Differentiation of Yin, Yang and Stasis Syndromes in Severe Aplastic Anemia Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation and Their Correlation with Iron Metabolism, cAMP/cGMP, 17-OH-CS and Thyroxine

Objective To better understanding and differentiation of traditional Chinese medicine (TCM) syndromes in severe aplastic anemia (SAA) patients undergoing hematopoietic stem cell transplantation (Allo-HSCT) and their correlation with iron metabolism, cAMP/cGMP, 17-OH-CS and thyroxine. Methods Eighteen patients with SAA who underwent HSCT were enrolled. The syndrome was evaluated before conditioning and days after stem cell reinfusion (-10d, -1d, +7d, +30d, +60d, and +90d). The correlation of TCM syndrome (Yin, Yang, and stasis) to cyclic nucleotides, 17-OH-CS, thyroxine, and iron metabolism were analyzed and compared to data from normal subjects. Results More "Yin deficiency" (n=11, 11/18) syndrome was observed before HSCT, and nearly 61% was complicated with "blood stasis". After conditioning, the proportion of "kidney Yin and Yang deficiency" increased to 61.6%. Fourteen days after HSCT, the syndrome developed into "Spleen-Kidney Yang Deficiency," and the stasis score decreased. On +90day, majority patients were diagnosed with "Kidney Yang Deficiency" (35.7%) or "Spleen-Kidney Yang Deficiency" (28.6%), and 88.9% were diagnosed without stasis. The correlation analysis showed that cGMP might represent "Deficient Yang" as well as low total triiodothyronine (T3) and free T3 (FT3). There was also a positive relation between labile plasma iron (LPI), hepcidin, soluble transferrin receptor (sTfR), and "Yin deficiency", and the last two factors, along with marrow nitric oxide synthase were also positively related to "Stasis" syndrome. Conclusion During HSCT, the syndrome evolved from "kidney Yin and Yang deficiency" to "kidney Yang deficiency" or "spleen-kidney Yang deficiency", and the "stasis" along with "Yin deficiency" syndromes were quickly relieved within 90 days. The changes of cyclic nucleotides, 17-OH-CS, thyroxine, and iron metabolism indexes can be applied for better differentiation of TCM syndrome.