2.2 Diagnostic Criteria

2.2 Diagnostic Criteria

2.2.1 Domestic Diagnostic Criteria [1]

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

2.2.1.1 Pancytopenia, with a decrease in absolute reticulocyte count.

2.2.1.2 Generally no hepatosplenomegaly.

2.2.1.3 Bone marrow shows reduced or severely reduced proliferation in at least one site (if proliferation is active, there must be a significant reduction in megakaryocytes), with an increase in non-hematopoietic cells in the bone marrow smear (bone marrow biopsy can show reduced hematopoietic tissue and increased adipose tissue).

2.2.1.4 Other diseases that can cause pancytopenia must be ruled out, including PNH, refractory anemia in MDS (MDS-RA), acute hematopoietic failure, bone marrow fibrosis, acute leukemia, malignant histiocytosis, etc.

2.2.1.5 General anti-anemia drug treatment is ineffective.

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

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

Blood Picture: In addition to a rapid decline in hemoglobin, at least two of the following must be present:

• Reticulocyte count less than 1%, with an absolute value less than 15×10⁹/L;
• Significant leukopenia, with an absolute neutrophil count less than 0.5×10⁹/L;
• Platelet count less than 20×10⁹/L.

Bone Marrow Picture: Reduced proliferation in multiple sites, with a marked decrease in all three lineages of hematopoietic cells and an increase in non-hematopoietic cells (if proliferation is active, there must be an increase in lymphocytes); non-hematopoietic cells and adipose tissue increase in the bone marrow smear.

Diagnostic Criteria for Domestic Chronic Aplastic Anemia

Clinical Manifestations: Slow onset, with milder anemia, infection, and bleeding.

Blood Picture: Hemoglobin declines more slowly, and reticulocyte, white blood cell, neutrophil, and platelet counts are generally higher than in acute aplastic anemia.

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

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

2.2.2 International Diagnostic Criteria

Internationally, the standard proposed by Camitta in 1979 is commonly used. Camitta classifies aplastic anemia into severe and mild types.

2.2.2.1 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 be less than 30%.

Blood Picture: At least two of the following three conditions must be met: neutrophil count less than 0.5×10⁹/L, reticulocyte count less than 1% or with an absolute value 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.

2.2.2.2 Diagnostic Criteria for Mild Aplastic Anemia

Reduced bone marrow proliferation, with pancytopenia.