At first, reports claimed that Arafat was suffering from a blood disease related to a viral infection, cancer or blood poisoning. Two days later, Palestinian officials denied news that Arafat was suffering from leukaemia.

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Later, medical sources mentioned that Arafat was "brain dead", although officials also denied these reports. And, on Tuesday, his condition deteriorated to such an extent that he fell into a deeper coma, according to a time line released by the Agence France Presse.

Arafat's bone marrow 'worn out'
Dr Izak Loftus of Pathcare, one of the biggest pathology laboratories in South Africa, believes that Arafat's bone marrow was failing.

As reported on 29 October, Arafat's blood platelet count was dangerously low. Platelets are cells in the blood that help blood to clot. Most important, they clump together to plug small holes in damaged blood vessels.

A low platelet count is often associated with bleeding of the internal organs, like the brain and liver. Recent reports claimed that Arafat had brain haemorrhage.

"A very important point is the fact that he apparently was at a high risk of infection," Loftus says. Arafat was treated for a severe bout of flu on 24 October. A high risk of infection is often associated with a low white cell count.

"If it is only the platelet count that is low, you don't have any risk of infection. But if the platelet count is low and you are also at risk of infection, you have to consider the fact that the bone marrow is not manufacturing platelets, white blood cells and red blood cells," Loftus says.

Loftus pointed out that Arafat appeared to be very pale in his television appearances during the last few months. His paleness confirms the notion that he has been suffering from anaemia (a low red blood cell count) for at least a couple of months.

All these factors point strongly to bone marrow failure.

A closer look at possible causes
Possible causes of bone marrow failure include the infiltration of the marrow by tumours. These tumours may include leukaemia (white cell cancer), myeloma (a rare, cancerous condition in which plasma cells in the bone marrow proliferate uncontrollably and function incorrectly), lymphoma (cancer of the lymph nodes) and carcinoma (a cancerous tumour arising from cells in the lining membrane of an organ, for example the most common cancers of the lungs, breast, stomach, skin, cervix, colon and rectum). According to one of the statements, leukemia had been ruled out as a possible cause, but no explanation was provided.

Infiltration by abnormal fibrous tissue - associated with an illness called myelofibrosis - may also lead to bone marrow failure.

Bone marrow failure may also be due to the inability of the bone marrow to produce mature and efficient elements, so-called myelodysplastic syndrome.

Malignancy isn't the only possible cause of a reduction in blood-producing bone marrow cells. When other, "external" factors are at play, it is known as aplastic anaemia.

"This may be congenital (e.g. Fanconi anaemia – however, Arafat was too old for it to present itself now for the first time) or acquired (e.g. virus infection, radiation or exposure to drugs/toxins)," Loftus says. Some anti-cancer drugs, radiotherapy, and long-term exposure to insecticides or benzeen fumes may cause bone marrow suppression.

In 50% of cases, the reason for the reduced production of cells by the bone marrow is unknown.

"I think it might have been leukaemia/lymphoma with bone marrow infiltration, myelodysplastic syndrome or aplastic anaemia," Loftus says. – (Carine van Rooyen, Health24)
 

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