Aplastic Anemia: Symptoms, Causes & Treatment

Aplastic anemia is a rare, serious disease affecting the bone marrow, the spongy tissue inside bones responsible for producing all blood cells. In this condition the bone marrow is damaged or stops working, so it cannot produce enough of the three blood cell types: red cells, white cells, and platelets.

As a result, symptoms arise from the deficiency of each type: low red cells cause anemia with fatigue, pallor, and breathlessness; low white cells weaken immunity and cause recurrent infections and fever; and low platelets cause easy bruising and bleeding. The disease may be inherited (rarely) or acquired, and is often immune-mediated where the immune system attacks the marrow cells, and may be linked to exposure to toxins, radiation, medications, or certain viral infections, and sometimes the cause remains unknown.

Aplastic anemia may be life-threatening and needs specialized care, but treatment has advanced greatly. It depends on the severity and the patient's age: supportive care with transfusions of blood and platelets and antibiotics protects the patient from complications, while definitive treatment aims to restore marrow function. Bone-marrow transplant from a matched donor is the treatment that may cure the disease, especially in children and young people, while immune-suppressing treatment is used for those without a donor. Early diagnosis by blood and bone-marrow testing, and avoiding drugs and substances that increase bleeding or suppress the marrow, are important.

• Fatigue, pallor, and breathlessness (anemia).
• Recurrent infections and fever (low white cells).
• Easy bruising and bleeding and gum and nose bleeding (low platelets).
• Palpitations and general weakness.

• Autoimmune, where the immune system attacks the bone-marrow cells (most common).
• Exposure to toxins (such as benzene), radiation, or some medications.
• Certain viral infections, and rarely genetic causes.
• Sometimes the cause remains unknown.

• Complete blood count showing a deficiency of the three cell types.
• Bone-marrow examination (aspirate and biopsy) to confirm the diagnosis.
• Tests to determine the cause and rule out other diseases.

Supportive care

• Transfusions of blood and platelets and preventive antibiotics to protect from complications.

Definitive treatment

• Bone-marrow transplant from a matched donor, which may cure especially in children and young people.
• Immune-suppressing treatment for those without a donor.

Avoid drugs that increase bleeding or suppress the marrow. This content is educational and does not replace consulting a hematologist.

• Serious infection from low immunity.
• Severe bleeding from low platelets.
• Complications of repeated transfusions, and progression of some cases to other marrow disorders.

• Avoiding exposure to toxins such as benzene and pesticides as much as possible.
• Caution with medications known to affect the marrow.
• Early diagnosis and treatment improve outcomes.