22 May 2020

Sickle Cell Anemia, Aplastic Crisis, Aplastic Anemia and a Virus

Bone Marrow Diseases (AA&MDSIF designation) Awareness Ribbon
I had a younger cousin who, when we were barely entering teen years, lost a gallant battle with aplastic anemia that had lasted a few very long years.  His father being in the Navy from which he eventually retired, the Navy covered the cost of treatment which included increasingly long hospital stays.  Ronnie was kept aprised and knew as much about his condition and treatment as the team treating him, more in some cases associated with the specific hospital care he required.  He was going to be a physician if he lived.  I still vividly recall the day of our Grandfather's funeral when all of us cousins took a walk to Grandpa's woods and sat around quietly on stumps for a while, in reverie, before returning to the house.  Ronnie broke the silence, calmy and quietly stating that he was going to die - and did approximately nine months later.

After nearly 40 years in which we never spoke of Ronnie, his brother finally talked to me about him.  The illness and loss had caused deep sorrow in the entire extended family.  He told me that the protocol created to treat his brother eventually resulted in the first successful effort to prevent a patient's death from Aplastic Anemia.  He also said Ronnie's medical records are still studied by medical students and fill up an entire room.  Additionally, he said that flexible IV containers were created to replace the bottles, initially, because of the demands of Ronnie's treatment.  Ronnie had needed  numerous and repeated blood transfusions for two years. 

My cousin finally seemed at peace with that part of his life that had been a widely share grief.  And it was an amount of closure for me.  Even though Ronnie did not live to become a physician, that he had more or less been the successful "test case" at the center of and focus of a team which finally created a successful treatment,  means that because of the suffering he endured which caused extensive grief for so many including those who studied the case and treated him, people have since been able to regain their health from a condition patients did not recover from in the past.  Until then I had only known that Ronnie had been treated at a Spokane Hospital (Sacred Heart, where my life had be spared, twice before age 2 1/2), and that the Navy and covered the cost of treatment.  In later years I learned that Walter Reed Army Hospital had become renown for treating Aplastic Anemia.

Additionally, until I read this relative short article a few months ago,"Aplastic Crisis", I was unaware in what ways Aplastic Anemia is connected to and similar to Sickle Cell Anemia, other than both being blood disorders.  It looks like they are very closely connected, even though they are each a result of differing causes.  It looks like Sickle Cell can be exacerbated by a virus, and that a virus could be the cause of Aplastic Anemia which, from what the article, says seems to be a permanent aplastic crisis that does not resolve on its own and then requires much more complex treatment. The article states that what causes an aplastic crisis is usually a virus, commonly Parvovirus B19, but that "other viruses besides parvovirus can cause an aplastic crisis."  The article makes the connection clear - at least clear enough for me have learned more - enough more to have new questions in place of the long-term old questions. 

Apparently a temporary "aplastic crisis" is a HUGE problem for folks with sickle cell anemia.  This article provides insight into the problem of an aplastic crisis.  Given the fact that people without Sickle Cell can also experience an aplastic crisis, and the fact that  a virus can create problems for people with Sickle Cell by causing an aplastic crisis, it seems possible to deduce that a virus can induce an aplastic crisis in anyone, in conditions where the immune system has been weakened, whether or not a person has Sickle Cell.  It may even be possible to extrapolate that long term effects of a virus being present could cause a condition of permanent aplastic crisis in anyone, or something like it perhaps in those with Sickle Cell who would suffer from the problem much sooner than most. 

Labeling of the medical condition as "Aplastic Anemia" suggests, to me at least, that it could be considered a permanent aplastic crisis.  Like Aplastic Anemia a permanent aplastic crisis would require much more complex and extensive treatment efforts to  attempt to undo the damage and restart the normal bodily processes which create healthy red blood cells.  I do not know if the protocol that was a result of my cousin's condition can be and is used, in some revision or another, for extreme cases of Sickle Cell, but it seems reasonable to imagine so, depending on the severity of the Sickle Cell case, that it would be and has been, whether or not there has been an episode of aplastic crisis from which a person with Sickle Cell has recovered.

That this came to my attention in current time and place several months ago, connecting it to current issues seems called for even though "a virus" is ubiquitous terminology.  Even so, it suggest to me that it would be wise for the medical field, for everyone, actually, to be vigilant about the possibility of unexpected "novel corona virus", CoVid-19, side-effects, some of which seem to already be more common in children.  In the "better safe than sorry" category, seems to me it would be advisable to be vigilant about the possibility of aplastic crisis as a later side effect of Covid-19, in some, especially in those who may be more immunocompromised at times - thus more at risk - like people with Sickle Cell Anemia.