What are the symptoms of aplastic anemia in children?

Aplastic anemia in children is a syndrome of pancytopenia caused by failure of bone marrow hematopoietic function. The main clinical symptoms of children with aplastic anemia are anemia, bleeding and repeated infections, and a simultaneous decrease in three blood cell lines. So what are its characteristics?

The characteristics of aplastic anemia in children are:

1. Peripheral blood showed pancytopenia, the absolute value of neutrophils, the percentage and absolute value of reticulocytes were significantly reduced, and the percentage of lymphocytes was significantly increased. There are no immature cells in the peripheral blood.

2. The bone marrow of the ilium and sternum showed multiple parts of hypoplasia, with a significant decrease in hematopoietic cells, a significant increase in non-hematopoietic cells, and a significant decrease in megakaryocytes, most of which were absent.

3. Active bone marrow proliferation can be seen in some children, but the proportion of non-hematopoietic cells such as lymphocytes has increased significantly, and megakaryocytes have decreased significantly.

4. In case of repeated infection, the liver, spleen and lymph nodes can be palpated.

Characteristics of children with aplastic anemia that are different from those of adults:

1. Physical signs: The liver can be felt in about 1/3 of children with aplastic anemia, 1 to 3 cm below the ribs; while it is generally not palpable in adult patients.

2. Blood picture: Children mainly show hemoglobin and thrombocytopenia. Leukocytopenia is less obvious, with the white blood cell count exceeding 4.0×10^9/L in about 50% of children. It is more obvious in children under 7 years old, but the number of cases of pancytopenia gradually increases with age.

3. Bone marrow: The degree of bone marrow hyperplasia in children is mostly active and significantly active, which is different from that in adults with aplastic anemia. The cellular components in the bone marrow, especially in chronic aplastic anemia with good growth, may have a roughly normal ratio of granulocyte and erythrocyte systems, with granulocytes showing maturation stagnation and the ratio of intermediate and late immature erythrocytes in the erythrocyte system even slightly higher than that of normal children. The percentages of granulocyte system and erythrocyte system in children with dysplasia were significantly lower than those in adults with aplastic anemia, while the proportions of non-hematopoietic cells such as lymphocytes, plasma cells, histiocytes, and histochromatin were significantly higher than those in adults with aplastic anemia. The bone marrow granules may be mainly composed of non-hematopoietic cells, mainly hematopoietic cells, or a combination of hematopoietic and non-hematopoietic cells. The megakaryocytes are significantly reduced, similar to those in adult aplastic anemia. The bone marrow of children with acute aplastic anemia is similar to that of adults.

4. Efficacy response: Generally speaking, the efficacy of allogeneic bone marrow transplantation in children with severe aplastic anemia is significantly better than that in adult patients, while the efficacy of immunosuppressive therapy in adult patients with severe aplastic anemia is higher than that in children with severe aplastic anemia.