Dissertations / Theses on the topic 'Pancytopenie'

Bovine Neonatal Pancytopenia (BNP) is a disease of calves, characterised by peripheral blood and bone marrow depletion, which emerged in Europe in 2007. A strong epidemiological association between BNP and the administration of a particular inactivated Bovine Viral Diarrhoea (BVD) vaccine (Pregsure BVD, Pfizer Animal Health) to the dams of affected calves has been reported. Early studies suggested that BNP is mediated by the transfer of alloantibodies in colostrum and that these alloantibodies recognise major histocompatibility complex (MHC) class I molecules. This led to the hypothesis that Pregsure contains bovine MHC I molecules, originating from the MDBK line cell used in vaccine production, and that this is responsible for the generation of alloantibodies in particular cows injected with the vaccine. This project aimed to investigate the mechanisms by which BNP arises and develops. In particular to gain an understanding of the molecular basis of the syndrome and how this influences the number of cows and calves affected and the specificity of the pathology for the haematopoietic system. Haematological analysis of clinically normal calves born on a BNP-affected farm demonstrated that 15% of calves had profoundly abnormal haematology and could be described as affected by subclinical BNP. BNP was reproduced experimentally by feeding pooled colostrum to neonatal calves, confirming the role of colostrum in mediating the condition. Detailed analysis of serial haematology and bone marrow pathology from these calves demonstrated variable alloantibody damages to different haematopoietic lineages. In vitro cellular assays using a panel of MHC I-defined bovine leukocyte cell lines and mouse cells individually transfected with the MDBK-MHC I alleles demonstrated that Pregsure vaccinated cows have significantly higher titres of functionally active MHC I alloantibodies than BVDV unvaccinated cows or cows vaccinated with alternative BVDV vaccines. The alloantibody response was found to be heterogeneous in individual Pregsure vaccinated cows. MHC I expression levels on peripheral blood and bone marrow cells, assessed by flow cytometry, was shown to correlate with levels of in vitro and in vivo alloantibody damage. Overall, the results of this project demonstrate that the pathogenesis of BNP is mediated by the transfer of MHC I-specific alloantibodies via colostrum that cause rapid destruction of peripheral blood and bone marrow cells, and which is dependent on the titre of alloantibody produced by an individual cow, its specificity for the MHC I alleles present, and density of MHC I expression on the specific cells.

Bovine neonatal pancytopenia (BNP) is a recently emerged alloimmune disease affecting neonatal calves and is strongly associated with the vaccination of dams with a specific inactivated BVDV (Bovine Viral Diarrhoea Virus) vaccine (PregSure® BVD, Pfizer Animal Health). The vaccine comprises a unique adjuvant based on nanoparticles and has been shown to be highly contaminated with cellular proteins of the vaccine producer cell line MDBK (Madin-Darby bovine kidney). The disease is induced by ingestion of colostral alloantibodies of certain PregSure® BVD-vaccinated dams. The hypothesis that BNP-associated alloantibodies might be directed against MHC class I has been proposed. Currently, there are published observations, which contradict this hypothesis and which suggest that the aetiopathogenesis of BNP has not been fully elucidated yet. The aims of this study were to gain more insights into selected factors and underlying mechanisms involved in BNP. The hypothesis of a genetic predisposition for clinical BNP had been proposed in a previous study, but the incidence and potential genetic predisposition for subclinical cases had not been investigated thoroughly before. Therefore, a well-defined cattle resource population was monitored for the incidence, vaccination-associated epidemiological factors and a possible genetic predisposition involved in subclinical BNP. Prominent immune responses to PregSure® BVD vaccination had been reported. This study characterised the immune response to a booster immunisation with PregSure® BVD to obtain insights into the structural and quantitative regulation of the blood transcriptome after vaccination by means of deep sequencing transcriptome analysis. Furthermore, this approach should facilitate insights into the composition of the vaccine. The previously proposed hypothesis of a genetic predisposition required for giving birth to clinical BNP-calves could be confirmed in this study. Our results suggest that a genetic predisposition is potentially also involved in subclinical BNP and additionally required for a significant decrease of thrombocytes and leucocytes in healthy calves without manifestation of clinical or subclinical BNP. In the monitored cattle resource population, the frequency of subclinical BNP did not exceed the frequency of clinical BNP-cases. Further vaccination-associated epidemiological factors, e.g. frequency of vaccination or time point of vaccination relative to parturition, could be excluded. Transcriptome analysis 14 days after booster vaccination with PregSure® BVD highlighted a very coordinated immune response to double-stranded (ds) RNA, although the inactivated vaccine was directed against a single-stranded (ss) RNA BVD virus. The source of the dsRNA is unknown and could have originated from the MDBK cell line, which would underline the contamination of the vaccine with host cells from vaccine production. Alternatively, a dsRNA analogue was potentially added to improve the efficacy of the vaccine. Finally, this study identified a cytokine-like gene, which was highly upregulated across all animals after booster vaccination. This gene has not been described before in any other species. It has to be evaluated if upregulation of this gene is specific for ruminant immune response and linked to PregSure® BVD vaccination. In conclusion, this study confirmed that a genetic predisposition of PregSure® BVD-vaccinated dams is required for producing BNP-colostrum. Therefore, prospective studies will have to consider genetically determined differential immune responses between BNP- and non-BNP-dams towards exogenous proteins combined with very potent adjuvants. Regarding the MHC class I hypothesis, published observations raise the question, if MHC class I should be considered as single causal agent for BNP-associated alloantibodies. This requires further research. Potential allogeneic effects of a whole panel of contaminating proteins contained in the vaccine still have to be validated.

Pancitopenia é uma manifestação frequente na leishmaniose visceral (LV) cuja patogenia não é esclarecida. Neste estudo, a patogenia foi analisada em cão e camundongo com LV. Cães com LV, naturalmente infectados, sem coinfecção com erliquiose, foram classificados de acordo com as alterações hematimétricas em: pancitopenia, bicitopenia, citopenia e sem alterações hematológicas. O mielograma revelou um aumento na proporção mielóide:eritróide nos cães infectados em relação ao grupo controle. Havia mudanças no padrão morfológico e quantitativo nas células sanguíneas, particularmente na série eritróide em cães pancitopênicos. Na contagem diferencial, notou-se a diminuição da porcentagem de linfócitos, plasmócitos e monócitos que tinham correlação com a gravidade das alterações hematológicas. No exame histopatológico da medula óssea, observaram-se aumento na celularidade, hiperplasia megacariocítica, proliferação macrofágica e degeneração e/ou necrose. No estudo de fatores de crescimento e citocinas, o aumento da expressão de IFN-?, GM-CSF, IL-7 e TNF-? parece assumir um papel importante nos cães bicitopênicos, e IL-3 nos cães com citopenia. A expressão de IGF-I, em contraste, estava diminuída significantemente em cães pancitopênicos em relação aos demais grupos. Os dados sugerem, portanto, a ocorrência de uma dishematopoiese com a diminuição da expressão de IGF-I na doença severa. Em camundongos C57BL/6 infectados por via intravenosa com L. (L.) donovani, as alterações hematológicas foram analisadas com 28 dias pós-infecção quando vimos o desenvolvimento de um quadro pancitopênico. O mielograma revelou displasia celular, aumento na proporção mielóide:eritróide e do índice de maturação mielóide, bem como, uma hipoplasia eritróide. Além disso, observamos um aumento significante na porcentagem de linfócitos e macrófagos nos animais infectados. No exame histopatológico havia um aumento significante da celularidade com infiltrado e/ou proliferação de células mononucleares similares a macrófagos. Na caracterização dessas células por microscopia confocal, estas expressavam F4/80, um marcador típico de macrófagos residentes e/ou estromais. Por citometria de fluxo, constatamos um aumento significante na porcentagem de células F4/80+ em proliferação. Além disso, utilizamos outros marcadores expressos em macrófagos como CD169 e CD11b, e vimos que a população F4/80+CD169+CD11b+ estava diminuída nos camundongos infectados. Com base nesses dados, consideramos o camundongo C57BL/6 infectado por L. (L.) donovani um bom modelo para o estudo da dishematopoiese na LV e que os macrófagos estromais devam ter um papel importante, o que merece estudos futuros mais aprofundados.
Pancytopenia is a common manifestation in visceral leishmaniasis (VL) that may contribute to lethality. We assessed the factors involved in the pathogenesis of pancytopenia in canine and murine VL. We selected dogs with VL but without erlichiosis that were classified according to hematological alterations in: pancytopenia, bicytopenia, cytopenia and dogs infected without hematological changes. The myelogram revealed an increase in the myeloid:erythroid cell ratio in infected dogs compared with healthy dogs and changes in the morphological and quantitative patterns in hematopoietic cells, particularly in erythroid series of the pancytopenic dogs. In differential cell count, decrease in the percentage of lymphocytes, plasma cells and monocytes correlated with the severity of hematological changes. In the histopathological examination of the bone marrow, the main alterations were the increase in cellularity, megakaryocytic hyperplasia, macrophage proliferation and degeneration and/or necrosis. Addressing the growth factors and cytokines, increased expression of IFN-?, GM-CSF, IL-7 and TNF-? seemingly plays an important role in bicytopenic dogs, and the expression fo IL-3 in dogs with cytopenia. In contrast, pancytopenic dogs had a significant decrease in the IGF-I expression compared with other groups. The data suggest a dyshematopoiesis with participation of IGF-I in severe stage of disease. In L. (L.) donovani-intravenously infected C57BL / 6 mice hematological changes were evaluated at 28 days post-infection when pancytopenia was established. The bone marrow examination showed cellular morphological changes, an increase in myeloid:erythroid ratio and myeloid maturation index, and erythroid hypoplasia. Moreover, we observed a significant increase in the percentage of lymphocytes and macrophages in infected animals. In histopathological examination, we observed a significant increase in the cellularity accompanied by infiltration and/or proliferation of mononuclear cells resembling macrophages. We characterized these cells as F4/80+ cells by confocal microscopy, a typical marker of residents and/or stromal macrophages. Using flow cytometry, we found a significant increase in the percentage of F4/80 in proliferation. In addition, we used other macrophage markers such as CD169 and CD11b, when a reduction in F4/80+CD169+CD11b+ population was shown in infected mice. Based on these data, we may consider L. (L.) donovani-infected C57BL/6 mouse a good model for the study of dyshematopoiesis in VL and that stromal macrophage may have important role in the in the hematopoiesis that deserve further studies .

Circoviren sind kleine, unbehüllte Viren mit einem einzelsträngigen zirkulären DNA Genom mit eine Größe von 1,7 bis 2,4 kb. Das Porcine Circovirus Typ 2 (PCV2), welches zum Genus Circovirus gehört, ist mit einer Anzahl von Krankheitsmanifestationen verbunden worden, die heute als Porcine Circovirus Assoziierte Krankheiten (PCVAD) zusammengefasst sind. Die PCV2-Infektion bei Rindern ist bis zum jetzigen Zeitpunkt marginal erforscht worden. Serologische Untersuchungen auf Circovirus spezifische Antikörperführten zu widersprüchlichen Ergebnissen. Im Jahr 2007 wurde von der Bovinen Neonatalen Panzytopenie (BNP) in Europa mit unklarer Genese berichtet. Das klinisch - pathologische Bild der Hämorrhagien ähnelte dem Krankheitsbild der Infektiösen Anämie, welche durch ein Circovirus bei Hühnern verursacht wird. Deshalb wurde in dieser Studie eine Breitspektrum PCR zum Nachweis von Cirocvirus-Genomen durchgeführt. In 5 von 25 BNP betroffenen Kälbern konnte circovirale DNA nachgewiesen werden. Das komplette Genom wurde nachfolgend amplifiziert, kloniert und sequenziert. Das nachgewiesene Genom (PCV2-Ha08) hat eine Länge von 1768 Nukleotiden und zeigte eine hohe Homologie (bis zu 99%) mit PCV2-Genotyp b (siehe Publikation 1). Als Ursache der BNP ist vor kurzen die Übertragung von Alloantikörpern über das Kolostrum beschrieben wurden, welche die Zerstörungen von Leukozyten und Thrombozyten sowie deren Vorläuferzellen bewirken. Ungeachtet dessen war es wichtig, die Empfänglichkeit und Immunantwort von Kälbern nach experimenteller Infektion mit PCV2 zu studieren. Für diesen Zweck wurden weitere 181 Proben von BNP-Kälbern aus Deutschland mit Hilfe einer Breitspektrum-PCR getestet. In zwei von 181 Proben wurde PCV2 DNA nachgewiesen. Die vollständigen Sequenzen konnten amplifiziert werden. Während das erste Genom aus einer Blutprobe eines Kalbs in Bayern stammte (PCV2-Ha09), stammte das zweite nachgewiesene Genom aus Lunge und Gehirn von einem Kalb in Sachsen (PCV2-Ha10). Das Genom (PCV2-Ha09) besteht aus 1768 nt, währenddessen das Genom (PCV2-Ha10) aus 1767 nt aufgebaut ist (siehe Publikation 2). Weiterhin wurden die PCV2 Empfänglichkeit und die Immunantwort von Kälbern durch experimentellen PCV2 Inokulation sowie die Möglichkeit, eine Serokonversion nach Impfung mit einer kommerziellen PCV2 Vakzin zu entwickeln, untersucht. PCV2-spezifische Antikörper wurden in den PCV2-infizierten Tieren und in den PCV2-immunisierten Tieren im Tag 11 und 7 nach Inokulation (p.i.) nachgewiesen. PCV2-Genome wurden durch quantitative Realtime-PCR zwischen Tag 4 und Tag 46 p.i. nur in den Blutproben sowie in verschiedenen Geweben (z.B. Milz, Lymphknoten, Thymus) der PCV2-infizierten Tiere nachgewiesen. Das Genom, welches von den Lymphknoten der PCV2-infizierten Kälber erneut isoliert wurde, zeigt eine Identität von 99,9% gegenüber dem Inokulum. Dies weist möglicherweise auf adaptierte Mutationen im PCV2 Genom hin. Die Mutationen C1708T und G365C sind während der Infektionen aufgetreten. Die Sequenzanalyse zeigt eine mögliche adaptierte Mutation an der Aminosäure Nr. 105 in Replikationsgen (Met zu Ile) (siehe Publikation 3). Zusammenfassend kann geschlussfolgert werden, dass der Nachweis der PCV2 Genomen und eine experimentell induzierte Serokonversion möglich war. Es konnte gezeigt werden, dass die Empfänglichkeit von PCV2 nicht allein auf Schweine begrenzt ist und eine Übertragung von PCV2 auf Rinder möglich ist.

A leishmaniose visceral é uma infecção grave que leva a pancitopenia. Quando se trata de disfunções medulares decorrentes de infecção por Leishmania (Leishmania) infantum há poucas abordagens descrevendo as alterações na mielopoiese e os mecanismos que levam a pancitopenia na LV. Alguns estudos demonstram uma relação importante entre a pancitopenia e o fator de crescimento insulin-like growth fator-I (IGF-I), no entanto, o seu papel endógeno na hematopoiese ainda não está claro. Propomos estudar a influência desse fator na hematopoiese e sua relação com o desenvolvimento da pancitopenia em hamsteres infectados por via intra-peritoneal com 2x107 de amastigotas por L. (L.) infantum. Avaliamos em 90 e 120 dias pós-infecção a LDU (Leishman-Donovan units) no baço e fígado, quando observamos tendência à progressão da infecção. Aos 60 dias pós-infecção, os animais com LV desenvolveram a plaquetopenia como primeira alteração hematológica, e a partir dos 90 dias pós-infecção, a anemia, e a leucopenia com reduções significantes nos leucócitos totais, linfócitos e neutrófilos. Já aos 120 dias de infecção, os leucócitos totais diminuíram significantemente acompanhados por uma redução de linfócitos, monócitos e eosinófilos. A partir desses dados, focamos a análise da medula óssea nos hamsteres com 90 e 120 pós-infecção. No mielograma, vimos alterações somente nos hamsteres com LV aos 90 dias pós-infecção, com um aumento significante na proporção células mielóides imaturas: células mielóides maduras. Na biópsia da tíbia, houve um aumento significante da celularidade quando comparados com seu respectivo controle, apenas no período de 90 dias pós-infecção. Em adição, observamos uma proliferação e/ou infiltrado macrofágico significante nos hamsteres com LV, mas sem diferença estatística nos períodos de 90 e 120 dias pós-infecção. Na avaliação semi-quantitativa de fibras de reticulina, somente aos 90 dias pós-infecção, observamos aumento significante nos infectados comparados aos controles, caracterizando um quadro fibrótico. Foi medida a expressão de mRNA de IGF-I por PCR em tempo real, aos 90 e 120 dias pós-infecção, onde ocorreu um aumento significante da expressão de IGF-I nos animais infectados em relação aos controles aos 90 dias. Como expostos, os hamsteres com LV apresentam alterações hematológicas como anemia, leucopenia e plaquetopenia, e ainda alterações na medula óssea como aumento da celularidade, proliferação macrofágica e fibrose acompanhados por um aumento da expressão de IGF-I. Assim podemos concluir que nossos dados indicam que o hamster se constitui num bom modelo para o estudo da patogênese da pancitopenia e das alterações medulares decorrentes da infecção por L.(L.) infantum. Neste modelo, ocorre alteração da expressão de IGF-I durante a evolução da infecção com possível papel na patogenia da pancitopenia.
Visceral leishmaniasis is a serious infection that leads to pancytopenia. When it comes to spinal cord dysfunction resulting from infection Leishmania (Leishmania) infantum there are few approaches describing the changes in myelopoiesis and mechanisms that lead to pancytopenia in LV. Some studies have shown a significant relationship between pancytopenia and insulin-like growth factor-growth factor I (IGF-I), however, their endogenous role in hematopoiesis is still not clear. We propose to study the influence of this factor in hematopoiesis and its relationship to the development of pancytopenia in hamsters infected intraperitoneally with 2x107 amastigotes by L. (L.) infantum. Evaluated at 90 and 120 days post-infection the LDU (Leishman-Donovan units) in the spleen and liver, when we observed a tendency to progression of the infection. At 60 days post-infection, animals with LV developed thrombocytopenia as the first hematologic changes, and from 90 days post-infection, anemia, and leukopenia with significant reductions in total leukocytes, lymphocytes and neutrophils. Already at 120 days of infection, total leukocytes decreased significantly accompanied by a decrease lymphocytes, monocytes and eosinophils. From these data, we focus on the analysis of the bone marrow in hamsters with 90 and 120 post-infection. The myelogram changes seen only in hamsters with LV at 90 days post-infection, with a significant increase in the proportion immature myeloid cells: mature myeloid cells. Biopsy of the tibia, there was a significant increase in cellularity compared with their respective control, only 90 days post-infection. In addition, we observed a proliferation and / or infiltration significant macrophage in hamsters with LV, but no statistical difference in the periods of 90 and 120 days post-infection. In semi-quantitative assessment of reticulin fibers, only at 90 days post-infection, we observed a significant increase in infected compared to controls, featuring a fibrous framework. MRNA expression of IGF-I was measured by real-time PCR, at 90 and 120 days post-infection, where a significant increase in IGF-I expression in infected animals compared to controls at 90 days occurred. As set out, the present hamsters VL hematological disorders such as anemia, leukopenia and thrombocytopenia, as well as changes in bone marrow cellularity increased, macrophage proliferation and fibrosis accompanied by a reduction in IGF-I expression. Thus we can conclude that our data indicate that the hamster is a good model to study the pathogenesis of pancytopenia and marrow changes resulting from infection by L. (L.) Infantum. In this model, alteration of IGF-I expression during the course of infection with a possible role in the pathogenesis of pancytopenia.

A anemia aplástica severa (AAS) pode ser tratada com sucesso na maioria dos casos com terapia imunossupressora (IS) ou transplante alogenêico de medula óssea (TMO). Os principais fatores que determinam a escolha da modalidade terapêutica são a idade e a disponibilidade de um doador HLA-histocompatível. Em pacientes mais jovens, o TMO de um doador aparentado é preferível, enquanto que em pacientes acima de 40-50 anos, a terapia IS é a modalidade terapêutica de escolha. Resposta hematológica é obtida em 60-75% dos casos com terapia IS na AAS, o que correlaciona com melhor sobrevida. Recidivas ocorrem em aproximadamente um terço dos respondentes e evolução clonal para mielodisplasia em 10-15% ao longo termo. A doença do enxerto-versus-hospedeiro (GVHD) agudo ocorre em 30-40% dos casos sendo a forma crônica presente em 40-50%. Infecções são frequentes e podem complicar o transplante. Portanto, a refratariedade à terapia IS, recidivas e evolução clonal limitam o sucesso da terapia IS na AAS, enquanto rejeição do enxerto, GVHD, e infecções limitam o sucesso do TMO na clínica. Fatores preditivos dessas complicações seriam de grande valor na clínica, uma vez que poder-se-iam realizar decisões terapêuticas com base mais racional, onde pacientes fossem alocados a diferentes tratamentos com base no seu perfil de risco. Ou seja, pacientes com alta probabilidade de resposta e baixo risco de recidiva e evolução clonal se beneficiariam de terapia IS, enquanto àqueles com baixa probabilidade de resposta e alto risco de recidiva e/ou evolução clonal teriam mais benefícios do TMO, por exemplo. Com base nessa premissa, desenvolvemos estudos para investigar fatores que pudessem estar associados ao sucesso da terapia IS na AAS. Os principais achados de 3 análises distintas sobre o tema evidenciou: 1) crianças (< 18 anos) apresentam alta taxa de resposta à terapia IS (em torno de 75%) com uma excelente sobrevida geral em pacientes respondentes; 2) o número absoluto de reticulócitos e de linfócitos pré-tratamento correlaciona com resposta hematológica aos seis meses após terapia IS; e 3) o comprimento telomérico não está associado à resposta hematológica, porém, está associado a probabilidade de recidiva, evolução clonal, e sobrevida geral após terapia IS. Esses parâmetros identificados nesses estudos podem servir de base em algoritmos futuros onde faz-se estratificação de risco de cada paciente, a fim de alocar a modalidade terapêutica mais apropriada com base no perfil individual de risco. No que diz respeito ao comprimento telomérico, é provável que esse marcador biológico não só esteja associado ao processo de evolução clonal na AAS, mas que também participe na biologia da instabilidade genômica de células na medula óssea levando a aberrações cromossômicas e o desenvolvimento de mielodisplasia e leucemias.
Severe aplastic anemia (SAA) can be treated successfully in the majority of cases with immunosuppressive therapy (IST) or allogeneic bone marrow transplantation (BMT). The principal factors that determine the choice of treatment modalities are age and availability of an HLA-histocompatible donor. In younger patients, BMT from a related donor is preferred, while in patients over 40-50 years of age, IST is often employed. Hematologic response is achieved in 60-75% of cases with IST, which correlates with better survival. Relapses occur in approximately one third of responders and clonal evolution to myelodysplasia occurs in 10-15% of cases long-term. Acute graft-versus-host disease (GVHD) occurs in 30-40% of cases and chronic GVHD in 40-50%. Infections are common and complicate transplant outcomes. Therefore, refractoriness, relapses and clonal evolution limit the success of IST in SAA, while graft rejection, GVHD, and infections limited the success of BMT in the clinic. Predictors for these complications would be of great value in the clinic since one could make more rational treatment decisions where patients were allocated to different treatment modalities based on their risk profile. For example, patients with high probability of response and low risk of relapse and clonal evolution would benefit more from IST, while those with low probability of hematologic response and high risk of recurrence and/or clonal evolution most likely to benefit from BMT. Based on this premise, we developed studies to investigate factors that could be associated with the success of IST in SAA. The main findings of three separate analysis on the subject showed: 1) children ( < 18 years) have a high response rate to IST (around 75%) with an excellent long-term survival rate among responders; 2) the absolute number of reticulocytes and lymphocytes pre-treatment correlates with hematologic response at 6 months after IST, and 3) telomere length is not associated with hematologic response, but, associated with the likelihood of relapse, clonal evolution, and overall survival after IST. These parameters may serve as a basis for future algorithms allowing for risk stratification for each individual patient allowing for better treatment allocation. With respect to the telomere length, it is likely that it not only represents a biological marker but that it is involved in the process of clonal evolution contributing to genomic instability in bone marrow cells leading to the development of myelodysplasia and leukemia

Trabalho final de mestrado integrado em Medicina (Hematologia), apresentado à Faculdade de Medicina da Universidade de Coimbra.
Aplastic anemia (AA) is a rare hematopoietic disease characterized by a pancytopenia and a hypoplastic bone marrow. AA can be congenital (CAA) or acquired (AAA). Acquired AA comprises those cases where a causative factor is identified (Secondary AA) and also idiopathic cases (Idiopathic AA). There was a marked improvement on treatment options in the last years that had resulted on increased overall survival rates. It is known that a correct management of this entity is directly related with an efficient diagnostic investigation, and for that, it is fundamental to be aware of the most effective strategies or techniques available nowadays. Therefore, the aim of this review is to make a state of art of the most recent available data concerning this disorder, particularly IAA, including all the sub-topics inherent: etiology, pathophysiology mechanisms, differential diagnosis, management and treatment options.
A Anemia Aplásica (AA) é uma doença hematopoiética rara caracterizada por pancitopenia e hipocelularidade da medula óssea. A AA pode ser congénita ou adquirida. A AA Adquirida inclui os casos em que é possível identificar um fator causal (AA Secundária) e também os casos idiopáticos (AA Idiopática). Nos últimos anos tem havido uma melhoria notável nas opções de tratamento o que tem conduzido a melhores taxas de sobrevivência. É também um facto estabelecido que uma orientação clínica correta está diretamente relacionada com uma investigação diagnóstica eficiente, o que por sua vez exige um conhecimento sobre as estratégias e técnicas mais eficazes disponíveis na atualidade. O objetivo desta revisão é fazer um estado da arte das publicações e dados mais recentes relacionados com esta doença, especificamente em relação à Anemia Aplásica Idiopática, incluindo assim todos os subtópicos inerentes: etiologia, mecanismos fisiopatológicos, diagnóstico diferencial, conduta e opções de tratamento.