Aplastic Anemia

DEFINITION

Aplastic anemia a condition in which the body does not create enough blood cells causing fatigue, inability to fight infection, and increased risk of bleeding. Bone marrow is the spongy material inside bones where new blood cell components are made from stem cells. The bone marrow makes three different components from stem cells: white blood cells (which fight infection), red blood cells (which transport oxygen from the lungs to the tissues in the body), and platelets (which help keep the body from bleeding). There is a constant turnover of blood components of the body. Red blood cells live about 120 days before being reabsorbed by the body. Platelets live about a week in the body. White blood cells live only one day. Aplastic anemia is the drop in production of all of these cell lines by destruction of the bone marrow. Aplastic anemia is a rare and very serious condition. Causes of aplastic anemia include: radiation or chemotherapy, toxic chemical exposure (like pesticides or insecticides), certain medications, autoimmune disorders, viral infections, and pregnancy. Treatment options include medications, blood transfusion, or even bone marrow transplant. Sometimes aplastic anemia can be confused with myelodysplastic syndrome, where the bone marrow produces abnormal and immature blood cell components. Some people with aplastic anemia have other rare disorders including paroxysmal nocturnal hemoglobinuria and Fanconi’s anemia. Risk factors for aplastic anemia include having radiation or chemotherapy, exposure to toxic chemicals, taking certain prescription medications, having autoimmune disorders, having serious viral infections, and being pregnant.

SYMPTOMS
Fatigue, pale skin, difficulty breathing, fast heart rate, irregular heart rate, frequent or bad infections, easy bruising, nosebleeds, bleeding for an extended period from cuts, rash, dizziness, headaches

DIAGNOSIS
Your doctor will first take a history and perform a physical exam. Your doctor will want to check some blood tests including a complete blood count (to look at you red blood cells, white blood cells and platelets), a peripheral smear of the blood (to look at the shape and number of all of the blood components), and perhaps a few other tests to look for other causes of low blood counts. In order to confirm the diagnosis of aplastic anemia, a hematologist will perform a bone marrow biopsy. The biopsy involves making a small hole in part of the hip bone to take out bone marrow cells. In people with aplastic anemia, the bone marrow shows very few cells. After being diagnosed with aplastic anemia, you may need further testing to help determine the cause.

TREATMENT
Treatment depends on the severity of your aplastic anemia. If you have extremely severe aplastic anemia, you will need to be hospitalized for treatment as the condition is extremely serious. For less severe cases of aplastic anemia, hospitalization may not be necessary. Many people with aplastic anemia will require blood transfusion or platelet transfusion (transfer of another person’s blood or platelets into your body). While the transfusions will not cure aplastic anemia, they will help relieve symptoms. Frequent transfusions can have side effects, such as buildup of iron in the body. Bone marrow transplantation is a more definitive treatment for aplastic anemia. Bone marrow transplantation involves replacing the bone marrow with healthy bone marrow from a donor (such as a sibling or family member). First, your bone marrow which is not working well is killed with radiation or chemotherapy to make space for the new cells. Then, the new cells are put into the blood stream through an IV in the arm. The bone marrow stems cell then make their way into the bones to replenish the bone marrow. For younger people with a sibling donor, bone marrow transplant can be quite successful. You will begin medications to help suppress your body’s immune response to the new bone marrow. As with all transplants, there is a chance that your body will reject the transplant, which can lead to life-threatening complications. If your aplastic anemia is due to autoimmune disorder, your doctor may recommend medications that suppress the immune system including cyclosporine (Gengraf, Neoral or Sandimmune), anti-thymocyte globulin (Thymoglobulin), or steroids like methylperdnisolone (Medrol or Solu-medrol). Some medications are also available that stimulate certain parts of the bone marrow like sargramostim (Leukine) for white blood cells, filgrastim (Neupogen) for white blood cells, and epoetin alfa (Epogen or Procrit) for red blood cels. Because aplastic anemia weakens the immune system, you may require treatment for any infections you get. It is extremely important that you see your doctor for any signs of infection including fever because infections can become serious very quickly. You should discuss your treatment options with your doctor.