Treatment

• Mild cases need careful observation only. More severe will need supportive treatment with red cell and platelet transfusions and antibiotics as needed. Blood products should be CMV -ve, and preferably leu-codepleted to reduce risk of sensitisation.

• Specific treatment options are between allogeneic transplant and immunosuppression.

• Sibling allogeneic transplant treatment of choice for those <50 with sibling donor. Should go straight to transplant avoiding immunosup-pression and blood products if possible.

• Matched unrelated donor transplant should be considered in <25 age group.

• Immunosuppressive options include anti-lymphocyte globulin (ALG) ± cyclosporin. Response to ALG may take 3 months. Refractory or relapsing patients may respond to a second course of ALG from another animal.

• Cyclosporin post-ALG looks promising.

• Androgens or danazol may be useful in some cases.

Abkowitz, J.L. (2001) Aplastic anemia: which treatment? Ann Intern Med, 135, 524-526; Young, N.S. & Barrett, A.J. (1995) The treatment of severe acquired aplastic anemia. Blood, 85, 3367-3377.

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