Transfusion science Revised

ROLE OF TRANSFUSION SCIENCE IN APLASTIC ANAEMIA
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Aplastic anemia can be described as the bone marrow’s failure to generate new blood cells in the body (Zeidan A. 2017, 8). The condition makes patients experience fatigue, prolonged infections, headache, dizziness, and nosebleeds as well bleeding gums (Gu Y et al. 2015, 3). Aplastic Anaemia can be inherited or acquired through exposure to poisonous chemicals, viral infection, pregnancy or use of some drugs (Killick S. 2016, 190) Aplastic anemia is managed through stem cell transplant, viral treatment, blood transfusions and marrow stimulation (Tandra, P et al. 2016, 22). The paper will critically analyze whether the aplastic anemia patients can live independent of blood transfusions?
Aplastic anemia patients mostly require red blood cell and platelet transfusions. If a patient is tired or has a problem catching a breath, the physician may recommend RBC transfusion. On the other hand, doctors can recommend a platelet transfusion for a patient that tends to bleed and bruise easily. The platelets have a lifespan of 10 days thus they are helpful for a short duration (Killick S. et al. 2016, 187).
Blood transfusion provides new red blood cells and platelets in the aplastic anemia patients. However, physicians can employ the stem cell transplant therapy to enable the patient to live independent of blood transfusion.

The therapy involves the transfer of a sample of the stem cells from the bone marrow of a donor to the patient. About 70% to 90% of the transplants are successive and compatible. After the transplant procedure, the patient is expected to show improvement between 2-12 weeks (Tandra, P et al. 2016, 21). Close to 10% of the patients that do not show improvement after successive transplant are termed incompatible with the initial donors. Therefore, the physicians conduct a second transplant procedure to provide another stem cell from a different donor.
Patients that undergo azathioprine, corticosteroids and gamma-globulin therapy can live independent of blood transfusion for 3 years (Pickard A et al. 2017, 13). The bone marrow produces red blood cells, Granulocytes, and blood platelets throughout the three years. A permanent therapy was introduced that involved treating patients with rituximab drugs. The therapy is administered after every four weeks in which patients tend to show improvement of 6.8* 10(9)/L and 232*10(9)/L in WBC and platelet count respectively (Shimizu H et al. 2016, 174). After five months, patients treated with Rituximab drugs become independent of blood transfusions.
Stem cell transplant does not apply to all patients since some cannot find compatible donors (Dufour C et al. 2017, 127). The physicians, therefore, opt for a procedure such as bone marrow stimulation to enable the aplastic anemia patients to live independent of blood transfusions. Drugs such as Leukine, Neupogen, and Neulasta are used to stimulate the bone marrow to generate new blood cells (Bendall L et al. 2014, 355). For the effective production of blood cells, the growth factors and immune-suppressing drugs are also used in the stimulation process.
Aplastic anemia patients can also live independent of blood transfusions through undergoing antibiotics and antivirals therapy (Mikulska M. 2015, 1). The procedure is however preferable for patients whose aplastic anemia condition is detected at the early stages as well those that do not have a compatible stem cell donor (Purev E et al. 2017, 750). Antibiotic and antiviral treatment enables hematopoietic stem cells present in the patient’s bone marrow to repopulate and produce new WBC, RBC, and platelets.
In conclusion, aplastic anemia patients can live independent of blood transfusions; however, this is possible through treatment procedures such as stem cell transplant, rituximab medication, bone marrow stimulation and antibiotics / antiviral medication. The treatment enables the patient’s bone marrow to generate new WBC, RBC, and platelets independently.

References
Bendall, L.J., and Bradstock, K.F., 2014. G-CSF: From granulopoietic stimulant to bone marrow stem cell mobilizing agent. Cytokine & growth factor reviews, 25(4), pp.355-367.
Dufour, C., Samarasinghe, S. and Miano, M., 2017. Management of Acquired Aplastic Anemia in Children. In Congenital and Acquired Bone Marrow Failure (pp. 127-139).
Gu, Y., Estcourt, L.J., Doree, C., Trivella, M., Hopewell, S. and Vyas, P., 2015. Comparison of a restrictive versus liberal red cell transfusion policy for patients with myelodysplasia, aplastic anemia, and other congenital bone marrow failure disorders. The Cochrane database of systematic reviews, 3.
Killick, S.B., Bown, N., Cavenagh, J., Dokal, I., Foukaneli, T., Hill, A., Hillmen, P., Ireland, R., Kulasekararaj, A., Mufti, G. and Snowden, J.A., 2016. Guidelines for the diagnosis and management of adult aplastic anemia. British journal of hematology, 172(2), pp.187-207.
Mikulska, M., 2015. How to Manage Infections Caused by Antibiotic Resistant Gram-negative Bacteria-EBMT Educational Meeting from the Severe Aplastic Anaemia and Infectious Diseases Working Parties, Naples, Italy, 2014. Current drug targets.
Pickard, A.S., Huynh, L., Ivanova, J.I., Totev, T., Graham, S., Mühlbacher, A.C., Roy, A. and Duh, M.S., 2017. Value of transfusion independence in severe aplastic anemia from patients’ perspectives–a discrete choice experiment. Journal of Patient-Reported Outcomes, 2(1), p.13.
Purev, E., Tian, X., Aue, G., Pantin, J., Vo, P., Shalabi, R., Reger, R.N., Cook, L., Ramos, C., Cho, E. and Worthy, T.Y., 2017. Allogeneic transplantation using Cd34+ selected peripheral blood progenitor cells combined with non‐mobilized donor T cells for refractory severe aplastic anemia. British journal of haematology, 176(6), pp.950-960.
Shimizu, H., Kobayashi, N., Mihara, M., Iriuchishima, H., Ishizaki, T., Kojima, Y. and Handa, H., 2016. Successful Treatment of Epstein-Barr Virus-Associated Lymphoproliferative Disorder with Rituximab in a Patient Undergoing Immunosuppressive Therapy for Aplastic Anemia. Acta haematologica, 136(3), pp.174-177.
Tandra, P., Kallam, A., Guduru, M., Bendi, V.S., Krishnamurthy, J. and Bierman, P., 2016. Paraneoplastic Manifestations of Lymphoproliferative Neoplasms. Lymphoma and Chronic Lymphocytic Leukemias, 2016(6), pp.21-33.
Zeidan, A.M., Battiwalla, M., Berlyne, D. and Winkler, T., 2017. Aplastic Anemia and MDS International Foundation (AAMDSIF): Bone marrow failure disease scientific symposium 2016. Leukemia research, 53, pp.8-12.