Difference between revisions of "Rakta dhatu"
(→Physiological effect of various tastes on blood:)
|Line 371:||Line 371:|
Shonitavarnaniya Adhyaya[Su. Sam. Sutra Sthana 14]
Shonitavarnaniya Adhyaya[Su. Sam. Sutra Sthana 14]
=== External links ===
=== External links ===
Revision as of 18:19, 26 June 2020
Rakta dhatu is a body component similar to blood tissue. Its important function is to give life or maintain vitality(jivana). Body fluid (rasa dhatu) after acquiring ‘red’ color is termed as “rakta”(blood).(SAT-B.429)
|Section/Chapter/topic||Sharira / Dhatu / Rakta Dhatu|
|Authors||Deole Y.S.,Anagha S.|
|Affiliation||Charak Samhita Research, Training and Development Centre, I.P.G.T.& R.A., Jamnagar|
|Date of publication:||June 18, 2020|
- 1 Etymology and derivation
- 2 Synonyms
- 3 Meanings in different contexts
- 4 Panchabhautika constitution and properties:
- 5 Formation and metabolism of rakta dhatu
- 6 Metabolic byproducts and waste products (Upadhatu and mala):
- 7 Characteristics of pure blood
- 8 Physiological aspects:
- 9 Functions:
- 10 Importance in diagnosis
- 10.1 Causes of vitiation
- 10.2 Abnormal states
- 10.3 Clinical features of decrease:
- 10.4 Clinical features of increase:
- 10.5 Disorders due to blood vitiation:
- 10.6 Clinical features of vitiation of channels of transportation and transformation of blood (raktavahasrotasa):
- 10.7 Role of rakta dhatu as vitiated factor in disease:
- 11 Importance in preservation of health and prevention
- 12 Principles of management of diseases of rakta dhatu
- 13 Contemporary approach
- 14 Current researches
- 15 More information
- 16 References
Etymology and derivation
The word ‘Rakta’ is derived from Sanskrit root “ranj”, meaning–to dye or colour, to affect or move, to excite/glad/charm/delight.
Shonita, rudhira, asrik, astra,lohita,kshataja
- Shonita: The term is derived from ‘shona’ meaning red color. The term is also applied to denote the female genetic prototype.
- Rudhira: The term is derived from root ‘rudh’ meaning to stop or hold. The blood tissue sustains the life of human beings, hence it is called ‘rudhira’’. [Su. Sam. Sutra Sthana 14/39]
- Lohita: The term indicates the coppery red color of blood. [Su. Sam. Sutra Sthana 14/5]
- Asrik/Asra: The term is derived from Sanskrit root ‘ashukshepane, srijvisarge'. It means to get ejected or expelled out. This synonym is used in the context of excessive bleeding. E.g.menorrhagia(asrigdara), bleeding disorders(asrapitta/raktapitta)
- Kshataja: It means that which originates from trauma (kshata) or wound/ulcer (vrana).
Meanings in different contexts
In different contexts, the word rakta denotes blood tissue (rakta dhatu), menstrual blood (raja or artava), ovum (shonita or streebeeja), red color, metals like copper, indulgence in some passion or desire.
Life begins with the unification of live sperm(shukra) and live ovum (shonita). The word ‘shonita’ denotes ‘fertile ovum’ whenever it is used in context of conception. [Cha. Sa. Sharira Sthana 3/3]
Otherwise, in general physiology, shonita denotes blood tissue (rakta dhatu). The term ‘jeevarakta’ denotes fresh blood. [Su. Sa. Sutra Sthana 14/8]
Panchabhautika constitution and properties:
The Rakta dhatu is constituted with the dominance of agni mahabhuta and all other mahabhuta. It possesses properties like peculiar smell (vistrata), liquidity(dravata), red color(raga), pulsation(spandanam) and lightness to get circulated (laghuta) due to Prithvi,jala,teja, vayu and akasha mahabhuta are spectively. [Su.Sa. Sutra Sthana 14/9]
Rakta dhatu is neither too hot nor too cold(anushna-sheeta), sweet (madhura), unctuous (snigdha), red(rakta), heavy(guru), with peculiar smell (vistra).It can get affected by the same substances that provoke pitta dosha.[Su. Sam. Sutra Sthana 21/17]
Formation and metabolism of rakta dhatu
- The rakta dhatu is formed from its predecessor rasa dhatu. The nourishing portion of rasa dhatu and constituents of nutrient fluid (ahara rasa) are transformed into rakta dhatu by action of ranjakapitta (type of pitta responsible for colour pigments). [Cha. Sa. Chikitsa Sthana 15/28] This process takes place in liver and spleen.[Su.Sa.Sutra Sthana 14/4-5]
- The pure blood is formed as per the suitable conditions at the place of living, season, and adaptation. [Cha. Sa. Sutra Sthana 24/3]
As per contemporary theories, in the early stages of embryogenesis, blood formation (hematopoiesis) occurs in blood islands. These are aggregates of blood cells in the yolk sac. As development progresses, blood formation occurs in the spleen, liver, and lymph nodes. These are the primary site until the first three months of gestation. In the seventh month of gestation, after the development of bone marrow, it eventually becomes the major site of formation of most of the blood cells for the entire organism. Hematopoietic stem cells (HSCs) in the bone marrow give rise to all of the different mature blood cell types and tissues. In children, hematopoiesis occurs in the marrow of the long bones such as the femur and tibia. In adults, it occurs mainly in the pelvis, cranium, vertebrae, and sternum. Sushruta highlighted the presence of adipose tissue (meda dhatu) in the medulla of bone. The adipose tissue (meda dhatu) present in long and big bones is known as marrow (majja). That present inside the small bones is termed as red marrow (saraktameda). [Su. Sa. Sharira Sthana 4/13]
This unctuous portion in the bone marrow can be linked to the formation of blood as per current views.
The liver acts as the major blood reservoir. It stores about 450 milliliters or almost 10 percent of the body's total blood volume. This capacity can increase up to 1 litre in certain cases due to the expanding capacity of the liver. It synthesizes some proteins including coagulation factors I (fibrinogen), II (prothrombin), V, VII, VIII, IX, X, XI, XII, XIII, as well as protein C, protein S and antithrombin. All of these play important roles in blood physiology. Moreover, the liver is a major site of production for thrombopoietin, a glycoprotein hormone that regulates the production of platelets by the bone marrow. The liver plays a major role in glucose, protein, and lipids present in the blood. It also purifies and protects blood from harmful toxins, metabolites, and heavy metals.
Thus, bone marrow is the site of formation of blood cells; whereas the liver is the major site in maturation of blood cells and maintaining the physiological status of blood tissue.
Metabolic byproducts and waste products (Upadhatu and mala):
During the process of metabolism and formation of rakta dhatu, tendons(kandara) and veins(sira) are formed as the metabolic byproducts(upadhatu).[Cha. Sa.Chikitsa Sthana 15/17]. Sharangadhara opines menstrual blood(artava) as the metabolic by-product. [Sharangadhara Sa. Purvakhanda chapter 5]
Various pigments and acidic secretions are formed as waste during this process. These are termed as malarupa pitta.[Cha.Sa. Sutra Sthana 15/5]
Quantity of Rakta:
The quantity of rakta is eight anjali. One Anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person specific.[Cha. Sa. Sharira Sthana 8/15]
Rakta dhatu is formed in a time span of 6030 kala (ten days). [Su. Sa. Sutra Sthana 14/14]
Characteristics of pure blood
The color of pure blood is like golden red, firefly, red lotus, lac-resinous material(laksha), and fruit of Gunja (Abrusprecatorius Linn.). [Cha. Sa. Sutra Sthana 24/22]
The person with pure blood has glowing complexion, well-functioning sense organs, and a cheerful state of mind. His digestion and natural urges are normal. He is endowed with happiness, satiety, and strength. [Cha. Sa. Sutra Sthana 24/24].
Characteristics of best quality of blood tissue (raktasara ):
The characteristics of the essence of rakta dhatu can be observed on ears, eyes, face, tongue, nose, lips, palms, soles, nails, forehead and genitals. These body parts are unctuous, red, beautiful and shining. The persons are endowed with happiness, sharp intellect, magnanimity, tenderness, moderate strength, lack of endurance, and intolerance to heat.[ Cha. Sa. Vimana Sthana 8/104]
Channels of transportation and transformation of rakta dhatu (raktavahasrotas):
The channels of transportation and transformation of rakta dhatu (raktavahasrotasa) originates from liver and spleen.[Cha. Sa. Vimana Sthana 5/8]The blood components are formed in the liver and spleen. It is circulated through blood vessels like arteries (dhamani). [Su. Sa. Sharira Sthana 9/12]. Considering the important role of bone marrow in the formation of blood cells, it can be included as an additional site in channels of transportation and transformation of rakta dhatu (raktavhasrotas).
There are various other structures related to rakta dhatu. These can be included in the channels of transportation and transformation.
Layer of blood tissue (raktadharakala):
Kala is the layer in outer coverings of the body observed in sagittal section. The layer of formation of blood tissue (raktadhara kala) is second beneath the layer of skin and muscles (mamsadhara kala). It is made of blood vessels connected with the liver and spleen. [Su. Sa. Sharira Sthana 4/10]
General physiological functions:
Giving life and sustaining vitality (Jeevana), enhancing complexion(varna prasadana), nourishing successor muscle tissue and other components (mamsa dhatu poshana) are the main functions of rakta dhatu. [Su. Sa. Sutra Sthana 15/5] The vitality depends on blood. [Cha. Sa.Sutra Sthana 24/4]
Role of rakta in the formation of body organs:
During embryogenesis, various organs are developed from dhatu by action of factors responsible for digestion and metabolism(agni).
The following table shows details of the role of rakta dhatu in the formation of body organs.
|Sr.no.||Body organ||Factors responsible for its formation|
|3.||Lungs||Shonitaphena(froth in pure blood)|
|4.||Appendix||Shoinitakitta(waste in formation of pure blood)|
|5.||Intestine, anus and urinary bladder||Asrija + shelshmaprasad acted upon by pitta and vayu(essence of blood and kaphadosha)|
|6.||Tongue||Kapha + shonita + mamsasara(essence of kapha, blood and muscles)|
|7.||Kidneys||Rakta + meda prasada (essence of blood and muscles)|
|8.||Testis||Mamsa + asrik + kapha + medaprasada(essence of muslces, blood, kapha and adipose tissue)|
|9.||Heart||Shonita + kaphaprasada (essence of blood and kapha)|
[Su. Sa. Sharira Sthana 4/25-31]
- Rakta is one among the ten seats of vitality(dashapranayatanani). [Su. Sa. Sharira Sthana 7/9]
- Rakta is the primary site of pitta dosha. [Cha. Sa. Sutra Sthana 20/8]
Importance in diagnosis
Causes of vitiation
The formation of blood is affected by following factors:
- Habitual intake of spoiled or unsuitable food and/or liquids
- acidic or pungent liquor and other similar drinks
- too much salty, alkaline substances
- sour and pungent food
- Dolichosbiflorus Linn. (kulatha)
- Phaseolus mungo Linn. (masha)
- Dolichos lablab Linn. (nishpava)
- Sesamum indicum Linn. oil (tila taila)
- Randiauliginosa DC.(pindalu)
- radish and all green (leafy) vegetables
- meat of aquatic and marshy animals, burrowing animals and those that snatch birds
- excessive intake of curd
- sour whey (curd-water), vinegars and other sour fermented liquids
- consuming decomposed, putrid food with opposite properties
- taking meal during indigestion
- excessive sleeping during the day especially after taking liquids, unctuous and heavy food
- excessive anger
- excessive exposure to the sun and the wind
- suppression of the natural urges like vomiting
- avoidance of blood-letting in prescribed time (autumn)
- too much exertion
Due to natural conditions in autumn season. [Cha. Sa. Sutra Sthana 24/5-10]
The channels of transportation and transformation of blood (raktavahasrotas) is affected due to the following causes:
Excess consumption of pungent and spicy food and drinks that cause burning sensation, unctuous, hot and liquid food, exposure to sun-heat, or fire. [Cha. Sa. Vimana Sthana 5/14].
The physician should diagnose the quantitative and qualitative imbalance of rakta by observing various features manifested due to decrease(kshaya) and increase(vridhi).
Clinical features of decrease:
- Symptoms of decrease of rakta are roughness of skin, cracks, dullness, and dryness of skin.[Cha. Sa. Sutra Sthana 17/65]. In addition, craving for sour food, liking for cold substances, looseness of blood vessels is also observed.[Su. Sa. Sutra Sthana 15/9].
Clinical features of increase:
- Reddish discolouration of eyes and other body parts and fullness of veins are considered as the signs of increase of rakta dhatu. [Su. Sa. Sutra Sthana 15/10].
Disorders due to blood vitiation:
Following disorders are caused by blood vitiation:
Stomatitis, redness in eyes, foul smell in nose and mouth, gulma (abdominal lump), gingivitis (upakusha), erysipelas, bleeding disorder, sleepiness, abscess, hematuria, menorrhagia, vatarakta, discoloration of skin, loss of digestive power, thirst, heaviness in body, pyrexia, extreme debility, anorexia, headache, burning sensation after meals, bitter and sour eructation, physical and mental exhaustion, excessive anger, state of confusion, saline taste in mouth, sweating, fetid odor in body, narcosis, tremors, decreased voice, drowsiness, excessive sleep and feeling of darkness, itching, pustules, patches, boils, leprosy, thick skin, etc.
The diseases, which, in spite of being curable, are not alleviated after treatment with any of six therapies like cold-hot, unctuous-rough etc. should be considered as caused by impure blood. [Cha. Sa. Sutra Sthana 24/11-17]
Clinical features of vitiation of channels of transportation and transformation of blood (raktavahasrotasa):
Following clinical conditions are observed due to affection of channels of transportation and transformation of blood:
Skin diseases (kushtha), erysipelas (visarpa), furuncles (pidaka), bleeding disorders(raktapitta), asrigdara(menorrhagia), inflammation of anus, penis, oral cavity, splenic disorders (pliha), abdominal lump (gulma), abscess (vidradhi), blue mole (nilika), jaundice (kamala), freckles/blemish (vyanga), portwine mark (piplu), black mole of the size of sesame seed (tilakalaka), ringworm (dadru), dermatitis (charmadala), leukoderma (shvitra), scabies (pama), urticaria (kotha), and circular erythema (asra mandala).[Cha. Sa. Sutra Sthana 28/11-13]
Role of rakta dhatu as vitiated factor in disease:
Rakta plays a major role in the pathogenesis of the following diseases:
- Bleeding disorders(raktapitta) [Cha.Sa.Chikitsa Sthana 4/7-9]
- Disease due to vata and rakta (vatarakta) [Cha. Sa. Chikitsa Sthana 29/10]
- erysipelas(visarpa) [Cha. Sa. Sutra Sthana 18/23] [Cha. Sa. Chikitsa Sthana 21/15]
- Intoxication(mada), syncope (moorcha), coma(sanyasa) [Cha. Sa. Sutra Sthana 24/25] skin diseases(kushtha) [Cha. Sa.Nidana Sthana 5/3]
- Obstinate urinary disorders including diabetes(prameha) [Cha. Sa.Nidana Sthana 4/7]
Subtypes of some diseases indicate the major role of rakta in their pathogenesis:
- Obstinate urinary disorders (raktameha) [Cha. Sa. Nidana Sthana 4/32]
- Micro-organisms originating in blood (shonitajaKrimi)[Cha.Sa.Vimana Sthana 7/11]
- Abdominal lump due to blood (raktagulma)[Cha. Sa. Chikitsa Sthana 5/18]
- Diarrhoea with blood (raktatisara)[Cha. Sa.Chikitsa Sthana 19/70]
- Abscess with blood (raktavidradhi) [Su. Sam. Nidana Sthana 9/14,26]
- In case of fever (jwara), when the vitiated dosha are located in the rakta dhatu, following clinical features are observed: Increase in body temperature, eruptions, thirst, frequent spitting mixed with blood burning sensation, discoloration, giddiness, intoxication, and incoherent speech. [Cha. Sa. Chikitsa Sthana 3/77]
- In fever (jwara) caused by trauma(abhighata),vitiated vata affects predominantly rakta (blood). This leads to clinical features like discomfort, swelling, discoloration, and pain.[Cha. Sa. Chikitsa Sthana 3/114].
- In all other exogenous causative injuries like poison (visha) etc, rakta dhatu is predominantly affected. In such cases, it has both diagnostic and therapeutic importance.
Importance in preservation of health and prevention
The pure blood provides the individual with strength, complexion, happiness, and life. [Cha. Sa. Sutra Sthana 28/4].
It is the fundamental source of vitality and life. [Su. Sam. Sutra Sthana 14/44]
Principles of management of diseases of rakta dhatu
- The principles of management for disorders of rakta are mentioned as below [Cha. Sa.Sutra Sthana 24/18].
If there is excessive vitiation of rakta dhatu, then purification procedures are indicated. This includes therapeutic purgation (virechana) and bloodletting (rakta mokshana) after considering the strength of the patient.
In the case of mild to moderate severity of disease and in patients with low strength, pacification therapies (shamana) is indicated. This includes therapeutic fasting (upavasa) and management on the lines of bleeding disorders (raktapitta).
- In case of fever (jwara), the dosha located in rakta dhatu are treated with pouring of medicated liquids (seka) and ointment application (pradeha).[Cha. Sa. Chikitsa Sthana 3/316].
- In case of poisoning, the spread of toxins is arrested by applying cooling external application (pradeha and alepa) and poring medicated liquids (seka). [Cha. Sa. Chikitsa Sthana 23/42-43] It shows pacifying actions on vitiated rakta and pitta. [Su. Sa. Sutra Sthana 18/3]
Best herbs in management (agryasamgraha):
Some food items and herbs have excellent action on blood as follows: [Cha. Sa. Sutra Sthana 25/40].
|Goat milk (ajaksheera)||Pacifying raktapitta (bleeding disorders) (raktapittaprashamana)|
|Ananta (Hemidesmus indicus R.B.)or Indian sarsaparilla||Astringent effect, pacifying raktapitta (Sangrahikaraktapittaprashamana)|
|Pollens of utpala (Nymphaca alba Linn.), kumuda (a variety of utpala) and padma (Nelumbo nucifera gaertn.) or pollen of blue and white water lilies||Astringent effect, alleviating raktapitta (sangrahikaraktapittaprashamana)|
|Bark of kutaja (Holarrhenaantidyscenterica wall.) or kurchi bark||Among astringent and desiccant of kapha, pitta and the blood (shlesma pitta raktasangrahikopsosananam).|
|Fruit of kashmari (Gmelina arboria) or fruit of white teak||Causing haemostasis and curing raktapitta (Raktasangrahikaraktapittaprashamana)|
|Guduchi (Tinosporacordifoliamiers) or amrita||Act as astringent, curative of vata, promotes digestion, curative of vitiation of kapha and blood (sangrahikavataharadipaniyashleshmashonitavibandhaprashamana).|
|Priyangu [Callicarpa macrophylla Vahi.] or the perfumed cherry||Alleviate the plethoric condition of blood and pitta (shonitapittatiyogaprashamana)|
Physiological effect of various tastes on blood:
The substances with predominant tastes (rasa) produce physiological effects on rakta dhatu as shown below.[Cha. Sa. Sutra Sthana 26/43]
|Sour(amla rasa)||Vitiates blood (raktam dushayati)|
|Salty(lavana rasa)||Increases volume(raktam vardhayati)|
|Pungent (katurasa )||Breaks the blood clots/anti-coagulant (shonitasanghatam bhinatti)|
|Bitter (tiktarasa)||Depletes the quantity of blood by absorbing fluid portion(raktam shoshayati)|
|Astringent(kashaya rasa)||Pacifies vitiated blood (Raktaprashamana)|
The above factors are used in diagnosis as well as treatment.
E.g. Sour substances are known to vitiate blood, hence the patients with disorders due to vitiation of blood are advised to avoid sour substance. Instead, they are advised to consume bitter and astringent substances. The substances with pungent taste can be used to prevent coagulation.
In contemporary physiology, red coloured fraction of blood is considered as rakta dhatu. The colourless fluid (plasma) is considered as rasa dhatu. Thus, rasa and rakta together form “blood”. The red fraction or red blood corpuscles are referred to as rakta dhatu in this article.
Blood is a complex liquid tissue composed of different types of cells. The plasma which represents the matrix of this tissue constitutes over 55% of it. Formed elements that are suspended in the liquid matrix constitute over 45% of blood, these comprise of erythrocytes,leukocytes, and platelets. The characteristic color of blood is due to the erythrocytes present in it. These cells are formed in the red born marrow and they survive for about 80 days in circulation and then disintegrate. Their debris is removed from the blood by liver and spleen. Ranjaka pitta which gives color to rakta may be considered as the ayurvedic analogue of the red cobalt linked enzyme B12 present in the liver.
The red color in blood is due to hemochrome present in the protein (hemoglobin). This is responsible for oxygen transport. Different groups of organisms use different proteins.
Blood accounts for 7% of the human body weight. The average adult has a blood volume of roughly 5 litres.
The blood has an important role in the physiology of the cardiovascular system and lymphatic system.
It carries important functions as below:
- Supply of oxygen to tissues (bound to hemoglobin, which is carried in red cells)
- Supply of nutrients such as glucose, amino acids, and fatty acids (dissolved in the blood or bound to plasma proteins (e.g., blood lipids)
- Removal of waste such as carbon dioxide, urea, and lactic acid
- Immunological functions, including circulation of white blood cells, and detection of foreign material by antibodies
- Coagulation, the response to a broken blood vessel, the conversion of blood from a liquid to a semisolid gel to stop bleeding
- Messenger functions, including the transport of hormones and the signaling of tissue damage
- Regulation of core body temperature
- Hydraulic functions
Hematopoietic stem cell transplantation (HSCT) is a curative modality for a wide variety of hematologic disorders. Early survival after HSCT is dependent on the occurrence of hepatic, cardiac, and pulmonary complications. This depicts the role of blood as origin in the formation of these organs during embryonic life as mentioned above. More research on this topic can open new avenues in the field of tissue engineering.
Future scope of research:
Considering views about the physiology of blood formation and maturation, the role of adipose tissue in marrow (saraktameda and majja), its connection with liver and spleen need to be explored. This can open a new window in the treatment of diseases due to blood vitiation like skin diseases and bleeding disorders.
List of theses done
1. Mohanti Krishna (2000): Critical study on Sroto-Vigyaneeyam in Bruht-trayi w.s.r. to RaktavahaStroto-Dushti and its management, Dept of Basic Principles, IPGT&RA, Jamnagar.
2. Kulkarni Mayur P (2003): Concept of Dhatu-PradoshajaVikaras in Brihattrayee with the principle of management in Rakta-PradoshajaVikaras, Dept of Basic Principles, IPGT&RA, Jamnagar.
3. Shinde Vaishali S (2004): A study on the concept of Upadhatu in Samhitas with applied aspect to Artava-Dushti, Dept of Basic Principles, IPGT&RA, Jamnagar.
4. Kailash Chandra (2006): Applied concept of Kala and Svabhava and their role in Shonita Dusti, Dept of Basic Principles, IPGT&RA, Jamnagar.
5. Anil Avhad(2015): Applied study of Srotasa and Srotomula w.s.r to Raktavaha Srotodushti and its management.
Shonitavarnaniya Adhyaya[Su. Sam. Sutra Sthana 14]
- SAT = Standard Ayurveda Terminology
- Cha. = Charak
- Su. = Sushruta
- Ka. = Kashyapa
- Sha. =Sharangadhara
- Sa. = Samhita
- Available from http://namstp.ayush.gov.in/#/sat
- Monier Williams (1899), “रक्त”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 0861.
- Available from https://www.wisdomlib.org/definition/shonita
- Birbrair, Alexander; Frenette, Paul S. (1 March 2016). "Niche heterogeneity in the bone marrow". Annals of the New York Academy of Sciences. 1370 (1): 82–96. Bibcode:2016NYASA1370...82B. doi:10.1111/nyas.13016. ISSN 1749-6632. PMC 4938003. PMID 27015419.
- Fernández KS, de Alarcón PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971
- Available from https://en.wikipedia.org/wiki/Liver accessed on 15/06/2020
- Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.343
- Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.330
- Kim BK, Chung KW, Sun HS, Suh JG, Min WS, Kang CS, et al. Liver disease during the first post-transplant year in bone marrow transplantation recipients: retrospective study. Bone Marrow Transplant. 2000;26:193–7