| Objective: To explore the common etiology,clinical features and relevant factors which affect the type of childhood aplastic anemia(AA).Methods: The medical records of AA cases hospitalized in Children's Hospital of Chongqing Medical University from September 1992 to March 2008,were reviewed and the clinical features were analyzed by SPSS11.5. The cases agree with the diagnostic criteria of AA which was instituted by Fourth National Symposium on Aplastic Anemia in 1987.Results: (1) In the 166 cases of AA, chronic AA: acute AA= 1.86: 1, male: female=1.86: 1, Rural: Urban=2.07: 1,and the mean age was 8 years and 7 months. The incidence in four seasons was roughly equal. (2) 8.4% of the patients had a history of analgesics use, 2.4% for insect repellents, 1.8% for chloramphenicol and 0.6% for Tapazole. (3) 13.9% of the patients had a history of exposure to pesticides, 8.4% for benzene or other chemicals and 0.6% for radiation. (4) The course ranges from 1day to 10+ years, and was 9.73±21.10months on average, 71.7% cases'courses were less than 6 months. Anemia as the patients'performance accounted for 77.1%, with hemorrhage for 75.2% and infection for 51.2%. Site of infection: respiratory (90.6%), sepsis (3.5%), skin and soft tissue (2.4%), gastrointestinal (1.2%), other (2.4%). (5) 97.0% of the patients had the performance of anemia, 80.7% of skin bleeding, 69.3% of mild swelling of superficial lymphnodes, 28.3% of hepatomegaly, and no one had splenomegaly. (6) Blood: three-line drop (80.7%), two-line drop (18.7%), one-line drop (0.6%). The patients with average mean corpuscular volume (MCV) increased accounted for 78.1%, and mean corpuscular hemoglobin (MCH) increased for 66.5%. The mean of MCV was 108.06±12.17fl in chronic AA, and 98.12±11.39fl in acute AA . In the comparative analysis between acute and chronic AA, the values of MCV had a significant differences (P <0.05). (7) The marrow is hypercellular accounted for 29.1%, and obviously hypercellular for 1.2%; 9.30% of patients had active proliferation of granulocyte; 36.3% had active erythroid hyperplasia, 1.5% was obviously active. Abnormal erythroid: megaloblastic variable (7.8%), carbon nuclear-like change (6.6%), other deformities (4.2%). (8) 73.1% of patients had the evidence of viral infection, and 52.4% was EBV. (9) 38.9% of patients had serum iron (SI) elevated, 70.6% had fetal haemoglobin (HbF) elevated. The mean of HbF was 8.30±7.98% in chronic AA, and 4.19±6.43% in acute AA . In the comparative analysis between acute and chronic AA, the values of HbF had a significant differences (P <0.05).Conclusions: (1) Childhood AA is more common in male,school-age children and rural children. (2) Pesticcides may be the risk factors for childhood AA in Chongqing. (3) The main performance of childhood AA is anemia and hemorrhage, and respiratory tract infection is common. Some patients have mild superficial lymph node enlargement or hepatomegaly. (4)Three-line drop of blood in patient is common, two-line drop and one-line drop are rare. Major patients have large cell anemia performance. (5) Bone marrow: hypercellular in the marrow is in part of the patients, and mild dysplasia can be seen. (6) Most patients have SI or HbF elevated. The elevation of HbF is more common. (7) The significant differences of MCV and HbF between chronic and acute AA is serviceable for the classification of AA, so we may select a value to be the reference of typing AA. But the significance of prognosis and the reaction of treatment need further study. |
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