Cancer of the Blood

“Have a seat, sir.  Someone shall be with you in a moment,” stated the secretary as she handed me my insurance card with a smile on her face.  I sat waiting for my name to be called to get my blood drawn.  My legs shook nervously, for the unknown is a scary place; the waiting is the worst part.  I fiddled with the magazines already knowing that nothing was going to interest me or hold my attention.
“Luke O’cyte.”
Oh God, here goes nothing, I thought to myself.  I stood up and felt the blood rush from my head; a slight dizzy spell, that’s all.
She directed me to the room and sat me in the chair while she wrapped my bicep with a rubberband.  Cleaning my arm with an alcohol swab, she began with the small talk.
“You’ve got some nice veins.”
“Thanks?”  I felt bad for being short with her, but I was tired and irritated.
I cringed as I watched her poke the needle into my vein.  The blood filling up the tube, I began to fill dizzy.  I turned my head.
“All done.  You feelin’ alright?”
“Yeah”, but I didn’t.
“Just keep this cotton on here for about 20 minutes or so.”
She then instructed me to have a seat in the waiting area and that the nurse would be calling me in shortly.  After about 10 minutes of sitting there, I noticed the cotton was almost saturated with blood.  That is a lot of blood for a little stick, I thought to myself.  Once again my attention was drawn to the pile of magazines on the table.  I was just picking up the six-month old edition of People Magazine, when I heard my name called.
After the walk to the exam room, I noticed I was a little winded.  The nurse turned towards me and mentioned something about my color.
“You’re awfully pale.”
Being the humorous individual that I am, my response was, “It’s winter and I’m polish.  My fair skin comes naturally.”
“No, I don’t mean that kind of pale, but we’ll see what the doctor says.  Your blood results should be in soon.”  Her eyes glanced down at the crimson cotton ball, “You didn’t stop bleeding yet?  Hmm…”
The door closed behind her.  A sense of despair came over me.  Maybe there really is something wrong, I thought.  I have had a lingering cold and I got short of breath easily, even if I was just climbing the stairs.  I laid back on the examining table and let out a sigh.
I heard a knock at the door, “Come in.”
In came this huge man with shoulders as wide as a refrigerator.  He extended his hand to me, “Doctor Neutro.  Phil Neutro.  Nice to meet you Mr. O’cyte.”  He noticed the blood-soaked cotton as I was shaking his hand.
“Looking at your blood counts, it seems that they are below normal.  Now we have to find out why that may be,” he stated with a concerned look on his face.  “We’ll start with a few questions about your occupation.”
“Alright, I’m employed as a city crew worker.  I cut grass.  I tar pot holes.  I spray weed killer.  I paint.  Just about everything they tell me to do, that’s what I do.”
“That’s interesting.  Do you wear any protective gear, such as masks, gloves, respirators?  Are you aware of the chemicals that you’re working with before you work with them, so that you know how to protect yourself?”
“Well, I never really thought it was a big deal.  We were never instructed that we had to wear any of that stuff.”
“Based on what you’re telling me Mr. O’cyte, the reason for your counts to be this low could be from your exposure to benzene.”
“What kind of chemical is that?”  I asked the doctor.
“Benzene is a chemical that is used in the production of plastics, oils, and pesticides.  It has been known as a carcinogen, a cancer causing agent.”
Cancer?  I started to get scared and anxious, “How long will it take to figure out what’s wrong?”
“We’ll start with a bone marrow biopsy.  A needle is inserted into your hip bone to pull out some bone marrow.  We then study the marrow to see whether it is normal or not.  It will also help us in the process of diagnosing you.  I would like to do a biopsy now, because your counts are very low.  The sooner we can do this, the sooner we’ll know what’s wrong, and the sooner we can treat you.”
Four hours later…
“Well Mr. O’cyte based on our preliminary findings, we have determined that you have severe aplastic anemia.”
“What the hell is that?!”  I began to panic.
“Aplastic anemia is a blood disorder that affects the bone marrow, which is the blood factory of your body.  Your bone marrow is not making enough red blood cells, white blood cells, or platelets.  Which would explain your fatigue, lingering illness, and failure to clot properly from your blood draw.  We also are confident in saying that based on the work that you do and for the number of years you have worked there, your illness was caused by benzene exposure.  Unfortunately, because you were not removed from the exposure immediately, your bone marrow has been damaged significantly.”
“I have never heard of this before!  Is it common?!”
“Years ago, I would say no it’s not common.  In the past year, we have diagnosed seven different patients with this disorder.  Due to occupational exposures to chemicals, such as benzene, which is commonly used in pesticides and herbicides, we have seen this disease on the rise.  On the plus side, please be aware that research has come a long way and we have been very successful with getting people into remission using different protocols.”

Blog Entry #16

I think the main concern about the novels is to take what you learned from the research you conducted and use it to create a story to support the answers to your research question.

Free Writing

Cancer of the Blood

I am going to write a narrative piece either about my father being diagnosed with aplastic anemia after the exposure to benzene in his workplace, or creatively write a narrative about a character who is diagnosed with aplastic anemia through environmental exposure to chemicals.

Which idea am I going to use?

I think it would be easier to create a piece using a narrative on my father, just because I’ve been there, done that.  But on the other hand, I think it would be a lot more entertaining to myself if I used another character.  Considering my other workloads in other courses, I’m probably going to go for the narrative on my father.  I could also base the story around my father/family, but create other characters.  The difficulty in this whole process had started around mid-term.  I have no clue what else to write.  I was also thinking about writing a piece based on a doctor/patient point of view.  I honestly still have no clue yet.  I don’t feel like free writing anymore.  I don’t have anything else to say, and we still have 7 minutes to keep writing.  I have no clue if I’m going to use the title mentioned above.  I guess it sounds kind of interesting, but I think I could do better.  Being put on the spot doesn’t really help me in thinking creatively.  Six more minutes.  I don’t know what to write about.  I don’t enjoy free writing.  I’m annoyed.  Five more minutes.  A sentence a minute.  If I type really slowly, I could make it work.  I’m still confused on how we’re supposed to create a piece based on our research.  But my question about how we incorporate our research into our paper has been answered.  I think maybe once I sit down and start writing that it will turn out fine.  I’m just still confused on what I want to do.  Base a story on my father?  Base a story on a character?  Base a story on diagnosing a patient with aplastic anemia?  Actually the last one doesn’t sound like a bad idea.  Three minutes.  Oh my God.  I seriously can’t think anymore.  I find the sound of a keyboard being typed on to be amusing.  Two more minutes.  Yes.  Okay, what else can I write about?  The idea of a doctor diagnosing a patient with aplastic anemia could be a really good story.  That way I would have to incorporate some of my research because most cases of aplastic anemia are caused by something unknown.  One more minute.  Come on 2:10.  Let’s go. 

Blog Entry #15

The important part of creating your novel is to turn your research question into reality. It is important to include the answers to your research question. It is also important to include specific facts that support or falsify your research.

The research part is already done. You should be able to take the research from your paper and use it to create a story. The creative novel is not just fact-filled, but it includes creativity as well. The research paper was designed to take a question and prove or disprove it through your research.

Whether your question was supported or not, the novel should reflect that. You can accomplish this by creating a story and using the facts of your paper in your novel.

Blog Entry #14

Without reading the novels we were assigned to read in class, creating a novel out of our research would have been more difficult. The books helped to provide examples of how we could create using our research. Using research to create a novel takes a different approach.

If the research weren’t present, it would have been difficult to create a story. The information from the research paper aids in making our novels more realistic and believable. One cannot just create a story out of nowhere incorporating false information. The authors of the books we have read did not just write a novel based on their own knowledge, but based on their own research as well.

Blog Entry #13

Based upon the evidence from the research that I have collected, I have decided to create a story about the risk of developing aplastic anemia in occupational environments. One of the characters names’ is Luke O’cyte. I have chosen this as his name because a leukocyte is a white blood cell. The other character’s name is Phil Neutro, because of the neutrophil is a type of blood cell.

Luke is employed at a city garage where he is exposed to the chemical benzene. Benzene is a major risk factor that could possibly cause aplastic anemia. The setting is in a hospital where Luke takes a blood test and gets a bone marrow biopsy. A point to get across in my creative novel is that aplastic anemia has become more common than it was a few years ago. While my father was in the hospital, two patients were admitted with aplastic anemia.

I. Introduction of main character

a. waiting to get blood drawn.

II. Introduction of symptoms

III. Introduction of doctor and diagnosis

IV. Introduction of prevalence of aplastic anemia.

V. Conclusion

Aplastic Anemia: The Disease of the Future

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Chelsey Fal                                                                                                                    Marlen Harrison

English 202, Section 016

31 March 2008

Aplastic Anemia:  The Disease of the Future

At the time, I was in fifth grade, around the age of 11.  I remember watching my mom run to the garage with the phone in her hand.  My father had just arrived home from getting his hair cut.  There was a doctor waiting to talk to my father about a recent blood test he had.  The doctor directed him to get to the nearest hospital as soon as possible; his blood counts were dangerously low.

Coping with a rare disease such as aplastic anemia is not an easy task. The hardest part to deal with is finding out what causes the disorder. I have not been diagnosed with the disorder, but my father has. The doctors believed the cause of his diagnosis was due to the exposure of benzene, a cancer causing agent, within his occupational environment. My father worked for the City Garage in Monessen, Pennsylvania.  He has told me stories of rolling blacktop and spraying pesticides without proper protection from the exposure to the chemicals in these certain agents.  I find that there is significant importance to knowing about the risks of developing aplastic anemia through occupational/environmental exposure.  How could these occupational/environmental exposures to certain chemicals lead to the prevalence of aplastic anemia in the future?

Aplastic anemia is a non-contagious, rare blood disorder that hinders the production of blood cells in the bone marrow.

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Aplastic anemia is considered a bone marrow failure disease.  Bone marrow is located in the center of the bone and produces three types of blood cells. Red blood cells transport oxygen throughout the body. White blood cells help to fight infections. Platelets are involved in the process of clotting the blood.  This means the person is often fatigued, very susceptible to infection, and can possibly bleed to death due to injuries.  Bone marrow stem cells transform into red cells, white cells, and platelets (Young, 1). Doctor Neal Young states, “In aplastic anemia, there are not enough stem cells in the bone marrow to produce a sufficient quantity of blood cells” (2).  Aplastic anemia is an autoimmune disorder, meaning that the individual’s immune system attacks its own cells (Young, 2).

There are two types of aplastic anemia, acquired and hereditary.  The discussion of hereditary aplastic anemia is not important for this research.  Acquired aplastic anemia means that the disease developed due to an exposure to something, but in most cases, the cause is unknown.

Aplastic anemia can be classified as moderate, severe, and very severe.  These three criteria developed by Dr. Bruce Camitta are still used by most doctors (Young, 2).  Moderate aplastic anemia is classified by low blood counts.  One or more cell type counts may decrease.  Doctors may not prescribe treatment, but will monitor blood counts.  Moderate aplastic anemia may not be discovered until it develops into severe aplastic anemia.  Severe aplastic anemia is classified by a bone marrow cellularity of less then 25 percent.

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It is also classified by a neutrophil count less than 500 cells per micro liter, a platelet count less than 20,000 per micro liter, or a reticulocyte count less than 20,000 per micro liter.  The American Cancer Society defines neutrophils as a type of white blood cell that helps to fight infection.  Wordnet 3.0 defines reticulocytes as immature red blood cells.  Very severe aplastic anemia is classified by a neutrophil count of less than 200 per micro liter.  Below is a table taken from an article written by Elaine Keohane (168):

Table 1. Classification of acquired aplastic anemia

Non-severe aplastic anemia (NSAA) or moderate

aplastic anemia (MAA)

Presence of” at least two of the following:

Hemoglobin < 10 g/dL

Platelets: 20-50 X lO’VL

Neutrophils 0.5-1.5 X 107L

Severe aplastic anemia (SAA)

Bone marrow cellularity <25%, or 25% to 50%

with <30% residual hematopoietic cells, and

presence of at least two of the following:

Neutrophils <0.5 X 107L

Platelets <20 X 107L

Reticulocytes <20 x lO’VL

Very severe aplastic anemia (VSAA)

Includes criteria of SAA plus:

Neutrophils <0.2 X 107L

166 VOL

Table 1 helps to simplify the blood counts in order to compare how moderate or severe the disease is.  Based upon the severity of the disease is how doctors approach the treatment.

My father was changing.  He was always tired and irritated.  He did not know what was wrong with him.  He had always been in shape and healthy.  We were unaware of the awful news that was about to be broken to us.  When my father was diagnosed with aplastic anemia, the doctors referred it to aplastic anemia as a “cancer of the blood.”

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Dr.  Young describes the symptoms of aplastic anemia as increased bleeding, bruising, susceptibility to infections, and shortness of breath, fatigue, decreased alertness, shortened attention span, pale skin, dizziness, and lingering illness (3).  To diagnose this disease, doctors will first review the patient’s symptoms and history, including possible exposure to toxins and other risk factors.  The doctor then needs to obtain a complete blood count by drawing blood from the patient.  A complete blood count is a test that “gives a profile of all the components of the blood” (Young, 3).  This test allows doctors to compare the counts of the patient to the counts of accepting standards.  If the blood counts are lower than normal, this may be a sign of aplastic anemia.

The doctor then needs to examine a sample of the patient’s bone marrow to diagnose the disease.  This procedure can be done by a bone marrow aspiration or a bone marrow biopsy.  Dr. Young describes how the procedure is performed; a needle is inserted into the back of the pelvis bone near the hip (4).  During a bone marrow aspiration, a small amount of bone marrow is sucked into a syringe through the needle.  This procedure provides information on the presence or absence of abnormal cells.  During a bone marrow biopsy, a small piece of bone marrow is pulled out with the needle.  This procedure is the most reliable in regards to information on the bone marrow cellularity.  In aplastic anemia, the bone marrow cellularity is usually reduced.

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Fig. 1.  Randy Ramage.   Aplastic Anemia & Myelodysplasia (http://www.citylightsnews.com/randy/glossary/glossary_b.htm).

Figure 2.  Randy Ramage.   Aplastic Anemia & Myelodysplasia (http://www.citylightsnews.com/randy/glossary/glossary_b.htm).

Figure 1 is a picture of a person’s bone marrow without aplastic anemia.  Figure 2 is an individual’s bone marrow affected by aplastic anemia.  Notice the absence of blood cells in Figure 2 as compared to Figure 1.

Rod De Llano’s aplastic anemia information site discusses some of the risk factors of developing aplastic anemia.  Excessive exposure to these agents may lead to the development of aplastic anemia arsenic and compounds, benzene, calcium arsenate, glycol ethers, heptachlor, lindane, 2-methoxyethanol, plutonium, radium, and 2, 4, 6-Trinitrotoluene.  High risk jobs include adhesive production, barge workers, chemical workers, dock workers, gasoline distribution workers, industrial plant workers who use solvents, newspaper press workers, offshore workers, painters, paper and pulp employees, pesticide manufacturers, pipe fitters, printers, refinery workers, rubber

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workers, shoe/leather workers, synthetic rubber producers, tanker men, and truck drivers.

The Agency for Toxic Substances and Disease Registry defines arsenic as an organic compound released from the earth’s crust.  Arsenic can be measured by a urine test, which is the best way to find arsenic in the body.  Dictionary.com states that calcium arsenate is highly toxic and used in insecticides and germicides.  Below is a table taken from an article written by Elaine M. Keohane (166):

Table 2. Agents infrequently associated with acquired aplastic anemia

Occupational and environmental exposures

Benzene

Insecticides

Petrochemicals

Lubricating agents

An article written by Garry Crystal discusses benzene.  Benzene has been linked to the development of aplastic anemia.  Benzene is an organic chemical compound with a sweet smell.  It is a colorless, flammable liquid.  Benzene is used in the production of plastic, oil, synthetic rubber, and in many dyes.  It is a carcinogen, a cancer causing agent, in cigarettes.  Benzene is also used in the manufacturing of drugs, detergents, and pesticides.  “In the United States, the maximum amount of benzene permissible in water is 0.005 milligrams per liter” (Crystal, 2003).  To test if an individual has been exposed to benzene, a blood test needs to be taken.  The test must be performed shortly after exposure, because the chemical does not stay in the body’s system for very long.

It is very important to state that the incidence of aplastic anemia is higher in the Far East than that of the incidence in the West.  Research has not found a definite answer as to why this is, but it may be caused by a few different factors such as, socioeconomic status, rice farming, and pesticide use.

Large numbers of aplastic anemia cases have come from hospitals located in

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China, Korea, Thailand, and Asia (Issaragrisil, et. al., 1).  The prevalence was significantly high in the specific location of the Mudanjiang region of China, as well as in certain populations of people, such as, industrial workers in Japan (Issaragrisil, et. al., 1).  Aplastic anemia is diagnosed in about 500 people in United States every year (Young, 1); approximately two cases per million occur in North America and Europe (Keohane, 165).

The incidence of aplastic anemia is high in Thailand, “where many drugs can be purchased without prescription and pesticides are widely used” (Issaragrisil).  A similar case-control study conducted by the International Agranulocytosis and Aplastic Anemia Study in Thailand is replicated.  Issaragrisil and his team report a new association with grain farming and a separate association with pesticide use that does not explain the finding for grain farming.  Since January 1989, the study has been in progress in Bangkok, where the population is 8.75 million (Issaragrisil, et. al).  In November 1991, the study was expanded to the province of Khonkaen, where the population is 7.64 million, and to Songkla, population is 4.99 million.  The aim of the study is to include all cases occurring in those regions.  The case patients admitted to the hospitals in these areas were chose by regular contact with hematologists or other physicians.

The case patients had to meet at least two of the following criteria: a white blood cell count of 3.5 X 109/L or lower, a platelet count of 50 X 109/L or lower, and a hemoglobin level of 100 g/L or lower or hematocrit level of 30 percent or lower.  A further criterion was a reticulocyte count of 30 X 109/L or lower.  The case patients had to be diagnosed by a bone marrow biopsy.  Patients given chemotherapy or radiotherapy were not included in the study.

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The control patients, four or more, were selected for each case patient.  The control patients were selected of the same sex and around the same age as the case patients.

The subjects were given a standard structured interview by physicians or nurses that solicited demographic data, relevant medical history, and details of drug and pesticide use and exposure to radiation and chemicals.  There were 284 case patients and 1174 control patients from Bangkok, Khonkaen, and Songkla.  The ages ranged from under 25 to 60 or older.  Farmers were categorized in two different groups, grain farmers and those who farmed other crops.  Agricultural pesticide exposure that occurred one to six months before hospital admission was studied.

The assumption was that the grain farmers who used pesticides would have a higher risk and incidence.  The annual risk estimation was six cases per million grain farmers.  Other farming types, such as fruit or vegetables, the risk was less common.  There fore, grain farmers are at a higher risk of developing aplastic anemia.  The prevalence of aplastic anemia was not linked to the exposure of pesticides.  Issaragrisil suggests that the correlation between aplastic anemia and grain farming may explain the prevalence of aplastic anemia in Thailand.  Research should be conducted on the specific exposures among grain farmers; agents in the water and soil, insect vectors, poor sanitation, flooded fields.

An interview-based case-control study in Great Britain was conducted by the United Kingdom Aplastic Anemia Study.  Consultant hematologists recruited cases that were diagnosed between July 1, 1993 and October 20, 1997.

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Research based on the hypothesis of aplastic anemia being caused by occupational/environmental factors attempts to explain the correlation between occupations that involve being exposed to chemicals that can cause aplastic anemia. The United Kingdom Aplastic Anemia study was interview based and was a case control study of those diagnosed with aplastic anemia located in Great Britain. The study concluded that there was an increase in the risk of those associated with occupational exposure. Two hundred patients out of 309 cases that were eligible ended up being interviewed. The study concluded a high risk to those exposed to radiation and pesticides in the workplace.

Aplastic anemia is diagnosed in about 500 people in the United States every year; approximately two cases per million people per year (Young, 1-2). Although it is a rare disease, it can target anyone of any age, race, or gender (Young, 2). The unusual aspect of this disease is that the cause of it is commonly unknown, approximately 60 to 75 percent (Young, 2) of the cases (Carson-Dewitt). There have been certain factors that are linked to developing aplastic anemia. These factors include exposure to radiation, certain drugs, or chemicals. High doses of radiation and cytotoxic chemotherapy can produce aplastic anemia (Young, 2). Cytotoxic is defined as something that is a threat at destroying certain cells (Young, 19).

I do not have access to aplastic anemia research centers where I can study or interview patients with this disease.  I do have knowledge of the disorder being influenced by excessive exposure to specific agents in the occupational environment itself.  How?  My father was employed at the Monessen City Garage in Pennsylvania.

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He was overly exposed to the chemical benzene without taking any precautions.  This research paper will discuss the likelihood of the prevalence of this disease in the future based upon the observations of research on occupational/environmental exposure to certain agents.  I will email my father’s hematologist and ask her of her opinion on the current prevalence of aplastic anemia.  I will ask her a few questions:  1. When did you first encounter a patient with aplastic anemia?  2.  How did you react?  3.  Was it difficult to diagnose?

To demonstrate how rare the disorder is, research will be done by comparing the population of those with this disorder located in the Western region as to those in the Eastern region of the world. Aplastic anemia is two to three times more common in Asian countries (Young, 2). By researching the certain chemicals linked to aplastic anemia and what environments they can be found, I will help to prove that the increasing use of these chemicals could lead to the occurrence of aplastic anemia in the future.  I will discuss with my father how it felt to be diagnosed with such a rare disease.

When I emailed my father’s hematologist I asked her three different questions.  The first question I asked her was, “When did you first encounter a patient with aplastic anemia?”  She responded that the first person she encountered with aplastic anemia was not a patient, but a friend that she went to high school with.  (Aplastic anemia starts to seem rather unrare to me after hearing that.)  Her friend ran on the track team.  Unfortunately, at that time, there was not any treatment and he passed away.  This encounter is what led her to become interested in medicine, which answered my question to her of how she reacted.

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She also responded that her first patient with aplastic anemia was diagnosed about 15 years ago.  She is a hematologist, which is defined as which is a doctor who studies the blood and blood-producing organs by Merriam-Webster Dictionary, such as the bone marrow.  Aplastic anemia was not difficult for her to diagnose at the time, since the bone marrow malfunctions in producing the blood.

My father was diagnosed with aplastic anemia about 10 years ago.  His doctors had a difficult time figuring out what was wrong with him.  They had performed stress tests, electrocardiograms, but never drew any blood.  The last test they performed on him was a blood test.  The results came back showing his blood count levels were extremely low and he was rushed to the nearest hospital.  They were unable to specifically prove that the exposure to benzene had caused aplastic anemia to develop because it hardly showed up in his blood results.  My father had continued to work at the City Garage while the disease continued to progress and as he was undergoing tests to figure out what was wrong.  His hematologist says it is safe to assume that if the detection of benzene in his system would have been sooner than what it was, he probably would have recovered.  My father described his job as rolling blacktop and spraying pesticides without any form of protection.  Unfortunately, it took his diagnosis to lead the City Garage in taking caution when using chemicals.

Could aplastic anemia develop into the disease of the future?  It is rather possible.  My father is an example of one of the two people per million in North America who was diagnosed with aplastic anemia.  There is not a direct link between environmental and occupational exposures to the specific agents discussed in this paper.

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There is a correlation between the specific agents and the risk of developing aplastic anemia due to excessive exposure though.  If proper precautions, such as wearing the correct clothes or some sort of apparatus to hinder breathing in these agents are not taken, the risk of aplastic anemia is significantly higher.  Perhaps further research needs to be conducted to determine the incidence ratios of the Eastern countries and the Western countries.

He was changing again.  He was sick for a few months and would not go to the doctor in fear that something would be going wrong.  At the beginning of March 2008, my mother rushed him to the emergency room.  A few days later, he was diagnosed with Acute Myelogenous Leukemia.  Not only can aplastic anemia be a deadly disease but it can lead to other diseases.  My father is putting up one hell of a fight.  After one week of chemotherapy, the doctors found that there are not any cancerous cells in his bone marrow or his bones.

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Works Cited

Arsenic.  Agency for Toxic Substances and Disease Registry.  Atlanta, GA: 5 Oct. 2007.

<http://www.atsdr.cdc.gov/tfacts2.html#bookmark02>.

Calcium Arsenate.  Dictionary.com. Lexico Publishing Group, LLC: 2008.

<http://dictionary.reference.com/browse/calcium%20arsenate?r=14>.

Carson-Dewitt, Rosalyn.  “Aplastic Anemia.”  HealthAtoZ.  8 Fed. 2008.

<http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?req

uestURI=/healthatoz/Atoz/ency/aplastic_anemia.jsp>.

Issarigrisil, Surapol, et. al.  “Aplastic Anemia in Rural Thailand.”  American Journal of

Public Health.  Sept. 1997: Volume 87, Issue 9.

Issarigrisil, Surapol, et. al.  “Regional Patterns in the Incidence of Aplastic Anemia in

Thailand.”  American Journal of Hematology.  3 March 1999: Volume 61.

Issarigrisil, Surapol, et. al.  “The epidemiology of aplastic anemia in Thailand.”  The

American Society of Hematology. 15 Feb. 2006: Volume 107.

Keohane, Elaine.  “Acquired Aplastic Anemia.”  American Society of Clinical

Laboratory Science.  Summer 2004: Volume 17.

Muir, K. R., et. al.  “The role of occupational and environmental exposures in the

aetiology of acquired sever aplastic anemia: a case control investigation.”  British

Journal of Hematology.  Dec. 2003: Volume 123.

Neutrophil.  American Cancer Society.  22 Jan. 2008.

<http://www.cancer.org/docroot/GRY/GRY_0.asp?dictionary=&pagKey=N>.

Ramage, Randy.  Aplastic Anemia & Myelodyplasia Glossary.  13 March 2008.

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< http://www.citylightsnews.com/randy/glossary/glossary_b.htm>.

Reticulocyte.  Wordnet 3.0.  Princeton University: 2006.                                                           <http://wordnet.princeton.edu/perl/webwn?s=reticulocyte>.

Young, Neal.  Aplastic Anemia: Basic Explanation.  AAMDS: 2007.

Young, Neal.  “Acquired Aplastic Anemia.”  Annals of Internal Medicine.  2002:

Volume 136.

Blog Entry #12

    I really enjoyed this class.  I’m not a big fan of research writing, but who is?  I feel that Marlen made this class so much fun!  He has an awesome personality and he definitely knows his stuff.  He’s well aware that research writing isn’t fun, as a matter of fact, it sucks!  If I were in any one else’s class I don’t think I would have enjoyed writing my paper as much.

I didn’t think I was nearly done with my paper, until Marlen told me otherwise.  I felt so relieved that I didn’t have to work on my research paper as much over break.  A lot of obstacles have come my way over the past few weeks, and they are all related to my paper.  My paper is based on the disease my dad was diagnosed with about 10 years ago.  Just recently, he was diagnosed with acute mylelogenous leukemia.  He’s just finishing his first week of chemotherapy.

All in all, I feel I learned a lot from this class thus far.  Not only from Marlen, but from my peers as well.  I’ve enjoyed reading the variety of topics of my peers papers.  I’m also looking forward to the creative stories we have to write.

Blog Entry # 11

I really enjoyed this course thus far.  I find Marlen to be humorous and very knowledgeable!  I have learned how to read other people’s writing without being entirely critical.  Which I feel is more important than reading critically.  It is essential to put yourself in the writer’s perspective and completely understand what they are trying to portray to the reader.  If you can’t do that, than the paper isn’t properly written.  I feel that there is more lee-way with the blog entries being submitted online.  Not that I’m complaining about that.  But I would definitely have them completed if I had to turn them in.  I hope to gain a better understanding of responsibility and punctuality out of this course.

Blog Entry # 10

Some changes that my peers have suggested is to add charts. I feel that I may do this, because in most of the peer reviewed articles that I am reading, they have also included charts. I will include charts to clearly explain the differences between blood cell counts and the severity of aplastic anemia.

I will also include pictures of what a healthy individual’s bone marrow looks like, compared to that of an individual’s bone marrow with aplastic anemia. I have some terms that I still need to define more clearly. I would like to include more of my personal experience to the paper.