2.3 Differential Diagnosis

2.3 Differential Diagnosis

2.3.1 Relationship Between Aplastic Anemia and Leukemia

Aplastic anemia and leukemia are both common diseases of the hematologic system. Although their clinical symptoms are similar, their nature is completely different. Leukemia is a clonal malignant disease of hematopoietic stem cells, in which the leukemic cells in the clone lose the ability to further differentiate and mature, remaining stuck at different stages of cell development. In the bone marrow and other hematopoietic tissues, leukemic cells proliferate and accumulate in large numbers, infiltrating other organs and tissues, while normal hematopoiesis is suppressed. The liver, spleen, and lymph nodes become enlarged, white blood cell counts are high but differentiation is immature, and there are large numbers of tumor cells. Treatment requires killing the tumor cells, with a very poor prognosis. Aplastic anemia, on the other hand, is a refractory hematologic disease—a group of conditions caused by chemical, physical, biological factors, or unknown reasons, resulting in bone marrow hematopoietic failure. It is characterized by damage to hematopoietic stem cells and pancytopenia in peripheral blood. Clinically, it often presents with severe anemia, bleeding, and infection, usually without hepatosplenomegaly. It is a benign disease, with no tumor cells in the white blood cells, and treatment mainly relies on medication to help restore hematopoietic function, with a relatively good prognosis.

2.3.2 Aplastic Anemia Needs to Be Differentiated from Paroxysmal Nocturnal Hemoglobinuria, Myelodysplastic Syndromes, and Malignant Histiocytosis

2.3.2.1 PNH

Acid hemolysis test (Ham test), sugar water test, and urine hemosiderin test (Rous test) are all positive. Clinically, there are often recurrent episodes of hemoglobinuria (soy sauce-colored urine), jaundice, and splenomegaly.

2.3.2.2 MDS

Blood picture shows a decrease in one or two parameters, not necessarily pancytopenia; bone marrow picture shows markedly active proliferation, with dysplastic hematopoiesis in all three lineages.

2.3.2.3 Malignant Histiocytosis

Often presents with high fever, severe bleeding, and in advanced stages, hepatomegaly and jaundice. Abnormal histiocytes are found in the bone marrow.

3 Current Treatment Status