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Research Article CODEN: IJPRNK IMPACT FACTOR: 1.862 Goyal PK, IJPRBS, 2014; Volume 3(3): 242-255

ISSN: 2277-8713 IJPRBS

INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND BIO-SCIENCE EPIDEMIOLOGICAL, ETIOLOGICAL AND HEMATOLOGICAL STUDIES ON ACQUIRED APLASTIC ANAEMIA SINGH I1, JAIN R2, GUPTA GN2, GOYAL PK1 1. Department of Zoology, University of Rajasthan, Jaipur, India 2. Department of Pathology, Satokba Dhurlabhji Memorial Hospital & Research Institute, Jaipur, India Accepted Date: 21/05/2014; Published Date: 27/06/2014 Abstract: Background: Aplastic anaemia (AA) is a severe case of the hematopoietic stem cells

destruction of the bone marrow. The incidence rate of AA is higher in Asian countries; in India, it has not received the sort of attention till now. Objectives: To assessment of the incidence, risk factors and clinico-hematological profile of patients suffering with acquired AA (AAA) in the part of Northern region of India. Materials and Methods: Clinical, hematological, bone marrow biopsy and socio-economic status analysis were done in details. Results: In this study, 40 cases were diagnosed as AAA as 22(55%) males and 18(45%) females (M:F,1.22:1), with the age range of 2-72 years. Furthermore, most cases were associated with unprocessed water consumption (90%) followed by tobacco abuse (52.5%) and pesticides exposure (32.5%). All cases had low hematological constituents (p80%) in preschool children, pregnant, lactating women, adolescent girls [4]. Aplastic anaemia (AA), first described by Paul Ehrlich in 1888, is a severe case of the progenitor cells deformities, hematopoietic stem cells destruction and bone marrow failure. Incidence of AA is more frequent in western countries [5,6]. However, some cases were observed in France [7] and Spain [8] also. The incidence of AA is higher in Asian countries [9-11], but in India, such disease has not received the much attention till now. The disease has been linked to various factors including pesticides [9,12], drugs [9,13],chemicals [14], viruses [15], and non-bottled water [9] while none of study reported association with tobacco abuse including smoking and chewing and unprocessed water. Textile workers commonly use unspecified chemicals (e.g. dyes, detergents, polymers) and benzene containing solvents for removing oils, waxes and resins [16,17]. In addition, benzene also forms a part of cigarette smoke and crude oils. Hence, exposure to benzene and its containing solvent is a considerable concern to public health. However, several chemical pesticides have been banned in most of the countries but many of them are still being used in India [12]. In addition, AA disease has been correlated with low socio-economic status and agricultural background also [9,18]. Though, a few studies have been published on AA in India [18,19], none of them has focused on epidemology of acquired Aplastic anaemia (AAA). Further, none of the study has been performed pertaining to Rajasthan, the largest state of India. The present study is designed to evaluate the prevalence of the disease, associated risk factors correlating with the socioeconomic status and the clinico-hematological profiles in the patients of AAA in the part of Northern region of India. MATERIALS AND METHODS Study participants For the present study, patients who had fulfilled the blood count and bone marrow criteria of the International Agranulocytosis & Aplastic Anaemia Society (IAAAS) [13] were selected from hematology clinics (i.e. Santokaba Dhurlabhji Memorial Hospital & Research Institute, Sawai Man Singh Medical College & Hospital and University Health Centre, Jaipur) during the period of January to December 2013. This study was approved by the Departmental Ethics Committee. Available Online at www.ijprbs.com

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Research Article CODEN: IJPRNK IMPACT FACTOR: 1.862 Goyal PK, IJPRBS, 2014; Volume 3(3): 242-255


The written consents were obtained from all the patients for their participation in the study. Patients with Fanconi anaemia were excluded to focus the entire study on AAA rather than inherited AA [1,20]. Similarly the patients who received radiotherapy and immunotherapy were also excluded from the study to avoid radiation induced bystander effects and immunological systematic suppression effects, respectively. Clinical analysis Clinical profiles of all the patients were analyzed in detail. Family history, physical and clinical examination were recorded. Symptoms of the patients included fatigue and headache, dyspnoea on exertion, pallor, fever, bleeding from gums and nose, menorrhagia etc were recorded. Hematological analysis Peripheral intravenous blood samples (2 ml) were obtained from the each patient in a vial containing 0.5 M EDTA. Complete blood counts (CBC) were done by automated haematology analyzer (Sysmex XT-1800). Hematological constituents included hemoglobin (Hb), total leucocytes counts (TLC), platelet counts (PC), absolute neutrophil counts (ANC) and absolute lymphocyte counts (ALC) were observed by adopting standard procedures. Platelet counts obtained from the counter were confirmed by peripheral blood smear examination. Bone marrow analysis Bone marrow aspiration was taken from posterior superior iliac spine using ‘BD Spinal needle 18G’ and processed according to the standard procedures [23]. For the assessment of bone marrow cellularity and iron stores, aspirates were stained with May-Grunwald-Giemsa and Perls’ stain, respectively. The bone marrow trephine biopsy samples (2 cm in length) were taken from same site by ‘Rup’s Bone Marrow Biopsy Needle’ and stained with Hematoxylin and eosin. Interpretation of biopsy material was done according to the cellularity comparison of the relative proportions of myeloid, erythroid and megakaryocytic cells, other bone elements and reticulin. On microscopy, all cases were classified as Aplastic marrow [18,20], and graded into three groups as non-severe, severe and very severe according to the criteria as under: 1. Non Severe Aplastic anaemia 

Blood: Neutrophils < 1.5 x109/L

Platelets < 100 x109/L Reticulocytes < 1% (corrected)*

Available Online at www.ijprbs.com

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Research Article CODEN: IJPRNK IMPACT FACTOR: 1.862 Goyal PK, IJPRBS, 2014; Volume 3(3): 242-255 


Bone marrow: < 30% (Hb