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Acquired aplastic anemia

Patient M. aged 14 was admitted to the Department of Hematology of Children Specialized Clinical Hospital with hypoplastic anemia and myelodisplastic syndrome suspected. On admittance, the patient complained headache, vertigo, palpitation, dyspnea on insignificant load, bad appetite, expressed asthenia, skin paleness and hemorrhagic eruption on lateral surfaces of extremities.

Blood count on admittance: erythrocytes 2.4x1012/l; Hb 72 g/l; color index 0.9; leukocytes 2.4x109/l; erythrocytes, 2 %; n.p., 10 %; n.s., 19 % lymphocytes 54 %; monocytes 15 %; tr., 12x109/l; ESR 15 mm/hr. To verify the diagnosis, sternal puncture was made. Myelogram (see Tables 1, 2) showed acute suppression of myeloid, erythroid growth, practical absence of megalokaryocyte growth.

Diagnosis: acquired aplastic anemia.

On the 5th day in the hospital, cryopreserved hematopoietic cells were transplanted intravenously. Total volume of cell suspension was 3 ml; cell concentration 55x106/ml; CFU-GM count 78.6x103/ml.

On the 42nd day from the first transplantation hematopoietic cells were transplantated once again. Volume of cell suspension was 4.5 ml; cell concentration 76.5x106/ml; CFU-GM count 60.8x103.

Myelograms on the 15th and 34th days from the second transplantation stated the improvement of hematopoiesis of all lines, including megalokaryocytic one (see Tables 1, 2).

The patient was discharged from the hematology clinic in better condition on the 37th day after the second transplantation. The corticosteroid therapy was gradually discontinued; no transfusions of blood components were performed. At present, the patient follows active living style and is observed by hematologist; his condition is good.

Table 1. Absolute contents of formed elements of bone marrow of patient M. before and after the treatment

Index Prior to the first transplantation, 109/l On the 9th day after the first transplantation, 109/l On the 15th day after the second transplantation, 109/l On the 24th day after the second transplantation, 109/l
Neutrophilocytes:
Promyelocytes
Myelocytes
Metamyelocytes
Stab
Segmented
 0.01
0.06
0.01
0.09

0.02
0.86
0.75
0.33
0.05

0.1
0.1
0.6
0.86
0.63

8.28
34.5
18.86
17.48
11.5
Eosinophils segmented 0.01 0.1 0.1 8.28
Basophils segmented 0.11 0.46 0.3 0.46
Erythroblasts 0.05 0.86 0.5 11.04
Normocytes:
basophilic
polychromatophilic
oxyphilic

0.136
0.07
0.004

1.13
2.33
0.06

0.8
2.3
0.16

20.24
53.36
10.12
Lymphoblasts 0.01 0.33 0.03 8.28
Lymphocytes 1.33 2.43 2.06 21.62
Holonuclear 0.1 0.06 0.26 5.52
Plasmatic cells 0.01 0.23 0.3 0.46
Megakaryocytes 0 Individual in preparation 2:25 in visual field, nonfunctioning 2:10000, functioning
Megakaryocytes 2 10 10 230

Table 2. Blood indices in 14 years old patient M. suffering from aplastic anemia

Day after the transplantation Erythrocytes, 1012/l Hemoglobin, g/l Leukocytes, 109/l Thrombocytes, 109/l ESR, mm/h Erythrocytes with fetal Hb (%)
1st Fetal Cell Transplantation
1 1.5 61 3.4 21 35
2 1.9 61 2.1 22 20 0.2
3 2.1 70 1.6 0.2
7 2.1 72 2.4 16 65
9 1.5 56 1.5 15 63 1.2
15 1.1 43 2.2 12 46
25 2.3 80 2.9 2.7
41 2.5 94 2.4 32 40 3.2
42 2nd Fetal Cell Transplantation
3 1.5 60 2.5 21 5.4
7 1.7 53 2.0 42 11
30 2.6 75 2.9 93 48 13
49 2.3 88 4.1 116 8 12
60 3.4 132 3.4 230 5 19
70 4.0 150 3.8 230 3 27

Fetal stem cells treatment results depend on: disease's severity, age of the patient, adherence for the medications and regime. Treatment results, presented on this site, are individual for each clinical case.