Aplastic anemia

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Aplastic anemia
Bone marrow biopsy showing aplastic anemia
Synonyms N/A
Pronounce N/A
Specialty N/A
Symptoms Fatigue, pallor, shortness of breath, frequent infections, easy bruising
Complications Bleeding, infection, heart failure
Onset Any age, but more common in young adults and older adults
Duration Chronic
Types N/A
Causes Autoimmune disease, chemotherapy, radiation therapy, toxic chemicals, viral infections
Risks Exposure to benzene, pesticides, certain medications
Diagnosis Complete blood count, bone marrow biopsy
Differential diagnosis Myelodysplastic syndrome, leukemia, paroxysmal nocturnal hemoglobinuria
Prevention N/A
Treatment Immunosuppressive therapy, bone marrow transplant, blood transfusions
Medication N/A
Prognosis Variable; depends on severity and response to treatment
Frequency Rare
Deaths N/A


Aplastic anemia is a condition where the bone marrow does not produce enough, or any, new cells to replenish the blood cells. The term 'aplastic' refers to the inability of the marrow to function properly. Anemia is the condition of having fewer blood cells than normal, or fewer than needed to function properly. Typically, anemia refers to low red blood cell counts, but aplastic anemia patients have lower counts on all three blood cell types: red blood cells, white blood cells, and platelets.

Causes[edit | edit source]

One known cause is an autoimmune disorder, where the white blood cells attack the bone marrow. In many cases, the etiology is impossible to determine, but aplastic anemia is sometimes associated with exposure to substances such as benzene, radiation, or to the use of certain drugs, including chloramphenicol and phenylbutazone.

Signs and symptoms[edit | edit source]

Diagnosis[edit | edit source]

The diagnosis can only be made on bone marrow biopsy. Before this procedure is undertaken, a patient will generally have had other blood tests to find diagnostic clues, including a full blood count, renal function and electrolytes, liver enzymes, thyroid function tests, vitamin B12 and folic acid levels.

Treatment[edit | edit source]

Treating aplastic anemia involves suppression of the immune system, an effect achieved by daily medicine intake, or, in more severe cases, a bone marrow transplant, a curing but risky procedure. Bone marrow transplant replaces the old bone marrow cells with new ones from a donor, giving the patient a new immune system. There is a risk that the newly created white blood cells may attack the rest of the body ("graft-versus-host disease"). Medical therapy of aplastic anemia often includes a short course of anti-thymocyte globulin (ATG or anti-lymphocyte globulin) and several months of treatment with ciclosporin to modulate the immune system. Mild chemotherapy with agents such as cyclophosphamide and vincristine may also be effective. Antibodies therapy, such as ATG, targets T-cells, which are believed to attack the bone marrow. Steroids are generally ineffective.

Follow-up[edit | edit source]

Regular full blood counts are required to determine whether the patient is still in a state of remission. 10-33% of all patients develop the rare disease paroxysmal nocturnal hemoglobinuria (PNH, anemia with thrombopenia and/or thrombosis), which has been explained as an escape mechanism by the bone marrow against destruction by the immune system. Flow cytometry testing is probably warranted in all PNH patients with recurrent aplasia.

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See also[edit | edit source]

External links[edit | edit source]

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