Clinical picture and management of clonal aplastic anemia patients

Aplastic anemia is a disease that can lead to life-threatening complications such as infection and bleeding, progressing with pancytopenia in which hypocellular bone marrow is seen, without abnormal infiltration or fibrosis of the bone marrow. In our study, it is aimed to analyze the parallelism between bleeding, infection and cytopenia levels in patients with aplastic anemia by determining the threshold values for hemoglobin, white blood cell, and platelet values and also to examine the management of the treatment of this disease in these patients retrospectively.87 patients with aplastic anemia followed between 2002-2019 were included in the study. In the patients with aplastic anemia included in our study, the mean age at the time of diagnosis was 42(17-93), and 49.4% of these patients were male, 50.6% were female. In the whole patient group, bleeding episodes were detected in 48 patients (55.2%), infection; bacterial in 68 patients (77.8%),viral in 31 patients (35.6%), fungal in 35 patients (40.2%), PCP in 6 patients (6.9%) during follow-up. In all patient group, bone marrow dysplasia was seen in 13 patients (52%) and bone marrow blast rate was >5% in 6 patients (18.8%) at the time of diagnosis. In the whole patient group, platelet transfusion was given to 80 patients (92%), erythrocyte transfusion to 78 patients (89.6%), and g-csf support to 38 patients (43.7%). There was a statistically significant difference in mortality rates between the combined use of cyclosporine and ATG as immunosuppressive therapy and the use of Cyclosporine or ATG alone in all patient groups (p <0.05). Also, when comparing allogeneic bone marrow transplantation with immunosuppressive therapy alone, a statistically significant difference was found in terms of mortality rates (p <0.05). 96% of the patients who underwent Allogeneic Bone Marrow Transplantation were found to be in right remission. Eltrombopag treatment was used in 8 patients (9.2%) in our study, and the mean age at the time of diagnosis was 46 (19-61). In the follow-up with eltrombopag treatment, there were no significant difference detected among bleeding (p> 0.05), infection; bacterial (p = 0.726), viral (p> 0.05), fungal (p = 0.056), pcp (p> 0.05) and mortality (p> 0.05). Keywords: Bleeding, infection, immunosuppressive therapy, allogeneic bone marrow transplantation, eltrombopag, mortality