB was the protected factor and the other two were risk factors.The renal function improved rapidly in the patients who received CR or blood transfusion for severe and moderate anemia.Compared with patients of normal renal funtion,RD patients survived shorter and had higher early death rate.Conclusion Hypertention and high tumor burden are risk factors of renal dysfunction in MM.Effective chemothemapy and supportive treatment helped renal function recovery.

Objective To analyze the clinical features of pure red cell aplasia (PRCA),and to improve the recognition of its pathogenesis and treatment.Methods Among 35 PRCA patients from 1990-01 to 2003-04 in our hospital,17 patients(group Ⅰ) had immunologic abnormality,and the other 18 patients (group Ⅱ)were normal at every immunologic index.Removed the primary affection,all patients were given the combine treatment with drugs:androgen,immunosuppressive agent or/ and glucocorticoid.Results Nine patients in group Ⅰ appeared T subgroup ratio inversion in peripheral blood,eleven patients had higher level than normal with TNF?,and six patients' IL-2 level was higher.The response was 70.6%.Some patients shifted to normal in immunologic index.The response was 86.7% in group Ⅱ.But 11 cases relapsed of the 25 cured and remission patients.They responded again to the initial therapy.Conclusion Dysimmunity is the most important pathogenesis in PRCA patients.Most patients respond to immunosuppression therapy.The relapse patients also respond to initial therapy.

Objective To investigate the quantitative abnormality of CD~+_5B lymphocytes in the bone morrow of the patients with autoimmunic hemocytopenia and its clinical significance.Methods The patients were referred to the Institute of Hematology & Blood Diseases Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College.Quantities of CD~+_5B lymphocytes in the bone morrow of 14 patients with autoimmune hemolytic anemia(AIHA)or Evans syndrome,22 immunorelated pancytopenia(IRP)patients and 10 normal controls were assayed by FACS.The correlation between their clinical and laboratory parameters with CD~+_5B lymphocytes was analyzed.Results The qutantity of CD~+_5B lymphocytes were significantly higher in AIHA and Evans and IRP patients than in normal controls;there was no significant difference between AIHA、Evans syndrome and IRP patients.The qutantity of CD~+_5B lymphocytes in the bone morrow of all cytopenic patients showed negative correlation with C_3 complement.In AIHA、Evans syndrome patients,the quantity of CD~+_5 B lymphocytes in their bone morrow showed positive correlation with IBIL.In Evans syndrome patients,the quantity of CD~+_5B lymphocytes in their bone morrow showed positive correlation with PAIgG and PAIgM.The qutantity of CD~+_5B lymphocytes in the bone marrow of all cytopenic patients showed negative correlation with treatment response,but no correlation with the yields of CFU-E、 BFU-E、CFU-F and CFU-GM cultured from their bone marrow mononuclear cells in vitro.Conclusion CD~+_5B lymphocytes in the bone marrow of the patients with autoimmunic hemocytopenia significantly increase and are related to the disease severity and clinical response.It is suggested that CD~+_5B lymphocytes might have important roles in the pathogenesis of autoimmunic cytopenia.