aplastic Anemia

Anemia is a condition where red blood cell count or the number homoglobin (oxygen-carrying protein) in red blood cells is below normal. Red blood cells contain homoglobin, allowing them to transport oxygen from the lungs and deliver it to all parts of the body. Anemia leads to reduced number of red blood cells or amount homoglobin in red blood cells, so that blood can not carry oxygen in the body as needed.

Aplastic anemia is anemia due to bone marrow aplasia in which hemopoiesis tissue is replaced by fat tissue, divided into two, namely:

A. Severe aplastic anemia
1. Bone marrow cells <25% and there are 2 of the 3 following symptoms

•  Granulocytes <500/uI
•   Platelets <20.000/uI
•   Reticulocytes <10% 0

2. plastic anemia

• The bone marrow is hypoplastic
• Pensitopenia with one of three blood tests such as severe aplastic anemia

DIAGNOSIS
• History:

1. History of exposure to toxic substances (drugs, workplace, hobbies), suffering from a viral infection last 6 months (hepatitis, parvovirus), had received a blood transfusion
2.   Symptoms of anemia: weakness / weakness, dizziness, shortness of breath / heart failure, dizzy
3.   Signs of infection: fever often
4.   As a result of thrombocytopenia: bleeding (menstrual length, epistaxis, bleeding gums, bleeding under the skin, hematuria, blood mixed bowel, vomiting of blood)

• Physical examination: conjunctival pallor, tachycardia, signs of bleeding
• Investigation: complete blood count was found pancytopenia, viral serology (hepatitis, parvovirus)
• Definitive diagnosis: bone marrow cytology and histopathology

DIAGNOSIS
Myelofibrosis, hemolytic anemia, deficiency anemia, anemia due to chronic disease, anemia due to disease of bone marrow malignancy, hypersplenism, acute leukemia
Examination support
• Laboratory: complete blood count, viral serology
• Aspiration and biopsy of bone marrow

TREATMENT
Adjunctive therapy:
• Transfusion of blood components (PRC and / or TC) as indicated (on the topic of blood transfusion)
• Avoid and cope with infection
• Corticosteroids: prednisone 1-2 mg / kg / day
• Androgens: Metenolol acetate 2-3 mg / kg / day. maximum is given for 3 months
• Splenectomy done when no response to steroids. If the patient refused splenectomy immunosuppressive therapy can be given:

• Cyclosporine 5 mg / kg / day
• ATG (anti-thymocyte globulin) 15mg/kgBB/hari intravenously for 5 days
• Bone marrow transplant, if found suitable HLA

COMPLICATIONS
Infection can be fatal, bleeding, heart failure in severe anemia

AFERESIS

DEFINITIONS
Aferesis is the separation of blood components directly to the person using the blood component separator

PURPOSE
Removing some blood components, can be either cell (cytopheresis) or plasma (plasmapheresis / plasma exchange)

INDICATIONS

therapeutic:
• Sitoferesis
• Eritrositoperesis: Sickle cell anemia, malaria parasitaemia
• Tromboferesis: Trombositemia symptomatic
• Leukoferesis: Leukemia with hiperleukositosis, rheumatoid arthritis (in certain circumstances)
• Plasmapheresis: Abnormalities of paraprotein (hyperviscosity syndrome, cryoglobulinemia, Fabry disease, familial hypercholesterolemia), immunological abnormalities (Goodpasture's syndrome, myasthenia gravis, eaton-lambert syndrome, guailain-barre syndrome, pemphigus, ITP, an inhibitor of coagulation factor), vasculitis (SLE, glomerulonefriitis mesangiokapiler, Wagener's granulomatosis), deficiency of plasma factor (TTP), toxicity of drugs or other toxic materials.

donor:
To meet the needs of the patient's blood components:
• Tromboferesis
• Plasmapheresis
• Leukoferesis, to support the program PBSCT

CONTRAINDICATIONS
• Aferesis therapeutic
• Patients with poor conditions and hemodynamic disturbances
• Aferesis donor
• Levels of platelet / leukocyte / albumin / hemoglobin / hematocrit below the normal
• ABO-Rh type is not suitable, cross matching the (+)
• Contain HBsAg / anti-HCV / HIV / VDRL and malaria
• less weight, old age, children
• Suffering from heart disease, lung, kidney failure, chronic or acute diseases other

PREPARATION

Materials and tools:
• Machine aferesis
• Set aferesis disposable, set trombaferesis, plasmapheresis sets, set leukaferesis, set eritositaferesis
• anticoagulant ACD-A
• Intravenous Access
• AV fisual
• Heparin injection of 0.9% saline infusion
• Albumin (to plasmapheresis)
• Emergency Drugs: Ca gluconate injection, inj adrenaline, corticosteroid inj, inj antihistamines, saline infusion, plasma expander, oxygen, resuscitation equipment and emergency drugs for resuscitation

patients:
• Explanation of procedures that will be undertaken
• Physical examination: hemodynamics, weight, height
• Laboratory: ABO-Rh blood goals, cross-matching, DPL, HBsAg, anti HCV
• Informed consent
• Swallowing calcium tablets a day earlier

COMPLICATIONS
Hypocalcaemia (tingling lips and fingers, chest distress, dark view) hemodynamic disturbances and impairment of consciousness