Subhash Chandra Jha et al/ International Journal of Biomedical and Advance Research 2015; 6(08): 569-573. 569 IJBAR (2015) 6 (08) www.ssjournals.com International Journal of Biomedical and Advance Research ISSN: 2229-3809 (Online); 2455-0558 (Print) Journal DOI: 10.7439/ijbar CODEN: IJBABN Original Research Article Acquired idiopathic aplastic anemia: Study of 20 cases and review of literature Subhash Chandra Jha *1 , Anju Singh 2 , M.A. Muzaffar 3 , Amod Kumar 4 , Shahab Raza 5 , Ghanshyam Jha 6 and Ramesh Prasad Dwivedi 7 1 Assistant Professor, Department of Pathology, Government Medical College, Bettiah, India 2 Assistant Professor, Department of Pathology, Indira Gandhi Institute of Medical sciences, Patna, India 3 Tutor, Department of Pathology, Patna Medical College, Patna, India 4 Consultant Pathologist, SRL Diagnostics, Patna, India 5 Associate Professor, Department of Pathology, Patna Medical College, Patna, India 6 Senior Internist, Care Hospital, Patna, India 7 Professor, Department of Pathology, Government Medical College, Bettiah, India *Correspondence Info: Dr. Subhash Chandra Jha Assistant Professor, Department of Pathology, Government, Medical College, Bettiah, Pin code: 845438, India E-mail: jhapatho25@gmail.com Abstract Aplastic anemia is pancytopenia with hypocellular bone marrow having cellularity<25%, usually cellularity is <10%. In most cases, acquired aplastic anaemia behaves as a T- lymphocyte mediated immune disease, only those cases of pancytopenia with hypocellular bone marrow (Aplastic anaemia) were selected for study that were seronegative for HBSAG, ANTIHCV and HIV and chromosomal breakage study was also negative for Fanconi Anemia. Male female ratio was 1:1. In our study, 90% cases had bone marrow cellularity<10%, either came in severe or very severe category. 85% patients had ANC<500/μL, 20% had ANC<200μL and 30% presented with platelet count <10,000/μL .Thus usual presentation was pancytopenia with severe to very severe aplastic anemia having hemoglobin <6gm/dl, platelets <20,000/μL and absolute neutrophil count <500/μL. The patients presenting with pancytopenia, must be evaluated by peripheral blood smear and bone marrow studies. Bone marrow trephine biopsy is diagnostic. The immunosuppressive to Peripheral blood stem cell transplantation is potentially curative modality of treatment. Keywords: Hypocellular bone marrow, Aplastic anemia, Pancytopenia, Immunosuppressive therapy. 1. Introduction Aplastic anemia (AA) is pancytopenia with hypocellular bone marrow having cellularity<25%, usually cellularity is<10% .[1] In most cases, acquired aplastic anaemia behaves as a T- lymphocyte mediated immune disease. Cellular and molecular pathways have been mapped in some details for both effector (T-lymphocyte) and target hematopoietic stem and progenitor cells.[2,3] There is autoimmune bone marrow depression, leading to severe suppression of hematopoiesis, manifested by marked decrease in CD34+ progenitor cells.[5] It is morphologically characterized by empty spicules of marrow aspirate, fatty bone marrow core and occasional to no CD34+ in flowcytometry. It is broadly divided into acquired and inherited type (inherited bone marrow failure syndrome.[6] Acquired idiopathic type is common cause of aplastic anemia and very difficult to treat. Usual presentation is progressive weakness followed by abrupt fall in blood counts in otherwise normal paediatric to old persons. There is moderate to severe pancytopenia in various combination of anaemia, thrombocytopenia and leucopoenia with severe neutropenia, usually absolute neutrophil count (ANC) is <500/μL, and manifesting with shortness of breath, petechial rashes, mucosal bleeding and infections.[1, 4] The annual incidence of acquired aplastic anemia is 2 cases per million person .In general; male and female are affected equally, but distribution is biphasic .Most cases of aplastic anemia are idiopathic; however radiation, chemicals, drugs, infections, and immunological diseases are possible causes in