日本内科学会雑誌
Online ISSN : 1883-2083
Print ISSN : 0021-5384
ISSN-L : 0021-5384
豫後並びに治療成績から觀た再生不良性貧血の考察
菊池 武彦説田 武鎌田 秀雄吉山 他喜雄池田 健治森本 義男岩橋 嘉明福井 佐平中川 文一
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1956 年 45 巻 1 号 p. 26-39

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29 cases of aplastic anemia admitted to our clinic were observed mainly from the viewpoint of prognosis and curative effect and the following results were obtained:
Age, hemorrhagic diathesis, blood pictures and bone marrow pictures were believed to be likely a good indicator to determine prognosis: general speaking, bad prognosis was found relatively in high frequency either in older patients over 60 years or in younger ones under 20. Gingival bleeding and petechiae in the skin were observed in many cases, but bloody stool, genital bleeding, meningeal hemorrhage, large epistaxis and retinal bleeding were found only in cases with bad prognosis.
A prolongation of bleeding time or clotting time and a decreased blood capillary resistance were found in either cases. It was revealed that after treatment the prolongation of bleeding time was markedly reduced in many cases with good prognosis, but on the contrary, in cases with bad prognosis the prolongation of the time was found to be much increased. In blood pictures R.B.C. count under 1.5 millions per cmm, blood platelet count under 30, 000 per cmm or W.B.C. count under 3, 000 per cmm was observed considerably in large number of cases. In the differential count decreased neutrophils under 40%, increased lymphocytes over 50%, decreased monocytes under 3% or aeosinophils was observed frequently in cases with bad prognosis, while not so frequently in those with good prognosis. It was difficult to determine prognosis by means of the nucleal cell count of sternal punctate.
The decrease of either nucleated red cell under 10% or granulocyte under 40% in the differential count of myelogram was found in many cases with bad prognosis.
Repeated blood transfusion (inclusive of intrasternal transfusion) and therapeutics such as folic acid (especially in large dose), vitamin B12 or methionine were considered to be effective and above all, the combination therapy of blood transfusion and folic acid was the most effective. Consequently it was believed that early diagnosis and early treatment are the most important and also that this disease needs especially improvement of blood disorders as well as treatment of hemorrhagic diathesis.

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