Questions 446-448: Specify the aplastic anemia classification:

Indicate the aplastic anemia classification of the primary disease for infusion.

If any of the following classifications are selected:

  • Acquired AA, not otherwise specified (301)
  • Acquired AA secondary to chemotherapy (313)
  • Acquired AA secondary to hepatitis (302) (any form of hepatitis)
  • Acquired AA secondary to immunotherapy or immune effector cell therapy (314)
  • Acquired AA secondary to toxin / other drug (303)

then, specify the severity in question 447 as either Severe / Very Severe or Not Severe at the time of diagnosis using the following criteria:

  • Severe / Very Severe Requires two or more of the following1:
    • Bone marrow cellularity < 25% (or 25% to 50% if < 30% of residual cells are hematopoietic)
    • At least two of the following:
      • Peripheral blood absolute neutrophil count (ANC) < 500 / µL (<0.5 x 109/L)
      • Peripheral blood platelet count < 20,000 / µL
      • Peripheral blood reticulocyte count < 20,000 / µL
  • Not severe: Does not meet the criteria for Severe / Very Severe

1 Olson, T. S. (2019, July 18). Aplastic anemia: pathogenesis, clinical manifestations, and diagnosis. UpToDate. https://www-uptodate-com/contents/aplastic-anemia-pathogenesis-clinical-manifestations-and-diagnosis?search=aplastic+anemia&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H683870569.

Select Acquired AA secondary to chemotherapy only when a recipient develops acquired AA after receiving chemotherapy. See example below:

Example: A female recipient in her 50’s was diagnosed with Stage IV breast cancer and received dose-dense chemotherapy with doxorubicin and cyclophosphamide every other week, followed by weekly Taxol. After receiving four cycles, the recipient became neutropenic requiring red blood cell and platelet transfusions. The chemotherapy was discontinued but the blood counts remained low. After three months of persistent neutropenia, the decision was made to proceed with transplant and the recipient was diagnosed with acquired AA secondary to chemotherapy.

If the classification is not listed, select Other acquired cytopenic syndrome and specify the other acquired cytopenic syndrome in question 448.

Section Updates:

Question Number Date of Change Add/Remove/Modify Description Reasoning (If applicable)
446 – 448 10/13/2021 Modify The response criteria for severe / very severe was updated: Indicate the aplastic anemia classification of the primary disease for infusion. If any of the following classifications are selected:
  • Acquired AA, not otherwise specified (301)
  • Acquired AA secondary to chemotherapy (313)
  • Acquired AA secondary to hepatitis (302) (any form of hepatitis)
  • Acquired AA secondary to immunotherapy or immune effector cell therapy (314)
  • Acquired AA secondary to toxin / other drug (303)
    then, specify the severity in question 447 as either Severe / Very Severe or Not Severe at the time of diagnosis using the following criteria:
  • Platelets < 10,000 or platelet transfusion to maintain platelets ≥ 10,000
  • Hemoglobin < 10 g / dL or red blood cell transfusions to maintain hemoglobin > 7 g / dL
  • Absolute neutrophil count (ANC) < 1000 or on G-CSF to maintain ANC ≥ 1000
  • Absolute reticulocyte count (ARC) < 20 × 109/L
  • Severe / Very Severe Requires two or more of the following1:
    • Bone marrow cellularity < 25 % (or 25 % to 50 % if < 30 % of residual cells are hematopoietic)
    • At least two of the following:
      • Peripheral blood absolute neutrophil count (ANC) < 500 / µL (<0.5 x 109/L)
      • Peripheral blood platelet count < 20,000 / µL
      • Peripheral blood reticulocyte count < 20,000 / µL
Updated to be consistent with current criteria
Last modified: Oct 13, 2021

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