Aplastic anemia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 26, 2016
StartDiseasesAplastic anemia

Aplastic anemia is a relatively rare condition involving the blood marrow. The condition can develop suddenly or build gradually and worsen with time. The symptoms may resolve quickly, or the condition may become chronic. Aplastic anemia is treatable but can be life-threatening if blood cell levels drop too low.

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Definition & Facts

A person develops aplastic anemia when their bone marrow stops producing enough blood cells. In most cases, the body does not produce enough of all three types of blood cells. Too few red blood cells affects hemoglobin, which is responsible for carrying oxygen throughout the body. A decrease in white blood cells leaves a person susceptible to infections.

An insufficient number of platelets can cause the blood not to clot properly. Anyone can develop aplastic anemia; however, it is seen more often in people in their early 20s and the elderly. The condition seems to affect men and women in about the same numbers. There is also a higher incidence of aplastic anemia in developing countries.

Symptoms & Complaints

A person with aplastic anemia may complain of constant fatigue, frequent illnesses and infections, and uncontrolled bleeding. Other symptoms can vary depending on which blood cells are low.

If red blood cells are low, symptoms include pale skin, rapid heart rate or irregular heart rate, shortness of breath with minimal exertion, headaches, dizziness, or chest pain. If white blood cells are low, fever is a symptom related to infections. If platelets are low, symptoms may include unexplained bruising, bleeding gums and frequent nosebleeds.

Causes

Aplastic anemia in children and young adults may be a genetic disorder that is inherited due to a gene defect. These individuals have a higher chance of developing leukemia, so they should receive regular follow-up care from a specialist. The most common form in older adults is acquired aplastic anemia. While the exact cause is unclear, researchers believe something triggers the immune system to attack the bone marrow.

Aplastic anemia may be a side effect of some radiation and chemotherapy treatments used for cancer. In addition to killing cancer cells, the treatments can also damage healthy bone marrow. Toxic chemicals seen in many pesticides and insecticides may trigger aplastic anemia. Benzene, which is found in gasoline, has been linked to the condition. Certain antibiotics and rheumatoid arthritis medications may cause aplastic anemia due to their effect on the immune system.

Viral infections, including HIV, hepatitis, and Epstein-Barr virus, may lead to aplastic anemia in some people. Pregnancy and autoimmune diseases may cause the body to attack the bone marrow and play a role in the development of aplastic anemia. In many cases, doctors are unable to pinpoint a specific cause of the anemia. This is called idiopathic aplastic anemia.

Diagnosis & Tests

Doctors use a variety of tools to diagnose aplastic anemia. The first step is usually a complete blood count, also known as a CBC. This is a blood test that measures a person’s red blood cells, white blood cells, and platelets. There is a strong indication of aplastic anemia when all three levels are low.

The blood test is normally followed-up by a bone biopsy to confirm the diagnosis. During the biopsy, a doctor inserts a needle into the hip bone to remove a small sample of bone marrow. The sample is viewed under a microscope to determine the number, size, and maturity of the cells and to rule out other blood disorders. The diagnosis of aplastic anemia is confirmed if there are fewer blood cells than normal.

In most cases, the biopsy is done as an outpatient procedure, and the patient is allowed to go home shortly after the procedure. The biopsy area may be a little sore for about a week after the procedure. Depending on the circumstances, the doctor may order additional tests to determine the underlying cause of the anemia.

Treatment & Therapy

Treatment for aplastic anemia typically depends on the severity of the condition. Doctors often take a “wait and see” approach for very mild cases. More serious cases may be treated with blood transfusions. The transfusions don’t cure the condition, but they can relieve certain symptoms. A transfusion of packed red blood cells may relieve symptoms like fatigue, shortness of breath, and general weakness. A platelet transfusion may be required if there is uncontrolled bleeding.

In life-threatening situations, a patient with aplastic anemia may have to undergo a bone marrow transplant. This procedure takes healthy stem cells from the bone marrow of a healthy donor and injects them into the bloodstream of the recipient. The cells travel to the bone marrow where they produce healthy blood cells. This procedure requires a lengthy hospital stay since the recipient is severely immunocompromised until the new bone marrow begins producing enough cells to protect the individual from infection.

Immunosuppressive drugs may be used if the aplastic anemia is due to an autoimmune disease. Unfortunately, these medications further weaken the immune system and increase the risk of opportunistic infections. Some patients may also benefit from medications like sargramostim, filgrastim, pegfilgrastim, and epoetin alfa, which may stimulate the bone marrow and promote blood cell production. It is also important that patients with aplastic anemia see their doctor if they suspect any type of illness or infection, so they can be placed on the appropriate antibiotic or antiviral therapy to prevent the infection from worsening.

Prevention & Prophylaxis

Aplastic anemia is a rare condition, and there is little to do in the way of prevention. Individuals who have undergone chemotherapy or high-dose radiation treatment for cancer or who have autoimmune disorders should be aware of the symptoms of aplastic anemia and see their doctor immediately if they suspect they have the condition.

Individuals who use toxic chemicals as part of their work should make sure they follow appropriate safety guidelines and practices. They should also make their health care provider aware of their exposure and seek medical attention if they begin to experience symptoms.

Individuals diagnosed with aplastic anemia should implement lifestyle changes to help them cope with their symptoms. This involves resting frequently to avoid fatigue, avoiding contact sports due to the risk of bleeding, and protecting against infections with good hand hygiene and avoiding people who are sick.