Aplastic anemia is a condition in which the bone marrowdoes notmake enough newblood cells. Bone marrow is the soft, fatty tissue in the center of bones.
Aplastic anemia results from injury to the blood stem cells. These areimmature cells in the bone marrow that give rise to all other blood cells types. The injury causes a decrease in the number of every type of blood cell. These cells are the red cells, white cells, and platelets.
Aplastic anemia canalso be caused by certain medical conditions such as pregnancy or lupus. Exposure tocertain toxins or medicines, including chemotherapy, can also lead to aplastic anemia.
Symptoms resultfrom thebone marrow not being able to make new blood cells. Symptoms may be severe from the start or gradually worsen over time.
Low red cell count (anemia) can cause:
- Pallor (paleness)
- Rapid heart rate
- Shortness of breath with exercise
- Lightheadedness upon standing
Low white cell count (leukopenia) causes an increased risk of infection.
Low platelet count (thrombocytopenia) can result in bleeding. Symptoms include:
- Bleeding gums
- Easy bruising
- Frequent or severe infections
- Nose bleeds
- Rash--small pinpoint red marks on the skin (petechiae)
Exams and Tests
The health care provider will perform a physical exam.
Blood tests will show:
- Low red blood cell count (anemia)
- Low white blood cell count
- Low reticulocyte count (reticulocytes are immature red blood cell)
- Low platelet count
A bone marrow biopsy shows fewer-than-normal blood cells and an increased amount of fat.
Mild cases of aplastic anemia may require no treatment. Symptomsare treated as needed.
If blood counts become lower, patients receive extra blood and platelets through transfusions. Over time, transfusions may stop working, resulting in very lowblood cell counts. This is a life-threatening condition.
Bone marrow transplant or stem cell transplantmay berecommended for patients under age 40. This treatment works best when the donor is a fully-matchedbrother or sister. This is called a matched sibling donor.
Older patients and those who do not have a matched sibling donor are givenmedicinesto suppress the immune system. These medicines may allow the bone marrow to once again make healthy blood cells. But the disease may return (relapse). A bone marrow transplant with an unrelated donor may be tried if these medicines do not help or if the disease comes back after getting better
Untreated, severe aplastic anemia leads to rapid death. Bone marrow transplant is very successful in young people. It is alsoused in older patients or whenthe disease comes back after medicines have been tried.
- Severe infections or bleeding
- Complications of bone marrow transplant
- Reactions to medicines
- Hemochromatosis (buildup of too much iron in the body tissuesfrom many red cell transfusions)
When to Contact a Medical Professional
Call your health care provider or go to the emergency room if bleeding occurs for no reason, or if bleeding ishard to stop. Call if you notice frequent infections or unusual fatigue.
Bagby GC. Aplastic anemia and related bone marrow failure states. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 168.
Young NS, Maciejewski JP. Aplastic anemia. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 28.
Review Date: 3/4/2013
Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.