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Blood, 15 February 2006, Vol. 107, No. 4, pp. 1299-1307.
Prepublished online as a Blood First Edition Paper on October 27, 2005; DOI 10.1182/blood-2005-01-0161.
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CLINICAL TRIALS AND OBSERVATIONS
The epidemiology of aplastic anemia in Thailand
Surapol Issaragrisil,
David W. Kaufman,
Theresa Anderson,
Kanchana Chansung,
Paul E. Leaverton,
Samuel Shapiro, and
Neal S. Young
From the Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; the Slone Epidemiology Center, Boston University, MA; the Department of Medicine, Faculty of Medicine, Khonkaen University, Khonkaen, Thailand; the University of South Florida, Tampa, FL; and the Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD.
Aplastic anemia has been linked to environmental exposures, from chemicals and medical drugs to infectious agents. The disease occurs more frequently in Asia than in the West, with incidence rates 2- to 3-fold higher. We report updated results of an epidemiologic study conducted in Thailand from 1989 to 2002, in which 541 patients and 2261 controls were enrolled. Exposures were determined by in-person interview. We observed significantly elevated relative risk estimates for benzene (3.5) and other solvents (2.0) and for sulfonamides (5.6), thiazides (3.8), and mebendazole (3.0). Chloramphenicol use was infrequent, and no significant association was observed. Agricultural pesticides were implicated in Khonkaen (northeastern Thailand). There were significant associations with organophosphates (2.1), DDT (6.7), and carbamates (7.4). We found significant risks for farmers exposed to ducks and geese (3.7) and a borderline association with animal fertilizer (2.1). There was a significant association in Khonkaen with drinking other than bottled or distilled water (2.8). Nonmedical needle exposure was associated in Bangkok and Khonkaen combined (3.8). Most striking was the large etiologic fraction in a rural region accounted for by animal exposures and drinking of water from sources such as wells, rural taps, and rainwater, consistent with an infectious etiology for many cases of aplastic anemia in Thailand.
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