Anemia may require marrow transplant

ON CALL

September 06, 1994|By Dr. Simeon Margolis | Dr. Simeon Margolis,Special to The Sun

Q: One of the men who works with me has just been hospitalized to get a bone marrow transplant for anemia. I have heard of treating anemia with iron or vitamins, but would like to know what kind of anemia requires a bone marrow transplant.

A: Anemia is defined as an inadequate number of red blood cells made by the bone marrow, which also manufactures platelets and most types of white blood cells. Some types of anemia can be treated with iron-rich diets and supplements. But when bone marrow is overrun with excessive numbers of white blood cells (as in leukemia), is replaced by tumor cells that spread from other sites, or simply fails to work properly, people can develop a deficiency of all of these blood cell types. Bone marrow %o transplants are used to treat both leukemia and bone marrow failure, or so-called aplastic anemia.

Leukemia, a form of cancer marked by overproduction of white blood cells, is usually diagnosed by discovering a high white cell count in a blood test. Bone marrow failure at times precedes the appearance of large numbers of white cells in the blood in the early stages of leukemia.

Aplastic anemia also can be caused by infections such as hepatitis; exposure to insecticides, toxic chemicals (such as benzene) and other industrial solvents; radiation; and by such drugs as gold compounds, thiouracils used to treat an overactive thyroid, the antibiotic chloramphenicol, immunosuppressive drugs and anti-cancer drugs. No cause is known for more than half the cases of aplastic anemia.

Patients with aplastic anemia can develop fatigue, shortness of breath, weakness and pallor from the low number of red blood cells. The lack of white cells makes them susceptible to serious infections. A possible clue to a low platelet count is the appearance of small red dots under the skin (petechiae) or unexplained bruising. A more serous problem associated with an inadequate number of platelets is the risk of spontaneous bleeding from the nose, gums, rectum or vagina. Of particular concern is the danger of bleeding into the brain.

Without treatment, life expectancy is limited in people with severe aplastic anemia. A bone marrow transplant is the preferred treatment, but a suitable donor must be found and a patient must usually be under the age of 50.

Red cell and platelet transfusions can ameliorate the anemia and bleeding tendency, but transfusions of white cells have not proven effective in preventing overwhelming infections.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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