Type d’époétine
III.6. EVOLUTION ET PRONOSTIC
L’évolution de la maladie de Blackfan-Diamond peut être favorable et l’anémie peut disparaître spontanément dans 30 % des cas. Cependant, il existe un risque de survenue de leucémie aiguë chez les patients en rémission (23 % des cas chez les patients de moins de 40 ans), ce qui justifie un suivi médical prolongé chez ces sujets et explique la limitation des approches thérapeutiques utilisant les facteurs de croissance [19]. Le pronostic de la maladie est surtout fonction de la surcharge martiale induite par les transfusions globulaires itératives.
Dans le cas des érythroblastopénies secondaires, le pronostic dépend de l’affection causale sous-jacente. Globalement, la survie médiane est de 20 ans environ. 10 % de résolutions spontanées sont observées, 70 % répondent après de multiples lignes de traitement mais 80 % des cas rechutent dans les deux années qui suivent le diagnostic. À noter que des transformations en leucémie myéloïde aigüe sont décrites dans 3 à 5 % des formes réfractaires [127].
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L’érythroblastopénie est une affection rare dont le diagnostic ne doit pas être méconnu devant une anémie arégénérative. Les études concernant cette pathologie ont bien évoluées ces dernières années et la liste des étiologies ne cesse de s’élargir pour inclure d’autres entités comme par exemple l’érythroblastopénie en rapport avec les syndromes myélodysplasiques. Le traitement repose d’abord et essentiellement sur la transfusion de culôts globulaires et puis sur le traitement spécifique en rapport avec la pathologie causale.
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RESUME
Titre : Les érythroblastopénies : A propos de 03 cas et revue de littérature.
Auteur : ER-RAHALI NADIA
Mots clés : érythroblastopénie ; anémie ; parvovirus B19 ; Syndrome myélodysplasique
L'érythroblastopénie est définie par une anémie strictement arégénérative, associée à la disparition totale ou subtotale des précurseurs érythrocytaires médullaires. Les lignées granuleuses et mégacaryocytaires sont strictement normales. Le diagnostic en est habituellement facile. On peut distinguer les formes congénitales ou les formes acquises qui constituent un groupe physiopathologique hétérogène. Elles peuvent être associées à de multiples causes : infection virale, agression toxique, phénomène auto-immun, association à un thymome, une leucémie lymphoïde chronique (B ou T), une prolifération à grands lymphocytes à grains. Une érythroblastopénie peut être aussi le premier signe d'une hémopathie en particulier d'une myélodysplasie.
La distinction entre une érythroblastopénie dont l'origine est une anomalie intrinsèque de la cellule souche et les autres étiologies est très importante du point de vue thérapeutique et pronostique. C'est là que l'étude de la croissance in vitro des progéniteurs apporte une aide certaine au diagnostic. En effet, il existe une corrélation étroite entre la croissance in vitro des progéniteurs érythroblastiques et la réponse au traitement immunosuppresseur.
Au total l'érythroblastopénie est une pathologie hématologique peu fréquente, mais il est important d'en faire le diagnostic étiologique car c'est une affection curable dans un grand nombre de cas.
A travers trois cas cliniques diagnostiqués au laboratoire d’hématologie de l’hôpital militaire d’instruction Mohammed V Rabat, nous allons faire le point sur les caractéristiques cliniques, physiopathologiques, biologiques et thérapeutiques de cette pathologie.
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SUMMARY
Title: Pure red cell aplasia: About 03 cases and review of literature.
Author : ER-RAHALI NADIA
Keywords :pure red cell aplasia; anemia ; human parvovirus B19; myelodysplastic syndrome
Pure red cell aplasia is defined by aregenative anemia,linked to total or subtotal disappearance of medullar erythrocytary precursors. Granulous and megacaryocytary lines are quite normal. Diagnosis is usually easy. We can distinguish congenital forms and acquired forms wich constitute an heterogenous physiopathological group. They can be associated to a multiple cause phs : viral infection, toxic aggression, auto-immune phenomenon, an association to a thymoma, a chronic lymphoid leukemia ( B ou T), a proliferation of large granular lymphocyte. Pure red cell aplasia can also be the first sign of hemopathy.
The distinction between an pure red cell aplasia whose origin is an intrinsic abnormality of the cell and the other etiologies is very important from and prognostic point of view. It is here where the study of the in vitro growth of progenitors brings a certain help to diagnosis. In fact, there is a close correlation between the in vitro growth of erythroblastic progenitors abd the reponse to immunosupressor treatment.
In total, pure red cell aplasia is an infrequent hematological pathology, but it is important to make the etiological diagnosis because it is a curable disease in a great number of cases.
Through three clinical cases diagnosed in the laboratory of hematology , of Mohamed V military hospital in Rabat, we will review the clinical, physiopathological , biological and therapeutical features of this pathology.
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