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.

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.

[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.

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.

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 analyze the incidence,severity and morphologic characteristics of anemia in patients with malignant tumors.Methods Five hundred and thirty hospitalized patients with a primary diagnosis of tumor were enrolled in this study at our hospital from Jan.2009 to Mar.2011.Their hemoglobin (Hb) levels,age,sex,and type of tumor were recorded.Anemia was diagnosed to be present when their Hb on admission was less than 110 g/L Results There were 111 in the 530 patients (20.94％) had anemia on admission.Anemia was seen in 35.3％ of patients with digestive system cancer,in 19.4％ with gynecologic cancers,in 18.3％ withlung cancers,in 6.8％ with urinogenital cancers and 1.8％ with breast cancers.The difference of incidence of anemia in different types of cancers was statistically significant ( x2=44.9785,P ＜ 0.01 ).Grade Ⅰ and Ⅱanemia accounted for 15.66％ ; and grade Ⅲ and Ⅳ accounted for 5.28％ of all.There was no significant difference of incidence of anemia between male and female [ 22.36％ ( 72/322 ) vs.18.75％ ( 39/208 ),x2 =1.0020,P ＞ 0.05 ].The more severe the anemia was,the smaller the erythrocyte mean corpuscular volume was.The rate of anemia was 2.08％ when patients were discharged,and 5.66％ were intervened.Conclusion The incidence of anemia was high in patients hospitalized with tumor,but only a small percent got enough medical care.

Objective To probe the clinical features and possible mechanisms of autoimmunic hemocytopenia complicated with thrombosis.Methods From 2007 to 2008,the clinical and laboratory data of seven patients with autoimmunic hemocytopenia complicated with thrombosis in the hematology department General Hospital tianjin medical university were analysed.Results One of the patients was with Evans syndrome,and another six patients with immuno-related pancytopenia.Three were complicated with lower extremity Veins embolism;two with cerebral vessel and pulmonary artery embolisms respectively;one with splenic artery and coronary artery embolisms respectively.Among them,three were complicated embolism of two parts;six patients had higher D-Dimer level.They were treated with glucocorticoids,cyclosporin A,and immunoglobulin for immunic hemocytopenia and with anti-coagulation therapy(aspirin、heprin and warfarin) for thrombosis.Seven patients' hemogram,signs and symptoms improved gradually since they received immunosuppression and anticoagulation therapy.The symptoms of thrombosis disappeared two weeks later.The degree and extent of thrombosis also alleviated;at the same time,the function of blood coagulation recovered partly or completely.Conclusion Thrombosis is a rare but severe complication of autoimmunic hemocytopenia.Promptly anti-coagulation and immunosuppressive therapies can get ideal therapeutic effects.

Objective To establish a multi-parameter diagosis criteria for Myelodysplastic syndromes(MDS).Methods Eight diagnostic parameters for MDS obtained from our retrospective study were prospectively studied.From Jan.2000 to June 2004,leukemic transformations in 38 MDS patients diagnosed according to the multi-parameter criteria plus WHO criteria were dynamically followed up,and compared with that in 79 MDS cases who were diagnosed only according to WHO criteria contemporaneously and that in 123 MDS cases historially who fit in with WHO criteria.Results Eighteen of the 38 MDS patients transferred into leukemia.Among the 79 MDS patients diagnosed only according to the WHO criteria,18 transferred(P