How a Hyderabad hospital treated an aplastic anaemia patient suffering with jaundice and prolonged fever

Aplastic anaemia. (Yashoda Hospital)

In this condition, the bone marrow fails to make enough of the three types of blood cells that our body needs to function properly — red blood cells, white blood cells, and platelets.

Red blood cells carry oxygen throughout our body, white blood cells help us fight off infections and diseases, and platelets help stop bleeding when we get hurt.

However, in aplastic anaemia, the bone marrow becomes unable to produce a sufficient number of these blood cells, leading to various health problems.

People with aplastic anaemia may experience fatigue, weakness, and frequent infections due to a shortage of red and white blood cells.

Additionally, they might notice easy bruising and prolonged bleeding, as the lack of platelets impairs the body’s ability to form clots.

Also Read: People of this blood group are more susceptible to heart disease 

Sudhir’s worsening condition

What made matters worse for Sudhir was that he had also been diagnosed with jaundice in the last week of March and had an alarmingly low white blood cell (WBC) count: A mere 500 per microlitre. The normal WBC count is between 4,500 and 11,000.

The situation took an even more worrisome turn when Sudhir experienced an abnormally prolonged neutropenic fever (febrile neutropenia), along with severe jaundice, lasting nearly 40 days.

“He had jaundice since 27 February, for which he took Ayurvedic medicine. But the jaundice persisted and it was coupled with prolonged fever for which he was admitted to Yashoda Hospital. Following some tests, he was found to have deranged LFT (Liver Function Test) and progressive cytopenia — low levels of red blood cells (anaemia), white blood cells (leukopenia) and also severe thrombocytopenia (low platelets),” the hospital told South First.

When the first set of medicines failed to show improvement in Sudhir’s condition, in light of the severity of his condition, the medical team at Yashoda Hospital decided to pursue a stem cell transplant as a last-ditch effort to save his life.

Thankfully, the patient’s brother emerged as a fully human leukocyte antigen (HLA)-matched stem cell donor, which was excellent news for the transplant process.

Also read: Is Anaemia Mukt Bharat to be achieved by lowering Hb cut-offs? 

Stem cell transplantation & HLA typing

A stem cell transplant is a medical procedure in which healthy stem cells are transplanted into a person’s body to replace damaged or diseased stem cells.

Stem cells are unique cells that have the remarkable ability to develop into different types of cells in the body. They play a crucial role in replenishing and renewing various tissues and blood cells.

Stem cells can grow into WBCs, RBCs, and platelets. (Lymphoma Action)

The goal of the transplant is to replace the unhealthy or malfunctioning stem cells with healthy ones, thus allowing the body to produce new, healthy blood cells, and restore normal immune function.

Before a stem cell transplant, doctors need to find a suitable donor whose stem cells match the patient’s.

This matching process is essential to minimise the risk of complications and rejection of the transplanted cells.

Human leukocyte antigen (HLA) testing is a crucial part of this matching process. HLAs are proteins found on the surface of most cells in the body. They act as markers to help the immune system recognise which cells belong to the body (self-cells) and which are foreign (non-self or potentially harmful).

The immune system can identify and attack foreign cells, so it’s essential to find a donor whose HLA markers closely match those of the recipient. This ensures that the transplanted stem cells are well-tolerated by the recipient’s immune system and increase the chances of a successful transplant.

Ideally, a sibling is the best HLA match, as siblings often share more similar HLA markers due to their common genetic background.

Also read: Telangana government scheme to fight anaemia

The recovery process

In Sudhir’s case, proceeding with chemotherapy — which is given as conditioning chemotherapy to prepare a patient’s body for a stem cell or bone marrow transplant — became a challenging task due to his severe blood infection.

However, the transplantation took place in the last week of April. Throughout the procedure, the patient faced a condition called febrile neutropenia — a condition characterised by fever and low levels of neutrophils in the blood — posing a serious risk for infections.

He also developed multidrug-resistant Klebsiella — a strain of bacterium that’s become resistant to multiple classes of antibiotics, making it challenging to treat infections in his blood.

Despite all the complications, after nearly 12 days following the transplant, the donated blood cells started to function effectively within the patient’s body. Subsequently, the patient’s health began to improve and he gradually regained strength, leading to his eventual discharge from the hospital.

“It has been almost 90 days from the date of transplant and his donor chimerism (person’s body contains two different sets of DNA — the coexistence of genetically distinct cell populations within an individual, resulting from the fusion or mixing of cells) was 100 percent. The patient is doing well with mild gut graft-versus-host disease (GVHD), which is treatable,” said the hospital.

“We are glad to announce that the procedure was a success and the patient is clinically well. Very severe aplastic anaemia is associated with very high mortality rates (100 percent) if not treated, and febrile neutropenia in these patients makes them ineligible for any form of immunosuppressive treatment. This patient’s clinical course was further complicated by acute hepatitis. The desperate measure of a stem cell transplant proved to be successful and timely,” said Dr Karuna Kumar in a statement.