1. State University of Medicine and Pharmacy "Nicolae Testemitanu“ Departmen of pediatric Subject : Aplastic anemia Amaria Ibrahem Group m1249 presented to : D.lilia Romanciuc

2. Definition  Aplastic anemia is a condition that occurs when your body stops producing enough new blood cells. Aplastic anemia leaves you feeling fatigued and with a higher risk of infections and uncontrolled bleeding.

3. Causes  A -Primary: 1- congenital (as Fanconi's anemia). 2- Idiopathic acquired (67% of cases).

4. Causes  B- secondary : 1-chemicals (benzene, toluene, glue sniffing). 2-drugs (chemotherapeutics, antibiotics, gold, phenytoin). 3-insecticides. 4-ionizing radiation. 5-infections (as hepatitis). 6-paraxysmal nocturnal haemoglobinuria.

5. Pathogenesis Reduction in the number of haemopoietic pluripotential stem cells -------> fault in the remaining stem cells OR Immune reaction against stem cells. -------> unable to divide and differentiate sufficiently to produce the blood cells.

6. Clinical Features  Aplastic anemia symptoms may include:  Fatigue  Shortness of breath with exertion  Rapid or irregular heart rate  Pale skin  Frequent or prolonged infections  Unexplained or easy bruising

7.  Nosebleeds and bleeding gums  Prolonged bleeding from cuts  Skin rash  Dizziness  Headache  palpitation  Thrombocytopenia (low platelet counts), leading to increased risk of hemorrhage, bruising and petechiae.

8. Clinical Features  Leukopenia (low white blood cell count), leading to increased risk of infection.  Reticulocytopenia (low reticulocyte counts).  Occurs at any age.  Male predominance.

9. Risk factors -Treatment with high-dose radiation or chemotherapy for cancer - Exposure to toxic chemicals -The use of some prescription drugs — such as chloramphenicol, which is used to treat bacterial infections, and gold compounds used to treat rheumatoid arthritis - Certain blood diseases, autoimmune disorders and serious infections - Pregnancy, rarely

10. Diagnosis  1- Complete Blood Picture (CBP): which shows pancytopenia and reticulocytes.  2-Bone marrow aspirate: Markedly hypocellular marrow, due to replacement of hemopoietic marrow by adipose tissue (not fibrosis or neoplastic cells).

11. Treatment 1-General:  To treat the disease which lead to the anemia  Supportive care with blood Transfusion, plts concentrate.  Prevention of infection.

12. 2. Specific: A-BONE MARROW TRANSPLANTATION:  Treatment of choice.  from HLA matched donor. Usually siblings.  Long term survival rates: 60-70%.

13. A-IMMUNOSUPPRESSION: by using drugs  Antithymocyte globulin (ATG)  Antilymphocyte glubulin (ALG)  Cyclosporin  Intensive immunosupression : cyclophosphamide  Corticosteroids.

14. Thank you for your attention