Aplastic Anaemia—A South African Context

Background: There is a paucity of data in South Africa documenting the various causes of aplastic anaemia (AA), as well as the response to immunosuppressive therapy. Objective: To determine the absolute number of AA cases, possible causes and response to immunosuppressive therapy at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Method: A retrospective cross-sectional analysis was conducted of all confirmed cases of AA at the CMJAH for the period of January 2014 to June 2019. Results: There were 35 cases of AA for the given study period. Sixty-five percent of the study sample had no identifiable cause for AA and were defined as idiopathic. Twelve patients (34%) had identifiable secondary causes for AA; these included exposure to drugs and toxins, pregnancy, viral infection and auto-immune conditions. All patients were treated with combination immunosuppressive therapy. None of the patients had received a stem-cell transplant. Eighteen percent of patients had a complete response to therapy, 49% had a partial response whilst 29% were refractory to therapy. Four percent of patients relapsed after treatment. Conclusion: AA is a rare disease with significant mortality. All possible secondary causes should be sought with a detailed patient history and relevant investigations. All patients must be treated with the recommended treatment protocol and exposure to offending drugs/toxins should be terminated. Every effort to improve patient follow-up should be made so as to establish concrete data on mortality and long-term complications.