1.1.3 Diagnostic Criteria

1.1.3 Diagnostic Criteria

1.1.3.1 Domestic Diagnostic Criteria

The final revisions made at the Fourth Academic Conference on Aplastic Anemia in 1987 are as follows [1]:

① Pancytopenia, with a marked reduction in reticulocyte count.

② Generally no hepatosplenomegaly.

③ Bone marrow morphology showing hypoproliferation or severe hypoproliferation in at least one region (e.g., if proliferation is active, there must be a significant reduction in megakaryocytes), along with an increase in non-hematopoietic cells in the bone marrow smear (those who can undergo bone marrow biopsy should confirm decreased hematopoietic tissue and increased adipose tissue).

④ Other diseases that could cause pancytopenia must be ruled out, such as PNH, refractory anemia in MDS (MDS-RA), acute hematopoietic arrest, bone marrow fibrosis, acute leukemia, malignant histiocytosis, etc.

⑤ Treatment with standard anti-anemic drugs is generally ineffective.

1.1.3.2 Diagnostic Criteria for Domestic Acute Aplastic Anemia (also known as SAA-I type) [1]

① Clinical Presentation: Sudden onset, progressive worsening of anemia, often accompanied by severe infection and visceral bleeding.

② Hematological Findings: In addition to rapid decline in hemoglobin, at least two of the following must be present: reticulocyte percentage less than 1%, absolute count less than 15×10⁹/L; marked leukopenia, with neutrophil absolute count less than 0.5×10⁹/L, and platelet count less than 20×10⁹/L.

③ Bone Marrow Morphology: Hypoproliferation in multiple regions, with significant reductions in all three hematopoietic lineages and an increase in non-hematopoietic cells. If proliferation is active, there must be an increase in lymphocytes, and non-hematopoietic cells and adipose tissue in the bone marrow smear must also increase.

1.1.3.3 Diagnostic Criteria for Domestic Chronic Aplastic Anemia

① Clinical Presentation: Slow onset, with milder anemia, infection, and bleeding compared to acute aplastic anemia.

② Hematological Findings: Hemoglobin declines more slowly, and reticulocyte, white blood cell, neutrophil, and platelet counts are often higher than in acute aplastic anemia.

③ Bone Marrow Morphology: Reduction in two or all three hematopoietic lineages, with at least one region showing poor proliferation, significant reduction in megakaryocytes, and an increase in non-hematopoietic cells and adipose tissue in the bone marrow smear.

④ If the condition worsens during the course of the disease, and the clinical presentation, hematological findings, and bone marrow morphology become identical to those of acute aplastic anemia, it is classified as SAA-II type.

1.1.3.4 Foreign Diagnostic Criteria [1]

The criteria commonly used internationally were proposed by Camitta in 1979 and have been adopted ever since. Camitta classifies aplastic anemia into severe and mild types.

① Diagnostic Criteria for Severe Aplastic Anemia: Bone marrow cell proliferation is less than 25% of normal; if it is less than 50% of normal, hematopoietic cells should account for less than 30%; hematological findings must meet at least two of the following three conditions: granulocyte count less than 0.5×10⁹/L; reticulocyte percentage less than 1% or absolute count less than 4×10⁹/L; platelet count less than 20×10⁹/L; if neutrophil count is less than 0.2×10⁹/L, it is considered extremely severe.

② Diagnostic Criteria for Mild Aplastic Anemia: Reduced bone marrow proliferation; pancytopenia.