Aplastic Anemia, Blood's Yin Deficiency
'Aplasia' means the lack of development of a tissue, cell or other body part. Aplastic anemia is the condition in which the bone marrow fails to produce blood cells. Normally, the bone marrow produces:
- Red blood cells (which carry oxygen in the blood)
- various types of white blood cell (which are part of the immune system)
- platelets (which are involved in blood clotting).
These different types of blood cell originate from simpler cells, known as precursors or stem cells, which develop into the more specialized forms. There are numerous reasons for the bone marrow to fail to produce blood cells in adequate numbers, but in aplastic anemia there is a marked deficiency of all the precursor cells that should mature into adult blood cells. Aplastic anemia is a rare disease with an incidence in developed countries of between 5 and 10 cases per million per year.
In 65 per cent of people the cause of aplastic anemia is unknown (the technical term is 'idiopathic'). Rarely, the disease is present at birth (congenital). The commonest congenital form is Fanconi's syndrome, but fewer than 1000 cases have ever been described. As well as aplastic anemia, patients with Fanconi's syndrome have short stature, abnormal skin pigmentation, abnormalities of the bones of their arms and thumbs, kidney problems and an elfin-like appearance. A characteristic abnormality of the chromosomes (random breaks) is seen.
Drugs and environmental toxins
The common of all known cause of aplastic anemia is exposure to drugs or environmental toxins. Benzene was the first known toxin to cause bone marrow failure. Despite this it is still widely used in industry in the manufacture of drugs, dyes, explosives and other chemicals. Exposure should be limited to 1 part per million, but this is often exceeded, especially in developing countries. Other related organic chemicals also cause aplastic anemia, including:
- toluene (in glues)
- the insecticides DDT and lindane
- the explosive TNT
- the wood preservative PCP
- petroleum distillates.
Drugs that cause aplastic anemia may also be related to benzene. The antibiotic, chloramphenicol and the anti-inflammatory, phenylbutazone are two examples. Neither is commonly used in Western countries, but because they are cheap to produce, they are in widespread use in the developing world. Other medicines with a moderate risk of aplastic anemia include gold salts and penicillamine, used to treat arthritis, carbamazepine and phenytoin, used to treat epilepsy, and the diuretic acetazolamide.
A large number of drugs have been associated with occasional cases of aplastic anemia. Most of these are useful drugs and cannot easily be replaced other then turning to herbal medicine. Radiotherapy (treatment with X-rays) suppresses the bone marrow, and may be intentionally used to do so in preparation for bone marrow transplantation. The use of these treatments should be confined to specialized centres where careful monitoring of the blood count takes place.
Some cases of aplastic anemia have occurred after viral infections. In particular, hepatitis A, hepatitis B and 'non-A, non-B, non-C' hepatitis have been implicated, and more rarely the Epstein-Barr virus. Very rarely aplastic anemia occurs during pregnancy. It is not clear whether this is just a coincidence. Sometimes the disease recovers spontaneously at the end of pregnancy.
Aplastic Anemia Symptoms
Patients complain of increasing tiredness, weakness and shortness of breath. Bleeding, bruising and blood spots may be noticed. Sore throats and other infections are noticeable. A high temperature with shivering attacks is an important symptom that demands immediate medical attention.
Aplastic anemia diagnosis
The following combination of three symptoms should raise suspicion of bone marrow failure:
- Anemia - tiredness, weakness and breathlessness
- low white cell count in the blood (neutropenia) - fever, sore throat, shivering attacks
- low platelet count (thrombocytopenia) - bruising and bleeding.
When you see pale skin it is possible sign of heart failure, bruises and patchier (small blood spots in the skin and mouth), mouth ulcers and fever. The back of the eye is likely to see small hemorrhages on the retina. An important negative finding is the absence of enlarged lymph nodes or an enlarged spleen. Their presence would point to other diagnoses, such as lymphoma or leukemia. The most important test is the full blood count, which will show reduced numbers of red cells, white cells (neutropenia) and platelets (thrombocytopenia) - in other words all of the cellular components of blood. This feature is called pancytopenia. The level of the neutrophil count defines the severity of the disease. Neutrophils are normally the most numerous of the various types of white cell we have in our blood and they are particularly involved in combating infection by bacteria and fungi. Counts below 0.5 x 109/L mean severe aplastic anemia. Counts below 0.2 x 109/L mean very severe aplastic anemia.
The most important distinction that the hematologist must make is between aplastic anemia and acute leukemia, which can show very similar blood pictures. For this reason a bone marrow sample is essential. The doctor will take samples both of the fluid of the bone marrow (an aspirate) and of the more solid bone marrow structure (a trephine biopsy). For most cases the diagnosis is easily made. In acute leukemia the marrow is full of abnormal cells but in aplastic anemia it is empty and comprises mainly fat spaces. Chinese Master's way of treatment has shown very positive result in treating and controlling these conditions.
Spontaneous bleeding into the skin (dark red and blue color) usually appears as a rash known as purpura (in the old Chinese saying ' ghost's pinch’). Patchier is the term given to the individual small red or red-blue spots about 1-20mm in diameter which make up the rash. They are caused by a small local amount of bleeding within the skin. Deeper bleeding beneath the skin may be seen as bruises (ecchymosed). Applying pressure to a red spot can show the difference between patchier and abnormally prominent blood vessels. If it is caused by an abnormal blood vessel the redness disappears temporarily. By contrast when pressure is applied to purpura the spots do not pale. Purpura usually appears in crops and may disappear over three to five days. It can occur on any part of body but is more common on specific areas, such as the front of the shins.
Causes of purpura
It may occur when the platelet count of the blood is low (thrombocytopenia) but there are other causes too. It can occur when the blood vessel wall is particularly fragile, has been damaged, or if the skin is thin. In elderly people so-called 'senile purpura' is often seen on the outer surface of the arm and back of the hand. Similar features are seen in some patients treated with long-term steroid therapy because steroids weaken the connective tissues of the skin. Some inflammatory conditions damage to the vessel wall, or 'vasculitis', may occur and can cause purpura. In this there is abdominal pain, joint pain, kidney inflammation and raised purpura typically over the buttocks and limbs. Purpura with painful bruising of the legs and around hair roots.
For details may include:
- idiopathic thrombocytopenic purpura (ITP)
- thrombotic thrombocytopenic purpura (TTP)
- hemolytic uraemic syndrome.
Chinese Master's Treatment
All these can be treated by Chinese Master's WAY OF MEDICATIONS depending on the severe and the length of time the patients has it. For normal conditions they will be cured in 4 weeks to 3 months Chinese Master's intensive treatment.