Aplastic Anemia

Aplastic anemia is a rare but serious blood disorder. It typically happens when your immune system mistakenly damages or destroys blood stem cells in your bone marrow. Stem cells make blood cells and platelets. Without healthy stem cells, you don’t have enough blood cells and platelets.

Anyone can develop aplastic anemia, but it usually affects people aged 15 to 25 and those aged 60 and older. It’s very rare. The National Institutes of Health (U.S.) estimates it affects 2 out of 1 million people each year.

Some treatments can manage your symptoms or keep your immune system from attacking stem cells. But a stem cell transplant (bone marrow transplant) using donated stem cells is the only cure.

Types of aplastic anemia

The two types are:

• Acquired aplastic anemia: This type happens when your immune system mistakenly attacks stem cells in your bone marrow. It’s the most common type.
• Hereditary aplastic anemia: People who have certain inherited disorders may develop aplastic anemia.

Symptoms of aplastic anemia

Symptoms typically take weeks to months to develop. Aplastic anemia symptoms may be mild, moderate or severe. Some common symptoms include:

• Bleeding or bruising more easily
• Dizziness
• Fatigue
• Feeling short of breath
• Fever
• Headache
• Skin color that’s paler than usual

Other, less serious issues may cause these symptoms. But you should talk to a healthcare provider if you’ve been sick for several weeks.

Aplastic anemia causes

This condition typically happens when your immune system attacks stem cells in your bone marrow. Experts don’t know exactly what triggers the attacks. Some other causes include:

• Medical conditions, like autoimmune diseases, and viral infections, like Epstein-Barr virus, hepatitis and HIV
• Inherited disorders like Fanconi anemia, Dyskeratosis congenita, Shwachman-Diamond syndrome, Diamond-Blackfan anemia and Pearson syndrome
• Long-term exposure to chemicals like arsenic, benzene or certain pesticides
• Medical treatments like chemotherapy, radiation therapy and some medications for autoimmune diseases

The rare blood disorder, paroxysmal nocturnal hemoglobinuria, and pregnancy are other potential causes.

Complications of this condition

Aplastic anemia can be life-threatening. It can lead to serious issues like:

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

How doctors diagnose aplastic anemia

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

• Complete blood count (CBC) with differential: This test checks the number of 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: In these tests, a provider removes small amounts of bone marrow and fluid. A pathologist checks the bone marrow and fluid to see if the number of blood cells in your bone marrow is lower than usual. Low blood cell counts may be a sign of aplastic anemia.

How is this disease treated?

Treatments vary depending on your situation. Treatments include:

• Active surveillance: Your healthcare provider may delay treatment if you don’t have symptoms. They’ll do regular follow-up tests and start treatment if your situation changes.
• Changing medications: Aplastic anemia may be a side effect of certain cancer or autoimmune medications. In that case, your provider may change treatments.

Treatments for more serious forms may include:

• Stem cell transplant: Providers replace damaged stem cells in your bone marrow with healthy stem cells from donated blood or bone marrow.
• Immunosuppressants: These medications keep your immune system from attacking your stem cells. Antithymocyte globulin injection (Atgam®) and cyclosporine (Sandimmune®) are examples of immunosuppressants that treat aplastic anemia.

Other treatments manage issues that aplastic anemia may cause. For example, you may take antibiotics for bacterial infections. Blood transfusions may ease some symptoms.

Is there a cure for aplastic anemia?

A successful stem cell transplant may cure it. Children and people aged 40 and younger are more likely to be cured after stem cell transplant.

When should I see my healthcare provider?

Some treatments cause side effects. Contact your provider if:

• You have a stem cell transplant and develop a rash, diarrhea, nausea and vomiting. These are graft vs. host disease symptoms, which can happen after a transplant.
• You take immunosuppressants and have symptoms of a bacterial infection. These include a fever of 102 degrees Fahrenheit (38.8 degrees Celsius) or higher.
• You have blood transfusions and develop symptoms of an iron overload. These include joint pain, belly pain or fatigue.

What can I expect if I have aplastic anemia?

Many things may affect your prognosis, or what you can expect after treatment. In some cases, an allogeneic stem cell transplant may cure this disease. Other times, treatment may help manage symptoms and reduce your risk for complications.

Life expectancy

Stem cell transplants and immunosuppressive therapy are helping people live longer. One study showed that, in some cases, the disease was still in remission 25 years after treatment. But many things affect life expectancy. Ask your healthcare provider what you may expect. They know you and your experience with aplastic anemia. They’re your best source of information.

Is aplastic anemia a form of leukemia?

No, but people with aplastic anemia may develop acute myeloid leukemia.