American Journal of Internal Medicine
Volume 4, Issue 2, March 2016, Pages: 36-42
Received: Apr. 6, 2016;
Accepted: Apr. 20, 2016;
Published: May 11, 2016
Views 3551 Downloads 120
Safaa A. A. Khaled, Department of Internal Medicine, Hematology & BMT Unit, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
Aplastic anemia (AA) is a hypoproliferative anemia that led to a significant morbidity and mortality. Recently, dramatic improvement in prognosis of AA was achieved; this was in part due to advances in immunosuppressive therapy and HSCT. Nevertheless, AA is still one of the most challenging hematological disorders that could face a hematologist. This study was conducted at Assiut University Hospital (AUH), Assiut, Egypt to evaluate current situation and future prospective of AA. 63 patients with AA were prospectively enrolled in the study; they were admitted at the Hematology unit, AUH in the period 1stJan2011 to Feb2012, a 38 patients with iron deficiency anemia (IDA) were included for comparison. Patients' demographic and clinical data were collected through medical history and clinical examination. Both direct and indirect health care costs of anemia were assessed Direct parameters included doctors' and hospital fees, costs of laboratory investigations, medication fees and costs of HSCT or any procedure. Indirect costs included travelling expenses and earning losses. Social burden of anemia was estimated by anemia related morbidity and mortality. Data were analyzed with SPSSV.17, results showed that AA affected young age group with mean age 30.89±13.39 years, without sex predilection, acquired AA was more common than idiopathic (55.6% vs. 44.4%), however mortality was higher in idiopathic AA (46.2%). Causes of aplasia were exposure to chemicals, drugs and hepatitis in order. Only 63.5% of AA were admitted once and 47.6% in general ward, the mean hospital days for patients with AA was 17.73±11.10, compared to 8.32±6.69 in IDA, P=0.000, also higher socio-economic burden of AA was found compared with IDA. These results denoted that management of AA is still ineffective, and that there is a definite need for a strict plan to prevent incidence of AA, particularly in developing countries where effective management of AA is too expensive and relatively unavailable.
Safaa A. A. Khaled,
Aplastic Anemia in Egypt: Current Situation and Future Prospective, American Journal of Internal Medicine.
Vol. 4, No. 2,
2016, pp. 36-42.
Smith E G, Marsh JC. Acquired aplastic anemia, other acquired bone marrow failure disorder and dyserythropoiesis. In: Hoffbrand AV, Catovsky D, Tudenham E, editors. Postgraduate Haematology. 5th ed. Oxford: Blackwell publishing Ltd; 2005: 965-78.
Brodsky RA, Jones. Aplastic Anemia. The Lancet London, 2005.7–13; 365 (9471): 1647-57.
Young NS. Acquired aplastic anemia; in Schechter GP, Berliner N, Telen MJ (eds): Hematology. Washington, The American Society of Hematology Education Program Book, 2000, pp 18-38.
Adil SN, Burney JA, Kakepto GN, Khurshid M. Epidemiologic features of Aplastic Anemia in Pakistan. J Pak Med Assoc. 2001; 51 (12): 443-5.
Malhotra P, GellaV, Murthy GSG, Varma N, and Varma S. Higdh incidence of aplastic anemia is linked with lower socioeconomic status of Indian population. J Public Health 2015;doi:10.1093/pubmed/fdv027.
Fuhrer M, Ramp fU, Baumann I, et al. Immunosuppressive therapy for aplastic anemia in children: a more severe disease predicts better survival. Blood 2005; 15 (6): 2102-4.
Ali AS, Hamid MH, Khan MA, Ahmed FN. Acquired Aplastic Anemia– and experience with different drug therapies. Pak Paediat J2003; 27 (1): 19-27.
Hernandez-Rivera EG. Hematopoietic stem-cell transplantation in aplastic anemia. Rev Invest Clini 2005; 57 (2): 298-304.
Mahmoud HK, El-Haddad AM, Fahmy OA, et al. Hematopoietic stem cell transplantation in Egypt. Bone Marrow Transplantation (2008) 42, S76–S80.
Davies JK, Guinan EC. An update on the management of severe idiopathic aplastic anemia in children. Br J Haem.2007; 136 (4): 549-564.
Young NS, Calado R, Scheinberg P. Current concepts in the pathophysiology and treatment of aplastic anemia. Blood 2006; 108: 2509-19.
Tichelli A, Schrezenmeier H, Bacigalupo A. Immunosuppressive treatment of aplastic anemia: Schrezenmeier H, Bacigalupo A., editors. Aplastic anemia: Pathophysiology and treatment. Cambridge UK: Cambridge University press, 2000; 154-96.
64th World Medical Association General Assembly, Fortaleza, Brazil 2013. All rights reserved. http://www.wma.net/en/30publications/10policies/b3
Dallman PR, Johnson C. Prevalence and causes of anemia in the United States, 1976 to1980. AmJ Clin Nutr1984; 39: 437–45.
Mary JY, Baumelou M, Guiguet M. The French Cooperative Group for Epidemiological Study of Aplastic Anemia. Epidemiology of aplastic anemia in France: a prospective multicentric study. Blood 1990; 75: 1646-53.
Montané E, Ibáñez L, Vidal X, et al. Haematologica. Epidemiology of aplastic anemia: aprospective multicenter study. 2008 Apr; 93 (4): 518-23.
Clausen N, Salmi T, Storm Mathisen I, Johannesson G. Severe Aplastic Anemia in Nordic Countries: A population based study of incidenc, course and outcome. Archives Dis Childhood 1996; 74: 319-22.
Kim JY, Shin S, HanK, et al. Relationship between socioeconomic status and anemia prevalence in adolescent girls based on the fourth and fifth Korea National Health and Nutrition Examination Surveys. Eur J Clin Nutr. 2014 Feb; 68 (2): 253-8.
Issaragrisil S, Kaufman DW, Anderson TE, et al. An association of aplastic anaemia in Thailand with low socioeconomics tatus. Br J Haematol. 1995 Sep; 91 (1): 80-4.
Ibrahiem OA, Haridi MA, Kamel RA. Outcomes of aplastic anemia patients in Assiut University hospital, one year study. 2014. Assiut Med. J.; 38 (1): 247-254.
Field SR, Follmann D, Nunez O, Neal S, Young MD. ATG and Cyclosporin–A for severe aplastic anemia. JAMA 2003; 289 (9): 1130-35.
Khera N, Zeliadt SB, Lee SJ. Economics of hematopoietic cell transplantation. Blood. 2012; 8: 1545-51.
Lee SJ, Klar N, Weeks JC, et al. Predicting costs of stem-cell transplantation. JClinOncol.2000; 18: 64-71.
Saito AM, Cutler C, Zahrieh D, et al. Costs of allogeneic hematopoietic cell transplantation with high dose regimens. Biol Blood MarrowT ransplant. 2008; 14: 197-207.
Espérou H, Brunot A, Roudot-Thoraval F, et al. Predicting the costs of allogeneic sibling stem-cell transplantation: results from a prospective, multicenter, Frenchstudy. Transplantation. 2004; 77: 1854-58.
Sharma SK, Choudhary D, Gupta N, et al. Cost of Hematopoietic Stem Cell Transplantation in India. Mediterr J Hematol Infect Dis. 2014; 6 (1): e2014046.