Course and Prognosis in Aplastic Anaemia.

The diagnosis of aplastic anaemia depends upon the demonstration of hypocellularity of the bone-marrow, and before making the diagnosis it is essential to demonstrate this by appropriate marrow aspiration, bone-biopsy, and special investigations: Even so, this diagnosis includes a number of entities which differ in behaviour and prognosis and are probably due to different fundamental defects. They include congenital and familial aplastic anaemias, bone-marrow injury due to ionizing radiation, and chronic acquired aplastic anaemia. In a number of instances of acquired aplastic anaemia there is an undoubted causal relation with a chemical substance, but often there is no apparent history of an -aetiological agent and, conversely, it may not be possible to define the relation of the disease with a drug known to have been previously administered. It is therefore convenient to study the idiopathic and secondary groups together. During the past 12 years 60 patients with chronic acquired aplastic anaemia have been investigated at the Postgraduate Medical School. On the basis of this experience problems of diagnosis are reviewed and influences which affect prognosis are analysed. The patients came from a wide area, including a few from overseas. Those referred for consultation tended to be the more serious cases, and the series cannot therefore be regarded as an unselected one.