Dr. Lamiya Gurbanova is a physician who completed her specialization training in…
View profile →We review our content at regular intervals and update it whenever new research or a change in clinical guidelines requires it.
Overview
What Is Aplastic Anemia?
Aplastic anemia is a rare bone marrow failure disorder in which the bone marrow makes too few red blood cells, white blood cells and platelets. These cells carry oxygen, help fight infections and control bleeding. Aplastic anemia can occur at any age and may be inherited or acquired later in life. In many acquired cases, the exact cause is not found.
Symptoms
Aplastic Anemia Symptoms
- Fatigue can occur when a low red blood cell count reduces oxygen delivery.
- Pale skin (pallor) may result from too few red blood cells.
- Shortness of breath can occur with anemia, especially during activity.
- Frequent or persistent infections may occur when white blood cell counts are low.
- Fever may be a sign of an infection requiring prompt medical attention.
- Easy bruising can occur when platelet levels are low.
- Nosebleeds (epistaxis) may occur because of a low platelet count.
- Bleeding gums can occur when platelets do not adequately support clotting.
- Heavy menstrual bleeding (menorrhagia) may occur with low platelet counts.
Seek prompt care
Symptoms can become serious
Symptoms may develop gradually or appear suddenly, and their severity depends on which blood cell counts are low. Seek prompt medical assessment for a fever, uncontrolled bleeding or severe difficulty breathing.
Causes
Causes of Aplastic Anemia
Aplastic anemia occurs when blood-forming stem cells in the bone marrow are damaged or suppressed. In many acquired cases, an abnormal immune response attacks these cells, so the marrow cannot make enough red blood cells, white blood cells and platelets.
- Autoimmune marrow destruction can damage the stem cells that produce blood cells.
- Inherited bone marrow failure syndromes can impair blood cell production from childhood or later in life.
- Certain medicines can rarely suppress or damage the bone marrow.
- Chemotherapy or radiation can injure blood-forming stem cells.
- Toxic chemical exposure, including some industrial chemicals, can affect marrow function.
- Viral infections may trigger marrow suppression or an immune response against marrow cells.
- Pregnancy is an uncommon setting in which aplastic anemia may develop or become apparent.
- Many cases are idiopathic, meaning that no specific cause is identified.
Risk Factors
Aplastic Anemia Risk Factors
NON-MODIFIABLE OR INHERITED
Inherited marrow failure syndromes, autoimmune disease and genetic susceptibility may increase the likelihood of aplastic anemia. These factors cannot usually be changed or prevented.
EXPOSURE OR MEDICAL FACTORS
Prior chemotherapy or radiation, selected medicines, toxic chemical exposure, certain infections and pregnancy have been associated with aplastic anemia. These factors may sometimes be avoided, treated or medically monitored.
Having a risk factor does not mean that someone will develop aplastic anemia. Many people with aplastic anemia have no known risk factor or identifiable trigger.
Complications
Aplastic Anemia Complications
- Neutropenia can lead to serious infections because the body has fewer infection-fighting white blood cells.
- Thrombocytopenia can cause dangerous bleeding because there are too few platelets to form clots.
- Severe anemia can reduce oxygen delivery and cause profound weakness or reduced exercise tolerance.
- Long-lasting anemia can place extra strain on the heart.
- Treatments such as transfusions, immunosuppression or transplantation can have their own complications.
- Fatigue, infections and bleeding can reduce a person’s ability to work or perform daily activities.
Medical warning
Infection and bleeding can become emergencies
Seek urgent medical care for a fever, unusual or uncontrolled bleeding, black or bloody stools, severe weakness, chest pain, confusion or trouble breathing. Low white blood cell or platelet counts can make infection or bleeding become dangerous quickly.
Diagnosis
Diagnosis of Aplastic Anemia
Clinicians assess symptoms, medical and medication history, examination findings and complete blood count results. Aplastic anemia is suspected when multiple blood cell types are reduced, but additional tests are needed to confirm the diagnosis and rule out other causes.
- A complete blood count measures red blood cells, white blood cells, platelets and related values.
- A peripheral blood smear examines the appearance of blood cells under a microscope.
- A reticulocyte count shows whether the bone marrow is making new red blood cells.
- Bone marrow aspiration and biopsy assess the number and activity of blood-forming cells in the marrow.
- Chromosome or genetic testing can identify inherited marrow failure syndromes or other abnormalities.
- Viral testing looks for infections that may contribute to low blood counts.
- Tests for other causes of pancytopenia help distinguish aplastic anemia from related conditions.
Treatment & Management
Aplastic Anemia Treatment and Management
| Approach | When it may be considered | Main purpose |
|---|---|---|
| Observation and specialist monitoring | Mild or stable disease with acceptable blood counts and no urgent complications | Track blood counts and detect worsening or relapse early |
| Supportive care | Low blood counts, symptoms, infection or bleeding | Use transfusions and prompt infection treatment to support the body |
| Immunosuppressive therapy | Acquired disease when an immune attack is suspected and transplantation is not the best initial option | Reduce immune damage to marrow stem cells and allow blood production to recover |
| Allogeneic stem cell transplantation | Selected patients, especially those with severe disease and a suitable donor | Replace damaged blood-forming stem cells with healthy donor cells |
Treatment is individualized according to severity, age, overall health, cause, donor availability and response to therapy. Hematology follow-up remains important even when blood counts improve, because relapse and treatment effects may need monitoring.
- Red blood cell or platelet transfusions can temporarily improve oxygen delivery or reduce bleeding risk.
- Infections require prompt evaluation and treatment, particularly when white blood cell counts are low.
- Marrow-toxic medicines or exposures should be avoided when possible under specialist guidance.
- Infection precautions may include hand hygiene, avoiding sick contacts and following the hematology team’s advice.
- Bleeding precautions may include avoiding injury and medicines that increase bleeding unless prescribed.
- Iron levels should be monitored after repeated transfusions because iron can accumulate in the body.
- Blood counts and symptoms are monitored for relapse, treatment effects and changes in marrow function.
Outlook and Prognosis
Outlook and Prognosis for Aplastic Anemia
Aplastic anemia is a serious but treatable condition. Its course ranges from stable disease that requires monitoring to severe disease requiring urgent therapy, and there is no single outlook that applies to everyone.
FACTORS THAT SUPPORT RECOVERY
A favorable outlook may be associated with less severe disease, a good treatment response, younger age, better overall health and timely specialist care. A suitable donor may also support the option of transplantation when it is appropriate.
FACTORS REQUIRING CLOSER MONITORING
More complex care may be needed with severe disease, serious infections or bleeding, significant health problems, transplant complications, relapse or evolution to another marrow disorder. Donor availability and response to treatment also affect the outlook.
When Should You See a Doctor
When Should You See a Doctor?
- Arrange medical evaluation for persistent or unexplained fatigue.
- Arrange medical evaluation for repeated infections.
- Arrange medical evaluation for unusual bruising or bleeding.
- Arrange medical evaluation for pale skin accompanied by shortness of breath.
- Arrange medical evaluation if blood test results show low blood counts.
Get urgent medical help
Fever or bleeding needs prompt attention
If you have known or suspected aplastic anemia, seek urgent or emergency care for fever, severe infection symptoms, uncontrolled bleeding, black or bloody stools, chest pain, fainting, confusion or severe trouble breathing. Follow your hematology team’s specific instructions about fever and when to call.
Branches
1 topic
Aplastic Anemia
Hematology
