Environmental determinants of aplastic anemia in Pakistan: a case-control study

Abstract

AimAplastic anemia (AA) affects the Asian population two to three fold more than people in other regions. Besides the host genetics and socioeconomic status, several other environmental exposures have been linked with an AA etiology. We aimed to examine the association of various environmental exposures with AA occurrence among Pakistani individuals.Subjects and methodsA case-control study was conducted in Karachi, Pakistan, where cases (diagnosed AA patients) were selected from the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), while for each case, a single control (who was free of AA and visited the outpatient department of the same hospital for the treatment of minor ailments) was selected matched by age and sex. A total of 428 participants were included in this study with equal proportions of cases and controls. Information related to disease characteristics, sociodemographics and exposure to chemicals was collected through a survey questionnaire, laboratory investigations and medical records. Descriptive results were reported as frequencies and proportions, adjusted odds ratios with 95 % confidence intervals and population attributable risk (PAR) as percentage.ResultsAmong study participants (n = 428), AA was significantly associated with various environmental exposures. Participants residing in rural settings (OR = 2.29, 95 % CI 1.12–4.67, p-value < 0.01) and those who reported exposure to pesticides (OR = 3.58, 95 % CI 1.27–10.10, p-value 0.01; PAR = 18.16 %) were significantly more likely to report AA. Participants with a formal education were significantly less likely to have AA (OR = 0.27, 95 % CI 0.10–0.71, p-value < 0.01).ConclusionsThis study observed a significant association of aplastic anemia with a lower socioeconomic profile, and certain environmental exposures among the Pakistani population. The evidence may be helpful in understanding the pathophysiology of aplastic anemia in the context of environmental exposures.

Comparison of Conventional Cyclophosphamide versus Fludarabine-Based Conditioning in High-Risk Aplastic Anemia Patients Undergoing Matched-Related Donor Transplantation

“…On the contrary, the management of AA in developing countries is challenging. The prevalence of AA is higher as compared to the Western populations [ 22 ] and, yet, there is paucity of information regarding mutational profile and disease pathogenesis in this region [ 23 ]. Delay in diagnosis and referral, long waiting time before transplant, lack of finances, use of non-leuko-depleted blood products, family donations and recurrent infections pre-transplantation result in allo-immunization, GF, GVHD and increased risk of infectious and noninfectious complications.…”

Pesticides and Chemicals as Potential Risk Factors of Aplastic Anemia: A Case–Control Study Among a Pakistani Population

“…Only one case–control study highlighted the environment risk factors for AA in Pakistan. 4 There are limited studies conducted to provide evidence that environmental risk factors are associated with AA. Pesticides (organochlorine, organophosphates, carbamates and paraquat) are known risk factors for AA.…”

Seasonal variations in hematological disorders: A 10‐year single‐center experience

“…In developing country such as Pakistan, several determinants such as higher population density, and environmental factors have largely increased the burden of hematological malignancies 11,12 . By using the MeSH terms such as “seasonal variation in haematological disorders, seasonal tendencies in hematological diseases,” no study has been found from Pakistan in which seasonal variations of hematological disorders have been observed and in general no international study covered these five disorders.…”