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Q1:
What are treatments available for Aplastic Anemia patients?
A:
-
Immunosuppressive therapy (ATG or ALG, Cyclosporine)
- Supportive
Treatment (platelets and blood transfusion)
- Growth
Factors
- Bone
marrow Transplant
Q2:
What is Immunosuppressive therapy?
A:
Immunosuppressive therapy means AntiThymocyte globulin (ATG)
or AntiLymphocyte globulin (ALG) and/or cyclosporine.
Q3:
What is difference between ATG and ALG?
A:
ATG is horse serum while ALG is rabbit serum.
Q4:
How does ATG/ALG work?
A:
ATG/ALG targets T-lymphocytes—the cells that are responsible
for destroying or suppressing the stem cells of patients with
Aplastic anemia. Horse ATG is typically given intravenously
over four days for approximately four hours a day and ALG
for five days. This schedule may vary depending on your needs
or the particular methods of your doctor or hospital. ATG/ALG
therapy used alone is helpful about half the time. When it
is used in conjunction with Cyclosporine, the chances of the
treatment working increase to about 70 percent and higher.
Q5:
How can I know whether Immunosuppressive Drugs is successful
or not?
A:
If it is successful, ATG/ALG will usually eliminate the need
for transfusions within two to three months, and patients
will feel well. Blood counts rise within several months, some
rising dramatically, some more slowly. Response times can
vary greatly, however, and some patients experienced delayed
response times of up to nine months or even longer. Blood
counts, however, may still be below normal.
Q6:
Should a patient be treated with ATG/ALG second time?
A:
Some patients who respond to ATG/ALG may need to have treatment
again because of falling blood counts. Some patients who do
not respond to ATG/ALG the first time will respond if the
treatment is repeated. (Ask the doctor). Mostly, Doctors have
opinion that since it didn’t work for first time, there
are hardly chances for its success for the second time.
Q7:
What are the side effects of ATG/ ALG?
A:
ATG/ALG has a number of side effects. You should discuss these
with your doctor. Less serious side effects include fever,
chills, and hives. A rare but severe side effect is anaphylaxis,
a life-threatening allergic reaction. Patients may be skin
tested to determine if they are likely to develop allergies.
If you are, you can still receive ATG/ALG therapy, but you
will need to undergo a procedure called desensitization, in
which small, gradually increasing doses of ATG/ALG are given,
reducing the body’s allergic reaction to the drug. Serum
sickness is another type of reaction against a foreign protein.
It causes rash and joint and muscle aches. Corticosteroids
are usually given to patients to reduce the chances of their
getting serum sickness or to reduce its severity.
Q8:
What is Cyclosporine (Neoral)?
A:
Cyclosporine is given with ATG/ALG and is another immunosuppressive
drug that targets Tlymphocyctes. Cyclosporine used alone is
less successful than ATG /ALG alone, and less successful than
ATG / ALG used in combination with cyclosporine. Cyclosporine
comes in liquid and pill forms. The first doses will be based
on your body weight. Subsequent doses will be adjusted based
on the amount of the medicine in your blood. Too much of the
drug will cause side effects and too little won’t be
effective.
Q9:
What are the side effects of Cyclosporine (Neoral)?
A:
Two of the most serious side effects are kidney damage and
high blood pressure. Both of these problems, however, are
usually easy to manage and are reversible. You may need to
take a blood pressure lowering medication while on cyclosporine
as well as a supplement of magnesium. You will generally need
to continue taking cyclosporine for months or even years.
If you have a stable, positive response to the drug, your
doctor will gradually decrease the dosage.
Q10:
What is Supportive Treatment?
A:
Supportive treatment includes blood and platelets transfusion.
Q11:
What is Blood Transfusion?
A:
If red blood cell is low, patients may need to receive transfusions.
Important advice about transfusions: do not ask close family
members to donate red blood cells until after a bone marrow
transplant has been done or ruled out. This is because if
a family member turns out to be the best bone marrow donor,
a prior donation from a family member could reduce the chances
for a successful transplant.
Q12:
What things to keep in mind for blood transfusion?
A:
Blood transfusions may contain viruses or other infections
that may be passed to the recipient. Blood products used for
transfusion are usually treated in some way (such as being
irradiated or filtered) to remove leukocytes. These measures
reduce the risk of certain complications from transfusion—
irradiation minimizes the risk of graft-versus-host disease.
Q13:
Why it is required to use blood filters (Leukocyte filters)?
A:
Leukocyte filters decrease the risk of sensitization to proteins
present in the transfused blood product, and also reduce the
risk of transmitting cytomegalovirus. Irradiation and filtering
are important in cases where the patients are severely immunosuppressed.
Q14:
Where can I buy the blood/platelets filters?
A:
Blood/platelets filters are available from medical stores
at Marine Lines, Bombay (as far as I know). Blood Filters
are around Rs.1000 and Platelets filters around Rs.1700. It
is suggested to buy these from wholesale medical dealers as
you can get a good deal. Please contact me for more information
Q15:
What is the life of Red blood cells (RBC)?
A:
RBC has a life span of 120 days.
Q16:
What is life of White Blood Cells (WBC)?
A:
White blood cells have a very short life span of only a few
hours.
Q17:
What are side effects of blood transfusions?
A:
One side effect of blood transfusion is Iron Overloading.
Q18:
What is Iron Overloading?
A:
If you receive regular red cell transfusions damaging amounts
of iron will begin to collect in key organs such as the heart
and liver. This is called iron overload (Hemochromatosis).
Untreated, this can lead to severe organ damage that can be
fatal.
Q19:
How is Iron removed?
A:
Iron can be removed by treatment with metal chelators like
Desferal.
Q20:
What is Complete Blood Count (CBC)?
A:
Refer to this link to understand Complete Blood Count. http://www.cc.nih.gov/ccc/patient_education/pepubs/cbc97.pdf
Q21:
What is platelets transfusion?
A:
Refer the platelets FAQ.
Q22:
What are Growth Factors?
A:
Growth factors are normal body products that encourage production
of blood cells. Granulocyte colony-stimulating factor (G-CSF)
and granulocyte macrophage colony-stimulating factor (GM-CSF)
have been the most effective growth factors for increasing
white cell production.
Q23:
Are Growth Factors successful in Aplastic Anemia Patients?
A:
To date, use of growth factors like erythropoietin to increase
red blood cells and platelets has not been particularly successful
in patients with Aplastic anemia. It is important to remember
that growth factors do not cure Aplastic anemia. Rather, they
may help damaged bone marrow to work better until other treatments
have a chance to reverse the processes causing the marrow
damage.
Q24:
What is BMT (Bone Marrow Transplant)?
A:
Please refer Bone Marrow FAQ.
Q25:
How to reduce the pain during the puncture for blood and platelets
transfusion?
A:
Use EMLA gel
Q26:
What is EMLA gel?
A:
EMLA (idocaine & prilocaine) is topical anesthetic used
for those people who are very sensitive to pain It is a prescription
gel that comes with its own bandaids. (In India, we get small
EMLA tube). It is applied to the area of puncture at least
one hour before needle insertion takes place. The result is
decreased discomfort with the needle insertion.
Q27:
Where do you get EMLA gel in India?
A:
You get EMLA gel from medical stores at Marine Lines, Bombay
(opposite to Bombay Hospital). Each tube cost nearly Rs.200.
It is very expensive
Q28:
What are Clinical Trails?
A:
For patients who have not responded to standard treatments,
new treatments may be tested without any comparison group.
You should consider participating in a clinical trial only
after your doctor has explained the trial’s specific
purposes, risks, and benefits. Clinical trials offer some
of the best medical care available. Trials not only provide
the latest and best medical expertise, but patients receive
close attention and monitoring. Most insurance companies cover
treatment done within a clinical trial - if not, first treatment
is free of charge at the National Institutes of Health.
Q29:
What are the website to learn more about clinical trials?
A:
www.aamds.org
www.clinicaltrials.gov
www.centerwatch.gov
www.nih.gov
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