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    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.

    Presentation

    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.

    Jaw & Teeth
    Bleeding Gums
    • Physical findings : Anemia with fatigue and pallor, bruising, petechiae (non-raised hemorrhage in the skin or in a membrane), and bleeding gums.[secure.ssa.gov]
    • Some additional signs and symptoms that occur with aplastic anemia include those due to decreased platelets: Prolonged bleeding Frequent nosebleeds and bleeding gums Easy bruising Pinpoint red spots on skin Blood in the stool Heavy menstrual bleeding[labtestsonline.org]
    • Symptoms include: Bleeding gums Easy bruising Frequent or severe infections Nose bleeds Rash, small pinpoint red marks on the skin (petechiae) Exams and Tests Blood tests will show: Low red blood cell count (anemia) Low white blood cell count (leukopenia[mountsinai.org]
    • The following are some of the most common symptoms: Headache Dizziness Nausea Shortness of breath Bruising Lack of energy or tiring easily (fatigue) Abnormal paleness or lack of color of the skin Blood in stool Nosebleeds Bleeding gums Fevers Sinus tenderness[chop.edu]
    • Symptoms may include: Headache Dizziness Nausea Shortness of breath Bruising Lack of energy or tiring easily (fatigue) Abnormal paleness or lack of color of the skin Blood in stool Nosebleeds Bleeding gums Fevers Sinus tenderness Enlarged liver or spleen[nationwidechildrens.org]
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  • Entire body system
    Anemia
    • Aplastic anemia involves all different cell lines.[en.wikipedia.org]
    • Anà mie {f} med. anemia [Am.][dict.cc]
    • Symptoms Symptoms of Aplastic Anemia The symptoms of aplastic anemia are similar to those of general anemia.[healthline.com]
    Exposure to Benzene
    • Known causes of aplastic anemia include various medications, rheumatologic disorders, hepatitis, pregnancy, and exposure to benzene.[cancernetwork.com]
    Fatigue
    • Too few red blood cells lead to a decrease in hemoglobin and symptoms of fatigue.[danafarberbostonchildrens.org]
    • Transfusions of red blood cells can help combat the fatigue and shortness of breath experienced by aplastic anemia patients.[hopkinsmedicine.org]
    • Call if you notice frequent infections or unusual fatigue.[mountsinai.org]
    • The following are some of the most common symptoms: Headache Dizziness Nausea Shortness of breath Bruising Lack of energy or tiring easily (fatigue) Abnormal paleness or lack of color of the skin Blood in stool Nosebleeds Bleeding gums Fevers Sinus tenderness[chop.edu]
    • Symptoms may include: Headache Dizziness Nausea Shortness of breath Bruising Lack of energy or tiring easily (fatigue) Abnormal paleness or lack of color of the skin Blood in stool Nosebleeds Bleeding gums Fevers Sinus tenderness Enlarged liver or spleen[nationwidechildrens.org]
    Fever
    • Side effects include fever, high blood pressure and kidney problems.[hopkinsmedicine.org]
    • Lack of energy or tiring easily (fatigue) Shortness of breath Pale skin, lips, and hands, or paleness under the eyelids Bruising, or a red or purple pinpoint rash on the face or body Bleeding (for example bleeding gums, nosebleeds, blood in the stool) Fevers[danafarberbostonchildrens.org]
    • If persistent fevers, consider fungal coverage.[pedemmorsels.com]
    • Symptoms may include: From decreased red blood cells: Headache Dizziness Shortness of breath Lack of energy or tiring easily (fatigue) Pale skin Chest pain Irregular heart beat Enlarged heart From too few white blood cells: Fevers Mouth sores Infections[urmc.rochester.edu]
    • Symptoms of chronic aplastic anemia include weakness and fatigue in the early stages, followed by shortness of breath, headache, fever, and pounding heart.[britannica.com]
    Pain
    • Radiation therapy- radiation may help a small number of people who have bone pain.[ohsu.edu]
    • Marrow Donation : Because donors are asleep during the procedure, donors feel no pain while marrow is extracted.[brentbishop.com]
    • Other symptoms of PNH may include back pain, abdominal pain, and liver failure.[marrowforums.org]
    • ., ehrlichia) Drugs and chemicals Estrogen administration Chemotherapeutic drug administration Albendazole (for parasitic treatment) Some types of antibiotics NSAIDs (given for relief of pain and inflammation) Radiation therapy in cancer patients Diagnosis[petmd.com]
    • These are common symptoms for each: Low red blood cell count: Tiredness Shortness of breath Dizziness Pale skin Headaches Chest pain Irregular heartbeat Low white blood cell count: Infections Fever Low platelet count: Easy bruising and bleeding Nosebleeds[webmd.com]
    Pallor
    • Physical findings : Anemia with fatigue and pallor, bruising, petechiae (non-raised hemorrhage in the skin or in a membrane), and bleeding gums.[secure.ssa.gov]
    • There is usually a waxy pallor, and hemorrhages occur in the mucous membranes, skin, and other organs.[britannica.com]
    • Low red cell count (anemia) can cause: Fatigue Pallor (paleness) Rapid heart rate Shortness of breath with exercise Weakness Lightheadedness upon standing Low white cell count (leukopenia) causes an increased risk for infection.[mountsinai.org]
    • Low red cell count (anemia) can cause: Fatigue Pallor (paleness) Rapid heart rate Shortness of breath with exercise Weakness Lightheadedness upon standing Low white cell count (leukopenia) causes an increased risk of infection.[nytimes.com]
    Recurrent Infection
    • Low white cells can lead to frequent and recurrent infections.[froedtert.com]
    • Recurrent infections Fever Petechial hemorrhage (red or purple spots on skin due to tiny hemorrhages) Blood in urine ( hematuria ) Nosebleed ( epistaxis ) Black-colored feces ( melena ) Pale mucous membrane Weakness Lethargy Causes There are a variety[petmd.com]
    Refractory Anemia
    • In addition, the 5q- syndrome was identified as a unique subset of refractory anemia with an excellent prognosis.[cancernetwork.com]
    Weakness
    • When you are anemic, your body does not transport oxygen efficiently and this can make you tired and weak.[healthline.com]
    • Symptoms of AA may include bleeding of the gums, bleeding of internal organs, bruising, frequent or severe infections, nosebleeds, rapid heart rate, rash, shortness of breath during physical activity, and weakness.[secure.ssa.gov]
    • Symptoms of chronic aplastic anemia include weakness and fatigue in the early stages, followed by shortness of breath, headache, fever, and pounding heart.[britannica.com]
    • Recurrent infections Fever Petechial hemorrhage (red or purple spots on skin due to tiny hemorrhages) Blood in urine ( hematuria ) Nosebleed ( epistaxis ) Black-colored feces ( melena ) Pale mucous membrane Weakness Lethargy Causes There are a variety[petmd.com]
    • In aplastic anemia, anemia may cause weakness and easy fatigability while severe thrombocytopenia may cause petechiae, ecchymosis, and bleeding from the gums, into the conjunctivae, or other tissues.[merckmanuals.com]
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  • Face, Head & Neck
    Epistaxis
    • Recurrent infections Fever Petechial hemorrhage (red or purple spots on skin due to tiny hemorrhages) Blood in urine ( hematuria ) Nosebleed ( epistaxis ) Black-colored feces ( melena ) Pale mucous membrane Weakness Lethargy Causes There are a variety[petmd.com]
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  • neurologic
    Difficulty Concentrating
    • Symptoms of systemic mastocytosis include allergic skin reactions, difficulty concentrating and diarrhea.[ohsu.edu]
    Headache
    • Symptoms of chronic aplastic anemia include weakness and fatigue in the early stages, followed by shortness of breath, headache, fever, and pounding heart.[britannica.com]
    • These are common symptoms for each: Low red blood cell count: Tiredness Shortness of breath Dizziness Pale skin Headaches Chest pain Irregular heartbeat Low white blood cell count: Infections Fever Low platelet count: Easy bruising and bleeding Nosebleeds[webmd.com]
    • Chronic CSA toxicities include increased susceptibility to infections, hypertension, and irreversible renal damage, as well as hypertrichosis, hyperaesthesias, gingival hyperplasia, headaches, tremors, and other troubling complaints; there is also a possible[clinicaltrials.gov]
    • The following are some of the most common symptoms: Headache Dizziness Nausea Shortness of breath Bruising Lack of energy or tiring easily (fatigue) Abnormal paleness or lack of color of the skin Blood in stool Nosebleeds Bleeding gums Fevers Sinus tenderness[chop.edu]
    • Symptoms may include: Headache Dizziness Nausea Shortness of breath Bruising Lack of energy or tiring easily (fatigue) Abnormal paleness or lack of color of the skin Blood in stool Nosebleeds Bleeding gums Fevers Sinus tenderness Enlarged liver or spleen[nationwidechildrens.org]
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  • Skin
    Petechiae
    • Symptoms result from anemia, thrombocytopenia (petechiae, bleeding), or leukopenia (infections).[merckmanuals.com]
    • Physical findings : Anemia with fatigue and pallor, bruising, petechiae (non-raised hemorrhage in the skin or in a membrane), and bleeding gums.[secure.ssa.gov]
    • Symptoms include: Bleeding gums Easy bruising Frequent or severe infections Nose bleeds Rash, small pinpoint red marks on the skin (petechiae) Exams and Tests Blood tests will show: Low red blood cell count (anemia) Low white blood cell count (leukopenia[mountsinai.org]
    • Symptoms include: Bleeding gums Easy bruising Frequent or severe infections Nose bleeds Rash--small pinpoint red marks on the skin (petechiae) Back to Top Treatment Mild cases of aplastic anemia may require no treatment.[nytimes.com]
    Purpura
    • Food and Drug Administration today approved Promacta (eltrombopag) to treat low blood platelet count in pediatric patients – ages one year and older – with a rare blood disorder called chronic immune thrombocytopenic purpura (ITP).[news-medical.net]
    • CONCLUSIONS: Acute lymphoblastic leukaemia was the commonest cause of haematological thrombocytopenia followed by idiopathic thrombocytopenic purpura and aplastic anaemia.[cancerindex.org]
    • Prolonged cyclosporine use however, produces renal impairment, and a syndrome resembling thrombotic thrombocytopenic purpura.[bio.davidson.edu]
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  • respiratoric
    Dyspnea
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  • gastrointestinal
    Loss of Appetite
    • Clinical signs include loss of appetite, a thick, purulent ocular (eye) and/or nasal discharge, fever, thickened and hard skin on the footpads and often a rash on the chin, abdomen, or groin.[vcahospitals.com]
    • Have a loss of appetite or lose weight.[aamds.org]
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  • musculoskeletal
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  • cardiovascular
    Tachycardia
    • Physical findings may help alert us to the presence of aplastic anemia: Pallor, petechiae Tachycardia, hepatomegaly, systolic flow murmur Physical findings can also highlight possible inherited condition: Ex, dystrophic nails, oral leukoplakia, and reticular[pedemmorsels.com]
    • Clinically it is manifested by weakness, exercise intolerance, hyperpnea which is only moderate, pallor of mucosae, tachycardia and a large increase in the intensity of the heart sounds.[medical-dictionary.thefreedictionary.com]
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  • urogenital
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  • hematological
    Easy Bruising
    • Low platelet counts can result in easy bruising or bleeding.[froedtert.com]
    • Some symptoms include tiredness, paleness, frequent infections, and easy bruising and bleeding.[urmc.rochester.edu]
    • Some additional signs and symptoms that occur with aplastic anemia include those due to decreased platelets: Prolonged bleeding Frequent nosebleeds and bleeding gums Easy bruising Pinpoint red spots on skin Blood in the stool Heavy menstrual bleeding[labtestsonline.org]
    • These are common symptoms for each: Low red blood cell count: Tiredness Shortness of breath Dizziness Pale skin Headaches Chest pain Irregular heartbeat Low white blood cell count: Infections Fever Low platelet count: Easy bruising and bleeding Nosebleeds[webmd.com]
    • Symptoms include: Bleeding gums Easy bruising Frequent or severe infections Nose bleeds Rash, small pinpoint red marks on the skin (petechiae) Exams and Tests Blood tests will show: Low red blood cell count (anemia) Low white blood cell count (leukopenia[mountsinai.org]
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  • Eyes
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  • Ears
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  • Workup

    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.

    Pathology

    Biopsy
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  • Laboratory

    Serum
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  • Treatment

    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].

    Prognosis

    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.

    Complications

    Acute Leukemia
    • In some patients, MDS progresses over time to acute leukemia.[marrowforums.org]
    • However, long-term survivors receiving immunosuppressive therapy are more likely to develop cancer, especially acute leukemia.[drugs.com]
    • Probability of evolution to MDS and / or acute leukemia in patients with acquired AA and treated with immunosuppression, according to pre-treatment age-adjusted telomere length.[nature.com]
    • Indications for SCT were acute leukemia in 46% (13/28) and severe aplastic anemia in 21% (6/28).[cancerindex.org]
    Acute Lymphoblastic Leukemia
    • ) for certain children, adolescents, and young adults with a form of acute lymphoblastic leukemia (ALL).[cancer.org]
    • lymphoblastic leukemia (ALL)(rarely) Drugs and elements (eg, chloramphenicol, phenylbutazone, gold) may cause aplasia of the marrow.[emedicine.medscape.com]
    • lymphoblastic leukemia Acute myeloblastic leukemia Myelodysplastic aplasia Mainly but not exclusively in children Spontaneous or steroid-induced remission followed by later appearance of leukemia Table 1 The disease can be congenital or acquired, with[bio.davidson.edu]
    Aplastic Crisis
    • Applicable To Hypoplastic anemia NOS Medullary hypoplasia Approximate Synonyms Anemia, aplastic Anemia, aplastic, secondary Aplastic anemia Aplastic anemia crisis Aplastic crisis Secondary aplastic anemia ICD-10-CM D61.9 is grouped within Diagnostic Related[icd10data.com]
    • Englisch Deutsch med. aplastic anaemia [Br.] aplastische Anà mie {f} med. aplastic anemia [Am.] aplastische Anà mie {f} Teilweise Übereinstimmung med. aplastic crisis aplastische Krise {f} med. anaemia [Br.][dict.cc]
    • More frequently parvovirus B19 is associated with aplastic crisis which involves only the red blood cells ( despite the name).[en.wikipedia.org]
    • The availability of molecular testing has assisted in partial resolution of this problem but has raised new issues, such as the p […] Tags: Anemia Aplastic Anemia Aplastic Crisis leukopenia Parvovirus B19 thrombocytopenia Sean Fox I enjoy taking care[pedemmorsels.com]
    • Sickle cell anaemia: aplastic crisis associated with parvovirus infection.[patient.info]
    Bacterial Infections
    • Treatment is supportive, with fluids, antibiotics (for secondary bacterial infections), nutrition, and oxygen therapy.[vcahospitals.com]
    • infections, especially if neutropenic![pedemmorsels.com]
    • Because fungal and bacterial infections are a major cause of death in patients with severe aplastic anemia, patients may require therapy with antibiotics, or with antiviral or antifungal agents.[hopkinsmedicine.org]
    • These include treatment with high-dose radiation or chemotherapy for cancer exposure to toxic chemicals, including some pesticides and insecticides use of some medications, such as chloramphenicol, which is used to treat bacterial infections, and gold[marrowforums.org]
    • These patients have a high chance of dying from overwhelming bacterial infections.[medical-dictionary.thefreedictionary.com]
    Eosinophilic Fasciitis
    • Other conditions associated with aplastic anemia include idiosyncratic drug reactions (chloramphenicol), chemical exposure, eosinophilic fasciitis, and seronegative hepatitis [ 5 ]. 78% of cases of aplastic anemia exhibit ophthalmic manifestations.[casesjournal.biomedcentral.com]
    • fasciitis Anorexia Severe nutritional deficiencies (B12, folate) Paroxysmal nocturnal hemoglobinuria (PNH) MDS Acute lymphoblastic leukemia (ALL)(rarely) Drugs and elements (eg, chloramphenicol, phenylbutazone, gold) may cause aplasia of the marrow.[emedicine.medscape.com]
    Hairy Cell Leukemia
    • Monocytopenia can be present and imposes the differential diagnosis of hairy cell leukemia.[nature.com]
    Hematoma
    • Typical ophthalmic manifestations include eyelid hematoma, subconjunctival hemorrhage, cotton wool spots, retinal nerve fiber layer hemorrhage, Roth's spots, pre-retinal hemorrhage, vitreous hemorrhage, and disc edema.[casesjournal.biomedcentral.com]
    Hypersplenism
    • Occasionally, diagnostic tests are negative for any specific disease, in which case the diagnosis of "benign hypersplenism" or "benign splenomegaly" will be made.[vcahospitals.com]
    • Differential diagnosis Hypersplenism Hypocellular myelodysplasia, acute myeloid leukaemia Hypocellular acute lymphoblastic leukaemia Hairy cell leukaemia Lymphoma Mycobacterial infections Anorexia nervosa or prolonged starvation Myeloma Systemic lupus[patient.info]
    • It also had to be established that the condition was not due to neoplastic or granulomatous disease involving the bone marrow, systemic lupus erythematosus, AIDS, hypersplenism or other conditions associated with pancytopenia such as myelodysplastic syndrome[haematologica.org]
    Infection
    • Short-lived aplastic anemia can also be a result of parvovirus infection.[en.wikipedia.org]
    • Following are some major causes of aplastic anemia in dogs: Infections Canine parvovirus infection Rikettsial organism infections (e.g., ehrlichia) Drugs and chemicals Estrogen administration Chemotherapeutic drug administration Albendazole (for parasitic[petmd.com]
    • CXR: to exclude infection.[patient.info]
    • This puts patients at risk for infections, often unusual ones.[drugs.com]
    • However, it is a very intensive therapy, and serious immune complications and infections are not unusual.[hopkinsmedicine.org]
    Leukopenia
    • Symptoms result from anemia, thrombocytopenia (petechiae, bleeding), or leukopenia (infections).[merckmanuals.com]
    • Low red cell count (anemia) can cause: Fatigue Pallor (paleness) Rapid heart rate Shortness of breath with exercise Weakness Lightheadedness upon standing Low white cell count (leukopenia) causes an increased risk for infection.[mountsinai.org]
    • In aplastic anemia, the patient has pancytopenia (i.e., leukopenia and thrombocytopenia) resulting in decrease of all formed elements.[en.wikipedia.org]
    • TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING Diagnostic testing : Bone marrow aspirate and biopsy is required for diagnosis and to rule out other causes of pancytopenia such as cancer or infection; blood counts documenting anemia, thrombocytopenia, leukopenia[secure.ssa.gov]
    Myelosuppression
    • ETIOLOGY OF ACQUIRED APLASTIC ANEMIA Drugs As a well-known cause of aplastic anemia, drugs may produce predictable marrow failure, such as a myelosuppression following cancer chemotherapy.[bio.davidson.edu]
    Pancytopenia
    • In aplastic anemia, the patient has pancytopenia (i.e., leukopenia and thrombocytopenia) resulting in decrease of all formed elements.[en.wikipedia.org]
    • AlSuliman AM, Al Qadaiub K ; A 15-year-old girl with pancytopenia and congenital defects.[patient.info]
    • The designation "aplastic anemia" is a misnomer because the disorder is defined as pancytopenia rather than anemia [ 1 ].[uptodate.com]
    • Relapse was common, but severe pancytopenia usually did not recur.[jama.jamanetwork.com]
    Paroxysmal Nocturnal Hemoglobinuria
    • Paroxysmal Nocturnal Hemoglobinuria Paroxysmal nocturnal hemoglobinuria (PNH) is a disease in which the bone marrow produces red blood cells with a defective protective layer.[marrowforums.org]
    • nocturnal hemoglobinuria, and inherited disorders (for example, Fanconi anemia).[medicinenet.com]
    • Paroxysmal nocturnal hemoglobinuria error Paroxysmal nocturnal hemoglobinuria (PNH) results from a mutation in a hematopoietic stem cell .[ohsu.edu]
    • Aplastic anemia and paroxysmal nocturnal hemoglobinuria (PNH) Some patients with aplastic anemia also get another rare, life-threatening blood disorder called paroxysmal nocturnal hemoglobinuria (PNH).[northwell.edu]
    • Many patients with aplastic anemia also have clones of cells characteristic of the rare disease paroxysmal nocturnal hemoglobinuria (PNH, anemia with thrombopenia and/or thrombosis), sometimes referred to as AA/PNH.[en.wikipedia.org]
    Severe Anemia
    • […] noun , Pathology. 1. severe anemia due to destruction or depressed functioning of the bone marrow, usually resulting from bone cancer, radiation, or the toxic effects of certain drugs or chemicals.[dictionary.reference.com]
    • It leaves scars in your bone marrow, leading to severe anemia, weakness, fatigue and often an enlarged spleen and scar tissue on the liver.[ohsu.edu]
    • In people with conditions where the cells die early (such as sickle cell disease), however, parvovirus infection can lead to severe anemia.[en.wikipedia.org]
    • […] anemia varies between institutions. [ Williams, 2014 ] “Aplastic Anemia” tri-lineage peripheral blood cytopenia due to reduced or absent production of hematopoietic cells without cellular infiltration . [ Barone, 2015 ] Bone marrow failure leads to: Severe[pedemmorsels.com]
    • The combination of poor diet and chronic loss of blood makes for particular susceptibility to severe anemia.[medical-dictionary.thefreedictionary.com]
    Thrombocytopenia
    • Symptoms result from anemia, thrombocytopenia (petechiae, bleeding), or leukopenia (infections).[merckmanuals.com]
    • Low platelet counts (thrombocytopenia) if present is associated with an increased risk of hemorrhage, bruising and petechiae.[en.wikipedia.org]
    • Thrombocytopenia-absent radius syndrome Thrombocytopenia-absent radius (TAR) syndrome is characterized by deletions located at chromosome 1q21.1 (which are typically about 200kb in size).[emedicine.medscape.com]
    • [ Barone, 2015 ] Lab Tests useful in the Emergency Department: CBC with Differential Usually shows normochromic, normocytic anemia In early stages, only one or two cell lines may be effected (usually thrombocytopenia). [ Barone, 2015 ] Reticulocyte Count[pedemmorsels.com]
    • Low platelet count (thrombocytopenia) can result in bleeding.[mountsinai.org]
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  • Etiology

    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.

    Epidemiology

    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

    Pathophysiology

    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.

    Prevention

    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.

    Summary

    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.

    Self-assessment

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    References

    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.
    3. Young NS. Pathophysiologic mechanisms in acquired aplastic anemia. Hematology Am Soc Hematol Educ Program. 2006;72-7.
    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.

    • Antibody-mediated aplastic anemia and diffuse fasciitis - R Hoffman, N Dainiak, L Sibrack - England Journal of , 1979 - Mass Medical Soc
    • Acute radiation injury: contingency planning for triage, supportive care, and transplantation - D Weisdorf, N Chao, JK Waselenko, N Dainiak - Biology of Blood and , 2006 - Elsevier
    • Acute childhood leukemia presenting as aplastic anemia: the response to corticosteroids - DK Melhorn, S Gross, AJ Newman - The Journal of pediatrics, 1970 - Elsevier
    • A prospective study of androgens and bone marrow transplantation for treatment of severe aplastic anemia - BM Camitta, ED Thomas, DG Nathan - , 1979 - bloodjournal.hematologylibrary.org
    • By combination therapy with recombinant human granulocyte colony‐stimulating factor and erythropoietin in patients with aplastic anemia and refractory anemia - M Bessho, I Jinnai, K Hirashima, M Saito - Stem , 1994 - Wiley Online Library
    • Antithymocyte globulin treatment in patients with aplastic anemia - R Champlin, W Ho, RP Gale - New England Journal of Medicine, 1983 - Mass Medical Soc
    • A pathogenetic link between aplastic anemia and paroxysmal nocturnal hemoglobinuria is suggested by a high frequency of aplastic anemia patients with a deficiency - H Schrezenmeier, B Hertenstein, B Wagner - Experimental , 1995 - ukpmc.ac.uk
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