Aplastic Anemia: A Contraindication?

I would think that it would be very unwise to consider any elective surgery in this case.The patient by definitiopn is not healthy-he has apolastic anaemia- and is therefore more susceptible to infection and bleeding, the severity and signigicance of this depending on the severity of the anaemia.He has to be in a high risk group.

Having recently had first hand experience with aplastic anemia (my asistant of 16 years daughter developed aplastic anemia her sophomore year in college). I can assure you that these patients are not candidiates for any elective surgery, including dental implants. Many of these patients undergo bone marrow transplants and or chemotherapy to "knock out " the bone marrow. They are extremly frail and suceptible to potnetially liife threatening infections until "cured". Fortunatly, with current therapy many of the young patients survive the disease and can resume productive lives. I would consult the oncologist before you assume any liability for treating this class of patients !!

In the early stages of aplastic anemia, few physical abnormalities are present. Fatigue and dyspnea are typical early symptoms. As the disease progresses neutropenia and anemia worsen, and bruising; purpura; petechiae; and pallor of the conjunctiva, face, and palms appear. Mucosal or dermal bleeding and infection may also occur. The findings of mild liver and spleen enlargement in Mr. West are prognostically worrisome, as hepatosplenomegaly and lymphadenopathy are not typically associated with aplastic anemia. When present, these features may indicate an underlying, more severe hematologic disorder, such as an acute leukemia. Treatment. Before the development of immunosuppressive therapy and bone marrow transplantation, most patients with severe aplastic anemia died within the first year of diagnosis. Today, with prompt diagnosis and treatment, long-term survival is not uncommon in such patients. The goal of treatment is to restore hemopoietic function. The severity of the disease, the patient's age and overall health, and the availability of bone marrow transplantation as well as the patient's eligibility for this procedure are variables to be considered. Studies indicate that the potential for complete remission and long-term survival is highest in patients younger than 40 years of age. Long-term survival in patients who receive an HLA-matched sibling donor transplant has been reported as high as 90%. However, this option is available only to about 30% of patients with aplastic anemia. When transplantation isn't an option, patients are given immunosuppressive therapy alone. Those who receive only immunosuppressive therapy with ATG or cyclosporine experience response rates of 60% to 80%, with five-year survival rates of approximately 75%. Transplantation with marrow from an unrelated donor is much less successful; one review stated that in such cases, “transplant-related mortality is substantially higher, with 100-day mortality rates of 30% to 70%.” Bone marrow transplantation involves the destruction of the patient's bone marrow using high-dose cytotoxic chemotherapy and possibly radiation. After the marrow has been destroyed and rendered incapable of producing cells, stem cells from the donor are infused into the patient through a peripheral intravenous line; the process usually takes from 30 minutes to three hours, depending on the volume of cells to be transfused. Almost immediately, the infused stem cells migrate to the bone marrow where, in a process known as engraftment, they settle and begin to produce new blood cells that differentiate into leukocytes, erythrocytes, and platelets. Typically it takes one to three weeks for leukocyte production to begin and 10 days to four weeks for production of erythrocytes and platelets to be sufficient such that transfusion support is no longer needed. This is a critical period for the patients, who lack neutrophils and are at high risk for overwhelming infection, even with aggressive antibiotic therapy. Bone marrow transplantation carries three major risks: graft failure, graft-versus-host disease, and infection. Graft-versus-host disease is an incompatibility reaction to donor tissue. In its mild form it manifests as a skin rash; more severe forms can manifest as acute renal failure or multiorgan failure, and can be fatal. The acute form appears within seven to 30 days of transplantation; the chronic form, within weeks to months thereafter, according to Stedman's Electronic Medical Dictionary. The incidence of chronic graft-versus-host disease varies by patient population, disease entity, and treatment regimen. Immunosuppressive therapy is used to prevent and minimize this disease. When no HLA-matched donor is available, immunosuppressive therapy with ATG or antilymphocyte globulin (ALG) will induce partial remission in 40% to 70% of patients with severe aplastic anemia, according to one review. The same review reported that the addition of cyclosporine to either ATG or ALG improved three-month response rates to about 65%; one large study reported a five-year survival rate of 70% for patients on a regimen combining cyclosporine with ATG. Improved survival rates in patients with severe aplastic anemia treated with immunosuppression has resulted in the unanticipated consequence of patients becoming refractory to immunosuppressive therapy and surviving long enough to develop secondary disorders such as paroxysmal nocturnal hemoglobinuria or myelodysplastic syndrome. In an uncontrolled pilot study, Brodsky and colleagues investigated the response of 19 patients with refractory severe aplastic anemia to high-dose (50 mg/kg) cyclophosphamide therapy alone (bone marrow transplantation was not an option). Sixteen of the 19 patients achieved complete remission (defined as “normal blood count for age and sex”) within a median of 36 months; the other three patients died within the first three months. The authors suggested that high-dose cyclophosphamide merits further study as primary treatment for such patients. An option for patients with severe aplastic anemia who aren't eligible for either bone marrow or peripheral blood stem cell transplantation and who don't respond to immunosuppressive therapy is maintenance on supportive transfusion: patients receive blood products (red blood cells and platelets), growth factors (such as erythropoietin with G-CSF), or both. The prognosis with this treatment is guarded. Eighty percent of patients with severe aplastic anemia who receive transfusion support alone will die within 24 months, according to one review. Most blood centers use irradiated blood products to decrease the development of antibodies that can render the transfusions ineffective or harmful. Patients with mild aplastic anemia may require only periodic erythrocyte and platelet transfusions and do not develop the destructive antibodies as readily.

If the patient is under immuno suppressive therapy one should consider the risk of infection. Comprehensive natural protocol, consisting of Nutraceutical, Homotoxologic, Resonance Homeopathic, Ayurvedic, Biotech and Herbal ingredients are available from Biogetica such as AB Factor. These, work together to eliminate not just your anemia symptoms, but also address the root causes of Anemia. I prefer them over other hematinics as they are safe and natural, giving me quick and lasting results.