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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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Submitted January 13, 2005
Accepted July 26, 2005
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
Department of Medicine, Faculty of Medicine, Sirriraj Hospital, Mahidol University, Bangkok, Thailand
Slone Epidemiology Center, Boston University, Boston, MA, USA
Department of Medicine, Faculty of Medicine, Khonkaen University, Khonkaen, Thailand
School of Public Health, University of South Florida, Tampa, FL, USA
Hematology Branch, National Heart , Lung, and Blood Institute, Bethesda, MS, USA
* Corresponding author; email: sisis{at}mahidol.ac.th.
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 2-3-fold higher. We report updated results of an epidemiological study conducted in Thailand, 1989-2002, which enrolled 541 patients and 2261 controls. 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 rural Thailand.
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