A STUDY ON THE THERAPEUTIC EFFECT OF CERULOPLASMIN IN APLASTIC ANEMIA

Abstract

An adequate treatment, such as iron for iron deficiency anemia or vitamin B12 and folic acid for pernicious anemia, has not been found for aplastic anemia. We assumed that erythropoietin might be a subunit of a serum apo-ceruloplasmin-like protein.
The result of our clinical data on the treatment of aplastic anemia by cerulopasmin was reported. Seventeen aplastic anemia patients were administrated separately or semultaneously with hog ceruloplasmin intramusculary or with floic acid parenterally. In some cases adrenal steroid hormone was given for their haemorrhagic diathesis.
The following results were obtained by the bone marrow, peripheral blood examination and the determination of serum iron, copper and ceruloplasmin.
(1) The combined application of ceruloplasmin and folic acid was the most effective for the treatment of aplastic anemia, especially that of maturation arrest type. This results agreed with the animal experimental data which showed the increase of erythropoietic substance in peripheral blood with combined administration of these drugs.
(2) In bone marrow, the increase of nucleated cells and polychromatic erythroblast was remarkable. The number of sideroblast decreased. In some cases hemoglobin remains in its high concentration which increased with the cell counts. In other cases hemoglobin increase delayed to the cell number.
(3) In most cases the serum iron level which was above 200 μg/dl remained in the same for one to two years after the remission when the treatment was terminated. The serum transferrin and the unsaturated iron binding capacity increased during the therapy.
(4) According to our method, the normal serum ceruloplasmin value is about 22-30 mg/dl. When it was under the normal level (about 10 mg/dl) the remission delayed. When it was over the normal level (about 30 mg/dl) prognosis is favourable. The normal ratio of serum copper to copper in ceruloplasmin is 90 %, in case of aplastic anemia it was 40-60 % and it returned to normal level after remission.
(5) No therapeutic effect was observed in aplastic type, when the disease was classified into four groups-aplastic type, hypoplastic type, normal type, and hyperplastic type.
The treatment was critisized as effective in cases who maintained the level over 3 million/cmm in red cell count and above 90 % in hemoglobin for more than one year without blood transfusion, and kept good condition in clinical manifestations such as haemorrhage, fever and so on.
This treatment is considered to be desirable for aplastic anemia, if the fetal emergency of the rapid decrease of leucocytes or platelets count could be avoided.