A plastic anaemia at the Kenyatta National Hospital during the period 1973-1978

Abstract

A total of 54 patients were diagnosed and treated for plastic anaemia between July, 1973 to December 1978 at the Kenyatta National Hospital. The sex distribution was equal. Most of the age groups were affected with the majority of Cases occurring in the young age groups. Most tribes in Kenya were found not to be free from a plastic anaemia and there was a predominance of the disease amongst the Kikuyu tribe who lived in and around Nairobi. Very few factors associated with actiology could. Be elicited and this was partially due to adequate histoties taken at the time of admission by the various physicians. Even though great difficulties are encountered in establishing an aetiologic role for a given agent, so that in large proportion of patients remains unexplained. The presenting clinical features were those of anaemic haemorrhages due to thrombocytopenia and infections resulting from leucopenia, all of which were observed in all the patients reviewed except for the 4 patients with pure red cell aplasia. The other 50 patients had hypoplastic marrows. Confirmation of diagnosis was delayed due to initial blood transfusion given before peripheral blood film examination in most patients. Massive blood transfusion was given to patients on remission. Although platelet concentrates are available and obviate the massive blood transactions, only very few patients received platelet infusions. Corticosteroid and androgenic asteroids were administered but there was no laid down policy as to the protocol to be followed. Hence administration of these drugs was done in a haphazard manner with a big proportion of patients going without any steroid therapy. This may have accounted to a great extent, for the very poor remission rate noted. Since it has been observed that pure red cell aplacia remits spontaneously, prolonged therapy of these patients should be pursued vigorously. Most of the deaths encountered occurred during the first 4 months of admission and they were mainly due to complications of the disease process mainly infections, congestive cardiac failure and excessive haemorrhage.