| Clinical Observation of Aplastic Anemia in Children; A Clinical Analysis of 40 Cases
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Hyung Ki Ko, Oc Chung Koh, Esook Oh, Keun Soo Lee |
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Department of Pediatrics, National Medical Center, Seoul, Korea |
| 小兒再生不良性 貧血의 臨床的 觀察 |
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高炯基, 高玉貞, 吳義淑, 李讓洙 |
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國立醫療院 小兒科 |
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| Abstract |
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A total of 40 cases of aplastic anemia in children diagnosed at N.M.C. from Jan. 1959 to June 1974 were analysed clinically with the following results. 1)The disease was more prevalent in male with the male to female ratio, 1. 7 : 1. Most of the patients were belonged to primary school age group. In the seasonal incidence, the main
distribution was in summer, being 45%. 2)The duration from onset of symptoms to first clinic visit was less than 2 months in 77.5% of the patients. 3) It was suspected to be CM as the causative agent in 3 cases, other chemical toxin in 4 cases, herb medicine in 2 cases and viral hepatitis in 1 case. But the causative agents could
not be determined in the remaining 30 cases. 4) The chief complaints on admission were facial pallor 40%, epistaxis 37- 5% and dizziness 30%. 5)The physical examinations on admission revealed febrile sensation 75%, systolic murmur 70%, significant lymphadenopathy and hepatomegaly 7. 5%, but spleen was not palpable in
any case. 7)The types of hemorrhage noted during the follow up period were subcutaneous bleeding
(purpura, petechia) 75%, epistaxis 72. 5%, and gingival bleeding 60%. 8)The peripheral blood findings showed pancytopenia in 62.5% of the patients, anemia and leukopenia in 22.5%, anemia and thrombocytopenia in 15%. Reticulocyte counts were, diminished and relative lymphocytosis was noted in 81- 8% of the patients. Bleeding time by Ivy method were prolonged over 5-min. in 82.9% and serum iron were increased in 38. 7%.
9)Bone marrow examination on admission showed hypocellularity 65%, normocellularity 5%, hypercellularity 20% and unknown 10%. 10) Basic therapies were blood transfusion, corticosteroid and testosterone. In some cases, liver extract, thyroid extract, citric acid or folic acid were added in the hope of bone marrow
stimulation. Complete remission was noted in the 6 cases of 40 patients, improvement in 7 cases, unchanged in 16 cases, recurrence in 1 case, deteriolation in 1 case, and death in 9 cases. 11)The number of admissions was twice in 45% of the patients and variable frequency in the rest. The number of transfusions was from 5 to 10 times in 43%, which was the most prevalent frequency. 12)The sex difference or type of therapy did not affect the course of the disease significantly while prognosis was worst in the group with the younger agebelow 6 years (old) and short duration from onset to first clinic visit (below lwk). 13)The majority of dead cases were treated for less than 6 months. Usually the striking changes in peripheral blood findings were noted after 6 months of therapy. 14) The majority of patients (88. 8%) expired within 6 months after onset of the symptoms,
and signs. The most common cause of death was hemorrhage (55. 5%) and infection in second. |
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