title: Incidence and risk factors of aplastic anemia in Latin American countries: the LATIN case-control study.
abstract: Background Associations between aplastic anemia and numerous drugs, pesticides and chemicals have been reported. However, at least 50% of the etiology of aplastic anemia remains unexplained.
  
  
  METHODS
  This was a case-control, multicenter, multinational study, designed to identify risk factors for agranulocytosis and aplastic anemia. The cases were patients with diagnosis of aplastic anemia confirmed through biopsy or bone marrow aspiration, selected through an active search of clinical laboratories, hematology clinics and medical records. The controls did not have either aplastic anemia or chronic diseases. A total of 224 patients with aplastic anemia were included in the study, each case was paired with four controls, according to sex, age group, and hospital where the case was first seen. Information was collected on demographic data, medical history, laboratory tests, medications, and other potential risk factors prior to diagnosis.
  
  
  RESULTS
  The incidence of aplastic anemia was 1.6 cases per million per year. Higher rates of benzene exposure (>/=30 exposures per year) were associated with a greater risk of aplastic anemia (odds ratio, OR: 4.2; 95% confidence interval, CI: 1.82-9.82). Individuals exposed to chloramphenicol in the previous year had an adjusted OR for aplastic anemia of 8.7 (CI: 0.87-87.93) and those exposed to azithromycin had an adjusted OR of 11.02 (CI 1.14-108.02). Conclusions The incidence of aplastic anemia in Latin America countries is low. Although the research study centers had a high coverage of health services, the underreporting of cases of aplastic anemia in selected regions can be discussed. Frequent exposure to benzene-based products increases the risk for aplastic anemia. Few associations with specific drugs were found, and it is likely that some of these were due to chance alone.
authors.affiliation: Centro de Pesquisa Clínica, Instituto Israelita de Ensino e Pesquisa Albert Einstein, Avenida Albert Einstein 627/701, Piso Chinuch, São Paulo (SP), Brazil.
authors.forename: Eliane
authors.initials: E
authors.lastname: Maluf
authors.forename: Nelson
authors.initials: N
authors.lastname: Hamerschlak
authors.forename: Alexandre Biasi
authors.initials: AB
authors.lastname: Cavalcanti
authors.forename: Alvaro Avezum
authors.initials: AA
authors.lastname: Júnior
authors.forename: José
authors.initials: J
authors.lastname: Eluf-Neto
authors.forename: Roberto Passetto
authors.initials: RP
authors.lastname: Falcão
authors.forename: Irene G
authors.initials: IG
authors.lastname: Lorand-Metze
authors.forename: Daniel
authors.initials: D
authors.lastname: Goldenberg
authors.forename: Cézar Leite
authors.initials: CL
authors.lastname: Santana
authors.forename: Daniela de Oliveira Werneck
authors.initials: Dde O
authors.lastname: Rodrigues
authors.forename: Leny Nascimento da Motta
authors.initials: LN
authors.lastname: Passos
authors.forename: Luis Gastão Mange
authors.initials: LG
authors.lastname: Rosenfeld
authors.forename: Marimilia
authors.initials: M
authors.lastname: Pitta
authors.forename: Sandra
authors.initials: S
authors.lastname: Loggetto
authors.forename: Andreza A Feitosa
authors.initials: AA
authors.lastname: Ribeiro
authors.forename: Elvira Deolinda
authors.initials: ED
authors.lastname: Velloso
authors.forename: Andrea Tiemi
authors.initials: AT
authors.lastname: Kondo
authors.forename: Erika Oliveira de Miranda
authors.initials: EO
authors.lastname: Coelho
authors.forename: Maria Carolina Tostes
authors.initials: MC
authors.lastname: Pintão
authors.forename: Hélio Moraes
authors.initials: HM
authors.lastname: de Souza
authors.forename: José Rafael
authors.initials: JR
authors.lastname: Borbolla
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pasquini
mesh_terms: D000293:Adolescent; D000328:Adult; D000380:Agranulocytosis / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D000741:Anemia, Aplastic / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D001555:Benzene Derivatives / Q000633:toxicity; D001853:Bone Marrow; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D001555:Benzene Derivatives