Sep 5 2013

Refractory Anemias

Posted by Martin Smithmyer

Refractory Anemia Is a type of myelodysplastic syndrome, which is a syndrome resulting from a deficiency in the myeloid (red blood cells produced in the spinal cord or bone marrow). Though the white blood cells and the platelet count remain at normal levels, the red blood cells count is lacking, which is what causes the anemia.

Refractory Anemia with Ringed Sideroblasts – there are a normal amount of white blood cells and platelets, however there are fewer red blood cells than there should be and those red blood cells contain more iron then they should.

Refractory Anemia with Excess Blasts – there are too few red blood cells in the blood and the patient has anemia. 5-19% of the cells in the bone marrow are blasts (early/immature cells), which may develop into acute myeloid leukemia. The white blood cells and platelets may or may not be affected.

Refractory Anemia with Excess Blasts in Transformation – there is a deficiency of red blood cells, white blood cells and platelets. 20-30% of the cells in the bone marrow are blasts and more than 5% in the blood are blast. There is a high chance that the cells with blasts can lead to acute myeloid leukemia.

Chronic Myelomonocytic Leukemia (CMML) – occurs when there is an elevated number of white blood cells  (monocytes) in the blood of at least 1000/mm3. The amount of blasts is below 20%. Often times, when a person has CMML, their spleen is also enlarged. About 15% to 30% of patients go to on to develop acute myeloid leukemia. Some patients with CMML may have a deficiency of a certain type of cell, but the main problem is having too many of a certain type of white blood cell (monocytes).


All the diseases mentioned are often treated with what is known as a stem cell transplant (SCT). SCT clears out the blood of blasts and the new stem cells in the body generate new and healthy monocytes, platelets and red blood cells within the bone marrow and blood stream. If any of the diseases progress to acute myeloid leukemia (AML) then a SCT would occur in conjunction with chemotherapy. The chemotherapy would weaken the immune system and destroy the immature cells. Then, following up the procedure with a SCT, the stem cells would generate new and healthy cells. Umbilical cord blood contains the hematopoietic stem cells needed for these transplants.

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