Aplastic Anemia

Aplastic Anemia[1]

Aplastic anemia is a form of anemia due to failure in bone marrow production of leukocytes, erythrocytes and platelets, resulting in peripheral blood pancytopenia.


Fatigue is the most common presentation as it is the first symptom of low red blood cell count. Fatigue also sets in when there is a lack of hemoglobin in the blood [7].

Other common symptoms of aplastic anemia are chest pain, pale skin, excessively cold extremities, headaches, dyspnea and dizziness shortly after standing.

Arrhythmia is another common presentation of aplastic anemia. In some cases, this may lead to an enlarged heart or heart failure.
Fevers, flu-like symptoms and persistent infections are also common and this is as a result of neutropenia.

Easy and prolonged bleeding also shows a reduction in platelets in the body. Some of the types of bleeding seen in people with lthrombocytopenia include epistaxis, bleeding gums, bloodied stool and red spots in the skin. In women, it may lead to heavy menstrual bleeding.

Skin rashes and nausea are other common symptoms.


In diagnosing aplastic anemia, the main procedures carried out include complete blood count, reticulocyte count and bone marrow tests [8]. However, other tests can also be used to improve diagnosis. These include [9]:

  • Liver tests and viral studies (EBV, CMV, hepatitis A, hepatitis B, hepatitis C, HIV, parvovirus B19) to confirm the absence of liver diseases and viruses.
  • X-ray, CT scans and ultrasound imaging tests to show any enlarged lymph nodes in the abdomen.
  • Iron, vitamin B12 and folate levels in the blood to rule out any forms of anemia.
  • Flow cytometric analysis of GPI-anchored proteins
  • Coagulation parameters: Quick value, PTT, fibrinogen
  • Hemolysis parameters
  • Kidney parameters
  • Electrophoresis, immunoglobulins
  • Blood glucose
  • C-reactive protein (CRP)
  • Antinuclear antibodies

The sonographic examination and radiograph of the thorax, HLA typing, as well as electrocardiography (ECG) complete the medical workup.


In people with mild to moderate cases of aplastic anemia, there may not be need for treatment unless the condition deteriorates. In those with proven severe cases of aplastic anemia, medical treatment is needed to prevent any types of complications.

Severe cases of aplastic anemia are treated in emergency units in the hospital as these cases can quickly become fatal if left untreated for long.

The most common treatment path for severe cases is blood transfusion and stem cell transplant [10].


This condition is a rare disorder but it is usually serious [6]. Its course of development may either be slow or sudden but the disorder always gets worse over a period of time when the etiologic factors are left untreated.

With the right type of care (may involve blood transfusion, stem cell transplants and use of medicines), people with the condition can be treated completely.


Damage to the bone marrow is the main cause of aplastic anemia [3]. Impairment to the stem cells makes them unable to grow into healthy blood cells. The cause of the stem cell defacing can either be acquired or inherited.

Acquired cases of aplastic anemia are most common and in many cases they are temporary. Inherited cases of aplastic anemia are relatively uncommon. In majority of aplastic anemia cases, the cause of the condition remains unknown. Some research explains that stem cell damage often occurs because the immune system’s non-deliberate attack on its own cells.

Acquired aplastic anemia can be caused by exposure to toxins (arsenic, benzene, pesticides), exposure to radiation or chemotherapy, use of antibiotics (chloramphenicol), infectious diseases (HIV, cytomegalovirus, Epstein-Barr virus, hepatitis, parvovirus) and autoimmune disorders (rheumatoid arthritis and lupus erythematodes).

Pregnancy has been noted in some cases as the etiologic factor for aplastic anemia but aplastic anemia as a result of pregnancy often resolves after delivery. Again, cancer from other parts of the body that spreads to the bone can bring about aplastic anemia.


Aplastic anemia is rare so the annual incidence is placed at about 2 cases for every one million [4]. The condition has a regional predilection as it is seen 2 to 3 more times in Asia than in the West.

Acquired aplastic anemia is seen mostly in people within the ages of 15 and 25 years but the condition is also common at old age with the next highest peak seen in people aged 60 and above.

Sex distribution
Age distribution


The pathophysiology of this condition is unclear but it is believed to be an immune mediated disease [5]. A variety of cellular and molecular pathways involving both the target and effector cells are involved in the process. The effector cells are the T cells and the target cells are hematopoietic stem and progenitor cells.


Most of the time there is no prevention for aplastic anemia but to lower risk of the disease even further, it is advisable to avoid insecticides, herbicides and all other toxic chemicals.


Aplastic anemia is a disease where the stem cells of the bone marrow are damaged [1]. This makes the body lose its ability to produce erythrocytes and leukocytes. The production of platelets is also affected. The disease is also known as bone marrow failure.

The condition is one of several types of anaemia. An anemia is a condition that develops when the blood has a far reduced number of red blood cells. It is also seen when there is a reduced amount of hemoglobin in the blood. 

The stem cells can get damaged by a variety of factors including diseases or conditions. The causes may be inherited or acquired.

However in majority of cases, the cause of aplastic anemia is unknown [2].

Patient Information

Aplastic anemia is a condition seen when the body is not producing the right amount of new blood cells. Patients are left fatigued and highly vulnerable to many kinds of infections as well as excessive and uncontrollable bleeding.

This condition is often serious and can develop at any stage. The progression is erratic so it may occur suddenly or gradually.

Treatment for the condition includes medications, blood transfusions and stem cell transplant depending on the severity of the condition.


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  1. Wu Y, Yu J, Zhang L, Luo Q, Xiao JW, Liu XM, et al. [Hematopoiesis support of mesenchymal stem cells in children with aplastic anemia]. Zhongguo Dang Dai Er Ke Za Zhi. Aug 2008;10(4):455-9. 
  2. Scopes J, Daly S, Atkinson R, Ball SE, Gordon-Smith EC, Gibson FM. Aplastic anemia: evidence for dysfunctional bone marrow progenitor cells and the corrective effect of granulocyte colony-stimulating factor in vitro. Blood. Apr 15 1996;87(8):3179-85.
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  4. Liu H, Mihara K, Kimura A, Tanaka K, Kamada N. Induction of apoptosis in CD34+ cells by sera from patients with aplastic anemia. Hiroshima J Med Sci. Jun 1999;48(2):57-63.
  5. Marsh JC. Long-term bone marrow cultures in aplastic anaemia. Eur J Haematol Suppl. 1996;60:75-9. 
  6. Young NS. Acquired aplastic anemia. Ann Intern Med 2002; 136:534.
  7. Wallerstein RO, Condit PK, Kasper CK, et al. Statewide study of chloramphenicol therapy and fatal aplastic anemia. JAMA 1969; 208:2045.
  8. Marsh JC, Ball SE, Cavenagh J, et al. Guidelines for the diagnosis and management of aplastic anaemia. Br J Haematol 2009; 147:43.
  9. Scheinberg P, Young NS. How I treat acquired aplastic anemia. Blood 2012; 120:1185.
  10. Rovó A, Tichelli A, Dufour C, SAA-WP EBMT. Diagnosis of acquired aplastic anemia. Bone Marrow Transplant 2013; 48:162.

Media References

  1. Aplastic Anemia, CC BY-SA 4.0