Lecture on Aplastic anemia by dr. Conrad Fischer how do I make difference between different cause of pancytopenia? The basic thing is to check the bone marrow. Most of the time doing bone marrow is a good start. I excluded infection, cancer. I exclude lupus with ANA. B12 and folate as in B12 and folate the BM is packed with cell. How do i know unless i do BM? No I dont. Pancytopenia may be due to B12 and folate deficiency. So get level plus the BM is packed with cell. I do a marrow, but found no etiology for pancytopenia. Then we have realize that there is a psychiatric problem of BM. We have red cell, white cell, platelet. White cell is broken into b cell & t cell. T cell could be cd4 or helper cell and cd 8 or suppressor cell.cd 34 which is stem cell. We can have this other cell called t killer cell. Antigen presents to the t killer cell and then t killer cells attacks the foreign substance and removes it from the body. Once upon a time in bone marrow the t killer cell wakes up and looks at rest of the BM and says who are you? One day the t killer cell starts to have acute psychotic reaction and the t killer cell no longer recognize the rest of the cell of BM and kill all of them and pancytopenia develops. pancytopenia with unclear etiology also known as Aplastic anemia. One group of people, you identify the toxin, stop the toxin, the BM will come back to life. In other group of people there is autoimmune psychosis paranoid schizophrenia of t killer cell. There is two types of rx for this one is 19 century psychiatry if you are under 50 and you have a match do a BM transplant. When i deem my 19 century psychiatry is take the psychotic people and kill them. Take them outside and execute and do a BM transplant and reset the BM. The marrow must be allogenic. Only 1/3rd pt go to this category. If you are under 50 or you have no match you have to have medical therapy cyclosporin which is basically anti psychotic medicine to t cell it goes to the t cell and rewinds the mind of t cell. So it does not psychotic anymore and anti thymocyte Ig. What if we take t cells and inject them into a horse? Well the horse will take the thymocyte t cell. if you inject the human t cell to horse it will reject them as foreign body and have some allergic reaction to t cell. Horse makes anti t cell Ig also known as anti thymocyte globulin. And these t cell Ig react just against the t cell and brings out of the circulation and all the sudden the the entire rest of the bone marrow comes back to life. The marrow dont show infection tb or fungi. I get no lupus and have spleenic sequestration. No B12 and folate deficiency plus here there will be hypercellular marrow . If it is from benzene then test will say CCl4 factor
Posted on: Wed, 11 Sep 2013 05:46:34 +0000
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