Clinical profile and mortality among children with Aplastic Anemia admitted at MNH

Abstract

ABSTRACT Background: Aplastic anemia (AA) is a relatively rare hematological disease, presenting with pancytopenia and unexplained hypo-cellularity in bone marrow. It is a condition with a high mortality rate if left undiagnosed and untreated. There is inconsistency in findings from previous studies regarding the clinical profile and factors associated with mortality among patients with AA. Objectives: The main aim was to find out the clinical profile and factors associated with mortality among children with AA admitted to Muhimbili National Hospital, Dar es Salaam, Tanzania. Methods: An analytical retrospective hospital-based cross-sectional study patients with AA at MNH admitted between 2016 and 2023. Records of 82 patients aged less than 18 years old were reviewed. Information obtained included age, sex, date of diagnosis, laboratory results, treatment given, and status of living or death. Descriptive analysis was summarized using proportions and medians with interquartile ranges (IQR). The overall clinical profile was calculated with a 95% confidence interval. Chi-square and, where applicable. Logistic regression was used to determine the independent factors associated with mortality among patients with AA. A p value of < 0.05 was considered statistically significant. Results: The majority of patients were male (62.2%), with a median age at diagnosis of 9 years. Common clinical presentation included bleeding tendencies (61.0%) and pallor (96.3%), while laboratory findings revealed severe anemia (60.9%), neutropenia (41.4%), and severe thrombocytopenia (75.6%). Treatment strategies primarily consisted of immunosuppressive therapy with ATG, cyclosporine, Danazole, with supportive measures such as blood products and antibiotics. The mortality rate among AA patients was 48.7%. statically significant factors associated with mortality were bleeding tendency, Absolute neutrophil count (ANC) and thrombocytopenia. No association with sex nor age was found. Conclusions: Despite advances in treatment, mortality remains a significant concern, emphasizing the need for early detection, prompt initiation of therapy, and close monitoring of high-risk patients. Identification of prognostic factors can aid in risk stratification and targeted interventions to improve survival rates in AA. Recommendations: Based on the findings, recommendations include enhanced education and awareness programs for healthcare providers and further research to explore novel therapeutic approaches and prognostic markers in AA.