Aplastic Anemia

What is aplastic anemia?

Aplastic anemia is a rare but serious blood disorder. It happens when your bone marrow can’t make enough blood cells and platelets. People with aplastic anemia have an increased risk of serious infections, bleeding issues, heart issues and other complications. There are treatments to manage aplastic anemia symptoms, but a stem cell transplantation is the only cure.

How common is this condition?

Each year, 300 to 900 people in the United States receive an aplastic anemia diagnosis. Studies show aplastic anemia affects 2 in 1 million people in Europe. Anyone can develop aplastic anemia, but it typically affects people ages 15 to 25 and age 60 and older.

What are the symptoms of aplastic anemia?

Aplastic anemia symptoms usually develop over weeks and months, so you may not notice changes in your body right away. In some cases, people have immediate severe symptoms. If you do develop symptoms, they may include:

• Frequent viral infections that last longer than usual.
• Fatigue.
• Bleeding or bruising more easily.
• Feeling short of breath (dyspnea).
• Skin color that’s paler than usual.
• Dizziness.
• Headache.
• Fever.

Some aplastic anemia symptoms mimic other, less serious illnesses. Having a cold or flu doesn’t mean you have aplastic anemia. You should talk to a healthcare provider if you’ve been sick for several weeks and you feel very tired all the time.

What causes aplastic anemia?

Experts don’t know all the reasons why you may develop aplastic anemia, but it typically happens when your immune system attacks your bone marrow so it can’t make stem cells. Certain medical conditions, inherited conditions, medical treatments and exposure to certain carcinogens may increase your risk of developing aplastic anemia.

Medical conditions

Medical conditions that can increase your risk include:

• Autoimmune diseases like lupus.
• Viral infections such as Epstein-Barr virus, cytomegalovirus (CMV), parvovirus B19 and human immunodeficiency virus (HIV).
• Paroxysmal nocturnal hemoglobinuria, an acquired disorder when your red blood cells break down too quickly.
• Pregnancy.

Inherited conditions

Experts link aplastic anemia to several inherited bone marrow failure syndromes. Bone marrow failure happens when your bone marrow doesn’t produce enough stem cells. Inherited conditions include:

• Fanconi anemia.
• Dyskeratosis congenita.
• Shwachman-Diamond syndrome.
• Diamond-Blackfan anemia.
• Pearson syndrome.

Medical treatments

Certain medical treatments put you at a higher risk of developing aplastic anemia, such as:

• Autoimmune disease treatments.
• Radiation and chemotherapy used to treat cancer.

Extended exposure to carcinogens, such as arsenic and benzene, may also increase your risk of developing aplastic anemia.

What are the complications of this condition?

People with aplastic anemia may have the following complications, some of which may be life-threatening:

• Anemia.
• Severe infections.
• Excessive bleeding.
• Arrhythmia or heart failure.
• Myelodysplastic syndrome.

How is aplastic anemia diagnosed?

Healthcare providers diagnose aplastic anemia by doing physical examinations, blood tests and genetic tests. Tests may include:

• Complete blood count (CBC) with differential. This tests and measures your blood cells, including all five types of white blood cells.
• Peripheral blood smear. Medical pathologists examine your blood cells and platelets under a microscope.
• Reticulocyte count. This test counts the number of immature red blood cells (reticulocytes).
• Bone marrow aspiration and bone marrow biopsy. Providers do these procedures to obtain bone marrow tissue that pathologists examine under a microscope.

How is aplastic anemia treated?

Treatments vary depending on your situation. For example, some people develop aplastic anemia because they’re receiving cancer or autoimmune disease treatments. In that case, providers may be able to treat aplastic anemia by changing the treatments.

If tests show your blood cell levels are lower than normal and you don’t have symptoms, providers may say you have moderate aplastic anemia. In that case, your provider may recommend monitoring your overall health and blood counts so they can move quickly if it looks as if your condition is getting worse.

Treatments for more serious forms of aplastic anemia include:

• Immunosuppressants. These medicines hold back your immune system so it stops attacking your stem cells. Antithymocyte globulin injection (Atgam®) and cyclosporine (Sandimmune®) are examples of immunosuppressants that treat aplastic anemia.
• Blood transfusions. Transfusions replace red blood cells and platelets. Transfusions don’t cure aplastic anemia, but they may ease some symptoms.
• Antibiotics. Aplastic anemia increases bacterial infection risk. Antibiotics help treat infections.
• Allogeneic stem cell transplantation. Providers replace damaged stem cells in your bone marrow with healthy stem cells from donated blood or bone marrow.

Side effects of treatment

Side effects differ based on treatments:

• Graft-versus-host disease, a complication of allogeneic stem cell transplantation.
• Increased risk of infection caused by immunosuppressant drugs.
• Iron overload (hemochromatosis) from blood transfusions.

Can aplastic anemia be prevented?

There’s no known way to prevent aplastic anemia.

Can aplastic anemia be cured?

Depending on your situation, a successful allogeneic stem cell transplantation may cure the condition. In general, children and people age 40 and younger are more likely to have successful treatment than people who are older.

What is the survival rate of aplastic anemia?

Many factors affect survival rates, including your age and your treatment. According to one study, overall 96% of people were alive after their stem cell transplantation. That same study showed 100% of children and adults under age 40 were alive five years after treatment.

Regardless of your situation, it’s important to remember survival rates reflect the experiences of large groups of people with a specific condition. What was true for them may not be true for you. If you have questions about aplastic anemia survival rates, your healthcare provider is your best resource for information.

I have aplastic anemia. How do I take care of myself?

You can take care of yourself by following your treatment plan and monitoring your symptoms. Here are some other suggestions:

• Avoid high-contact activities. You’re at risk for excessive bleeding if you’re hit or injured. You may need to avoid sports like football, hockey or wrestling.
• Protect yourself from viruses and germs. You’re more vulnerable to infections. Ask your provider what vaccinations make sense in your situation. Wash your hands and stay away from people who may have infectious diseases such as colds, flu or stomach flu.
• Rest as needed. Anemia is a complication of aplastic anemia. You may feel weak, breathless and very tired just getting through your daily activities. Get enough sleep, and rest when you need to, not just when you can.
• Eat a healthy diet. A diet that’s a good balance of lean protein, vegetables and whole grains boosts your energy. Ask to speak to a nutritionist for guidance so you get the most out of your meals.
• Get some exercise. Gentle exercise may help with stress. Talk to your provider before you start a new routine.

When should I see my healthcare provider?

Contact your provider if:

• You have a fever that’s 102 degrees Fahrenheit (38 degrees Celsius) or higher.
• Your symptoms get worse.

What questions should I ask my healthcare provider?

If you have aplastic anemia, you may want to ask the following questions:

• What’s the most likely cause of my condition?
• Is my condition serious?
• What treatments do you recommend?
• What are the treatment side effects?
• I don’t have symptoms. Will I need treatment?
• I have symptoms. What are my treatment options?

Is aplastic anemia a kind of cancer?

No, but people with aplastic anemia may develop leukemia, a form of blood cancer.