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PREDICTION OF PROGNOSIS IN APLASTIC ANEMIA BY FERRO KINETIC STUDIES

Criteria are needed to identify at diagnosis patients with idiopathic aplastic anemia (AA) who have a poor prognosis, since early bone marrow transplantation may improve their survival. In the past 4 yrs we have studied 11 patients, aged 2-14 yrs (median 7 yrs), with AA. All had pancytopenia and aplastic or markedly hypoplastic bone marrows. In addition to the usual hematologic evaluation, studies with 59Fe were done to measure plasma Fe clearance (FeC) and Fe utilization (FeU). All patients were treated with androgens and received supportive care, Six have died (median survival 8 mos). The others have improved and have a median survival of 25 mos. Significant differences between survivors and nonsurvivors were found in initial absolute reticulocyte counts (ARC)(p< 025), absolute neutrophil counts (ANC) (p<.005), and %, FeU (p<.002). Values for nonsurvivors were ARC 1.35±0.28(×1010/1), ANC 3.48±0.76(×108/1), and % FeU 8.0±3.3 (mean ± S.E.M.). Survivors had ARC 3.11±0.84, ANC 7.03±1.14, and % FeU 48±14. RBC, WBC, and platelet levels had no predictive value for long term survival. Plasma FeC was prolonged in all, reflecting poor Fe uptake. Of 7 patients who had ARC less than 2.5, ANC less than 5.0 and less than 25% FeU, 6 died. FeU studies characterize the total erythropoietic capacity of the marrow better than aspiration, which is subject to sampling error. These data suggest that poor FeU at diagnosis of AA should be used as one criterion for early bone marrow transplantation.