Aplastic anemia occurs when damage to stem cells in the bone marrow (spongy core of many bones) leads to an inability to produce an adequate supply of red blood cells, white blood cells, and platelets. The onset can be gradual but may be sudden (acute).
Low levels of red cells result in weakness, fatigue, pallor, and shortness of breath. Lack of white cells leaves the patient vulnerable to serious infection, while an inadequate number of platelets increases the risk of bleeding. For these reasons, aplastic anemia is potentially life-threatening. In fact, left untreated, severe aplastic anemia is fatal within a year for more than 80 percent of patients. This relatively rare disorder is more common among men.
What Causes Aplastic Anemia?
- In half of all cases, no cause is established.
- Most other cases are due to external causes, including toxic agents (benzene, some solvents, industrial chemicals), certain drugs (such as antibiotics, anti-inflammatory, immunosuppressive and anticancer drugs), radiation exposure and chemotherapy.
- Certain diseases, such as viral hepatitis or a tumor of the thymus gland, may cause aplastic anemia.
- Risk is increased among those with a family history of a rare disorder called Fanconi’s anemia.
- Autoimmune disorders (e.g., lupus)
- Aplastic anemia may develop during pregnancy, but this is rare.
Symptoms of Aplastic Anemia
- Increased susceptibility to infection
- Ulcers in the mouth, throat, and rectum
- Unusual bruising or bleeding (including spontaneous unexplained bleeding from the nose, gums, rectum, or vagina and prolonged bleeding from cuts)
- Small red dots (petechiae) under the skin, indicating bleeding; paleness (pallor)
- Weakness, fatigue, and breathlessness
- Rapid heart rate
- Pale skin and skin rash
- Coldness in the hands or feet
Prevention of Aplastic Anemia
- There is no known way to prevent aplastic anemia. Avoiding exposure to toxic chemicals, radiation, and drugs known to cause the disorder, such as the antibiotic chloramphenicol or the nonsteroidal anti-inflammatory phenylbutazone, may be helpful.
Diagnosis of Aplastic Anemia
- Blood counts indicating a reduction in red cells, white cells, and platelets suggest the presence of aplastic anemia.
- A bone marrow biopsy is necessary to verify the presence of aplastic anemia and its severity.
How to Treat Aplastic Anemia
- For cases of mild to moderate severity, no treatment may be necessary.
- The patient should eliminate exposure to any identifiable potential cause of aplastic anemia. If a medication is the suspected cause, a safer substitute should be used.
- Medications such as antithymocyte globulin, cyclosporine, and cyclophosphamide are available; these are successful in treating over 50 percent of patients.
- Antibiotics are typically given (often intravenously) when fever occurs to treat infection.
- A bone marrow transplant is the treatment of choice for people under age 55 with severe aplastic anemia, provided a compatible donor can be found. (A twin or other sibling is the best choice.)
- For severe cases, a doctor may order periodic transfusions of whole blood or specific blood cells until the bone marrow begins to function properly again. However, transfusions, particularly from family donors, should be avoided, if possible, if bone marrow transplantation is being considered as an option.
- Because of the risk of serious bleeding, the patient should avoid handling sharp instruments, such as razors or knives. To this end, using items such as electric shavers and soft toothbrushes is advised. Aspirin, aspirin-containing products, nonsteroidal anti-inflammatory drugs, and alcohol should also be avoided.
- Medicated mouthwash or diluted hydrogen peroxide is often used to ward off mouth infections.
When to Call a Doctor
Symptoms of aplastic anemia warrant a doctor’s prompt attention.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media