'Aplasia' means the lack of development of a tissue, cell or other body part. Aplastic anaemia is the condition in which the bone marrow fails to produce blood cells. Normally, the bone marrow produces:

red blood cells (which carry oxygen in the blood)
various types of white blood cell (which are part of the immune system)
platelets (which are involved in blood clotting).
These different types of blood cell originates from simpler cells, known as precursors or stem cells, which develop into the more specialised forms.

There are numerous reasons for the bone marrow to fail to produce blood cells in adequate numbers, but in aplastic anaemia there is a marked deficiency of all the precursor cells that should mature into adult blood cells.

Aplastic anaemia is a rare disease with an incidence in developed countries of between 5 and 10 cases per million per year.

In 65 per cent of people the cause of aplastic anaemia is unknown (the technical term is 'idiopathic'). Rarely, the disease is present at birth (congenital). The commonest congenital form is Fanconi's syndrome, but fewer than 1000 cases have ever been described. As well as aplastic anaemia, patients with Fanconi's syndrome have short stature, abnormal skin pigmentation, abnormalities of the bones of their arms and thumbs, kidney problems and an elfin-like appearance. A characteristic abnormality of the chromosomes (random breaks) is seen.

The common of all known cause of aplastic anaemia is exposure to drugs or environmental toxins. Benzene was the first known toxin to cause bone marrow failure. Despite this it is still widely used in industry in the manufacture of drugs, dyes, explosives and other chemicals. Exposure should be limited to 1 part per million, but this is often exceeded, especially in developing countries. Other related organic chemicals also cause aplastic anaemia, including:
toluene (in glues)
the insecticides DDT and lindane
the explosive TNT
the wood preservative PCP
petroleum distillates.

Drugs that cause aplastic anaemia may also be related to benzene. The antibiotic, chloramphenicol and the anti-inflammatory, phenylbutazone are two examples. Neither is commonly used in Western countries, but because they are cheap to produce, they are in widespread use in the developing world. Other medicines with a moderate risk of aplastic anaemia include gold salts and penicillamine, used to treat arthritis, carbamazepine and phenytoin, used to treat epilepsy, and the diuretic acetazolamide.

A large number of drugs have been associated with occasional cases of aplastic anaemia. Most of these are useful drugs and cannot easily be replaced other then turning to herbal medicine.

Radiotherapy (treatment with X-rays) suppresses the bone marrow, and may be intentionally used to do so in preparation for bone marrow transplantation. The use of these treatments should be confined to specialised centres where careful monitoring of the blood count takes place.

Some cases of aplastic anaemia have occurred after viral infections. In particular, hepatitis A, hepatitis B and 'non-A, non-B, non-C' hepatitis have been implicated, and more rarely the Epstein-Barr virus.

Very rarely aplastic anaemia occurs during pregnancy. It is not clear whether this is just a coincidence. Sometimes the disease recovers spontaneously at the end of pregnancy.

Patients complain of increasing tiredness, weakness and shortness of breath. Bleeding, bruising and blood spots may be noticed. Sore throats and other infections are noticeable. A high temperature with shivering attacks is an important symptom that demands immediate medical attention.

The following combination of three symptoms should raise suspicion of bone marrow failure:

anaemia - tiredness, weakness and breathlessness
low white cell count in the blood (neutropenia) - fever, sore throat, shivering attacks
low platelet count (thrombocytopenia) - bruising and bleeding.
When you see pale skin it is possible sign of heart failure, bruises and petechiae (small blood spots in the skin and mouth), mouth ulcers and fever. The back of the eye is likely to see small haemorrhages on the retina.

An important negative finding is the absence of enlarged lymph nodes or an enlarged spleen. Their presence would point to other diagnoses, such as lymphoma or leukaemia.

The most important test is the full blood count, which will show reduced numbers of red cells, white cells (neutropenia) and platelets (thrombocytopenia) - in other words all of the cellular components of blood. This feature is called pancytopenia.

The level of the neutrophil count defines the severity of the disease. Neutrophils are normally the most numerous of the various types of white cell we have in our blood and they are particularly involved in combating infection by bacteria and fungi.
Counts below 0.5 x 109/L mean severe aplastic anaemia.
Counts below 0.2 x 109/L mean very severe aplastic anaemia.

The most important distinction that the haematologist must make is between aplastic anaemia and acute leukaemia, which can show very similar blood pictures. For this reason a bone marrow sample is essential. The doctor will take samples both of the fluid of the bone marrow (an aspirate) and of the more solid bone marrow structure (a trephine biopsy). For most cases the diagnosis is easily made. In acute leukaemia the marrow is full of abnormal cells but in aplastic anaemia it is empty and comprises mainly fat spaces.

THE TOLE'S way of treatment has shown very positive result in treating and controling these conditions. At present time we have been doing a lot of research on this sickness.

Spontaneous bleeding into the skin ( dark red and blue colour )usually appears as a rash known as purpura ( in the old chinese saying ' ghost's pinch' ).

Petechiae is the term given to the individual small red or red-blue spots about 1-20mm in diameter which make up the rash. They are caused by a small local amount of bleeding within the skin. Deeper bleeding beneath the skin may be seen as bruises (ecchymoses). The difference between petechiae and abnormally prominent blood vessels can be shown by applying pressure to a red spot. If it is caused by an abnormal blood vessel the redness disappears temporarily. By contrast when pressure is applied to purpura the spots do not pale.

Purpura usually appears in crops and may disappear over three to five days. It can occur on any part of body but is more common on specific areas, such as the front of the shins.

It may occurs when the platelet count of the blood is low (thrombocytopenia) but there are other causes too. It can occur when the blood vessel wall is particularly fragile, has been damaged, or if the skin is thin. In elderly people so-called 'senile purpura' is often seen on the outer surface of the arm and back of the hand. Similar features are seen in some patients treated with long-term steroid therapy because steroids weaken the connective tissues of the skin.

Some inflammatory conditions damage to the vessel wall, or 'vasculitis', may occur and can cause purpura. An example is the inflammatory disorder in children known as Henoch Schönlein purpura. In this there is abdominal pain, joint pain, kidney inflammation and raised purpura typically over the buttocks and limbs. Purpura with painful bruising of the legs and around hair roots .

For details may includes :
idiopathic thrombocytopenic purpura (ITP)
thrombotic thrombocytopenic purpura (TTP)
haemolytic uraemic syndrome.

All these can be treated by THE TOLE'S WAY OF MEDICATIONS depending on the severe and the lenght of time the patients has it.
For normal conditions they will be cured in 4 weeks to 3 months THE TOLE"S intensive treatment.

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