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What is Aplastic Anemia?

When your bone marrow does not produce enough new blood cells it is called aplastic anemia. Blood cells die and there is nothing abnormal about that as long as they are being replaced. While red blood cells can live 120 days on average, platelets only live for about 6 days and white blood cells die every day. This means that your bone marrow is responsible for making new blood cells every single day. Health conditions such as arrhythmias, heart failure, bleeding, infections and an enlarged heart can occur when the bone marrow cannot produce enough new blood cells.

Fast Facts about Aplastic Anemia

  • Aplastic anemia occurs when your body does not produce enough new blood cells.
  • Many health problems can be caused by aplastic anemia, such as heart failure, arrhythmias, infections, bleeding and an enlarged heart.
  • Aplastic anemia is a type of anemia. Anemia usually means that the body does not have enough red blood cells or enough hemoglobin in their red blood cells.
  • There are many symptoms of this disorder such as dizziness, tiredness, cold hands and feet, chest pain, pale skin, bleeding, shortness of breath and headache.
  • There are several treatment options for aplastic anemia and they include blood and marrow stem cell transplants, blood transfusions and treatment with medications.
  • Most people suffering from aplastic anemia can be successfully treated with proper medical care.

Common Causes of Aplastic Anemia

Damaged stem cells cannot grow into strong blood cells. The cause of aplastic anemia is damage to bone marrow’s stem cells. Aplastic anemia can be acquired, which means that you were not born with it, or it can be inherited. Inherited means that you were born with this condition. Acquired aplastic anemia is more common than inherited and sometimes it is only a temporary condition. Although the exact cause of acquired aplastic anemia is not always known, there are some factors, such as various diseases and conditions, that can cause it:

  • Pregnancy – this type of aplastic anemia often resolves after delivery
  • Chemotherapy and radiation – when these are used for cancer treatment
  • Autoimmune disorders – examples include lupus and rheumatoid arthritis
  • Infectious diseases – cytomegalovirus, parvovirus B19, Epstein-Bar virus, hepatitis and HIV
  • Cancer – when certain cancers metastasize to the bones
  • Medications – antibiotics such as chloramphenicol
  • Toxins – e.g. benzene, arsenic and pesticides

There are several inherited conditions that can cause aplastic anemia as well. These conditions damage the bone marrow’s stem cells. Some of these conditions include dyskeratosis congenita, Diamond-Blackfan anemia, Shwanchman-Diamond syndrome and Fanconi anemia.

Risk Factors for Aplastic Anemia

Aplastic anemia is a serious and rare blood disorder. People of any age can develop this disorder. It is more common in the elderly, young adults and adolescents, though. Women and men have an equal chance of having aplastic anemia. It is more common in Asian countries. There are certain factors that can increase your risk of developing aplastic anemia. If you have had or been exposed to:

  • Certain inherited conditions, autoimmune disorders or infectious diseases
  • Certain medications or having chemotherapy or radiation treatment for cancer
  • Toxins

Symptoms of Aplastic Anemia

The cause of most of the symptoms of aplastic anemia is having a lower than normal number of platelets, white blood cells and red blood cells. Low blood counts of each type of cells cause different symptoms.

Fatigue is the most common symptom of low red blood cell count. The lack of hemoglobin causes fatigue because it helps carry oxygen to the body. Low red blood cell numbers can also cause cold hands and feet, pale skin, chest pain, shortness of breath, dizziness and headaches. When your red blood cell count is low, your heart has to work harder to move the oxygen to your body because there is less of it in your blood. Several conditions can be triggered because of this. They include heart murmur, heart failure, enlarged heart and arrhythmias.

Since white blood cells are responsible for fighting infections, a reduced amount of them produces symptoms like frequent infections, fever and flu like symptoms that persist.

Platelets are responsible for sealing breaks on blood vessel walls or small cuts. Bleeding can be hard to stop when a person’s platelet count is low and they may bruise and bleed easily.

Another condition associated with aplastic anemia is paroxysmal nocturnal hemoglobinuria. It is a red blood cell disorder and most people who have this condition do not have any signs or symptoms. When patients have both, paroxysmal nocturnal hemoglobinuria (PNH) and aplastic anemia, either condition could have developed first.

Diagnosing Aplastic Anemia

The first step in diagnosing aplastic anemia is your doctor taking a personal and family medical history. The doctor will want to learn about your medical history and whether you have had a history of anemia or are suffering from any of the symptoms of anemia. They will also need to know if you have been exposed to certain medications or toxins. You will also have to tell your doctor if you bleed or bruise easily or if you have had any infections.

During a physical, the doctor will look at your skin and eyes as well as listen to your heart and lungs. Other things your doctor will be looking for are swellings in the legs and irregularities with the size of your liver.

There are several tests used to diagnose aplastic anemia. These tests help rule out other conditions, check for paroxysmal nocturnal hemoglobinuria (PNH) and diagnose the cause of the aplastic anemia and its severity. Your doctor may order a complete blood count (CBC), a reticulocyte count to see how many young red blood cells you have and perform bone marrow tests. Your doctor may also do x-rays, liver tests and check your blood for signs, indicating that your anemia is caused by vitamin deficiency.

Treatment Options for Aplastic Anemia

There are several existing treatments for aplastic anemia. They include medication therapy, marrow and blood stem cell transplants and blood transfusions. Treatment is intended to relieve symptoms and improve the quality of life. The condition can also be cured if the cause of anemia, such as toxins, is removed.

Coping with Aplastic Anemia

With prompt treatment most patients can go back to their normal activities fairly quickly. It is important for patients to adhere to their treatment so that their condition does not get worse. One concern for people with aplastic anemia is the increased risk of infection. There is a number of steps you can take to reduce your risk of infection:

  • Talk to your doctor about whether you would benefit from a flu shot and/or a pneumonia vaccine.
  • Reduce your risk of infections in the throat and mouth by brushing and flossing your teeth. You should get regular dental care.
  • Wash your hands frequently.
  • Stay away from large crowds and from people who you know are sick.
  • Avoid undercooked meals and foods you know could expose you to bacteria.

You should discuss with your doctor how much and what kinds of physical activity are safe for you. Patients who bleed easily may need to avoid contact sports. Some patients may also need to avoid activities that can cause shortness of breath and chest pain.

Where to Get More Information and Support:
The Aplastic Anemia and MDS International Foundation
MSD Manuals
Aplastic Anemia & Myelodysplasia Association of Canada