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Aplastic anemia

Hypoplastic anemia; Bone marrow failure - aplastic anemia

Aplastic anemia is a condition in which the bone marrow does not make enough blood cells. Bone marrow is the soft, tissue in the center of bones that is responsible for producing blood cells and platelets.

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Bone marrow aspiration

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Causes

Aplastic anemia results from damage to the blood stem cells. Stem cells are immature cells in the bone marrow that give rise to all blood cell types (red blood cells, white blood cells, and platelets). Injury to the stem cells leads to a decrease in the number of these blood cell types.

Aplastic anemia can be caused by:

Sometimes, the cause is unknown. In this case, the disorder is called idiopathic aplastic anemia.

Symptoms

Symptoms are due to the underproduction of red cells, white cells, and platelets. Symptoms may be severe from the start or gradually worsen over time as the disease progresses.

Low red cell count (anemia) can cause:

Low white cell count (leukopenia) causes an increased risk for infection.

Low platelet count (thrombocytopenia) can result in bleeding. Symptoms include:

Exams and Tests

Blood tests will show:

A bone marrow biopsy shows fewer-than-normal blood cells and an increased amount of fat.

Treatment

Mild cases of aplastic anemia that do not have symptoms may not require treatment.

As blood cell counts become lower and symptoms develop, blood and platelets are given through transfusions. Over time, transfusions may stop working, resulting in very low blood cell counts. This is a life-threatening condition.

Bone marrow, or stem cell transplant may be recommended for people under age 40. This treatment works best when the donor is a fully-matched brother or sister. This is called a matched sibling donor.

Older people and those who do not have a matched sibling donor are given medicine to 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.

Outlook (Prognosis)

Untreated, severe aplastic anemia leads to rapid death. Bone marrow transplant can be very successful in young people. Transplant is also used in older people or when the disease comes back after medicines have stopped working.

Possible Complications

Complications may include:

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 is hard to stop. Call if you notice frequent infections or unusual fatigue.

Related Information

Anemia
Hemolytic anemia
Chemotherapy
Radiation therapy
Toxins
Systemic lupus erythematosus
Thrombocytopenia
Acute
Chronic
Bone marrow transplant
Bone marrow transplant - discharge

References

Bagby GC. Aplastic anemia and related bone marrow failure states. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 165.

Young NS, Maciejewski JP. Aplastic anemia. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 30.

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Review Date: 1/19/2018  

Reviewed By: Richard LoCicero, MD, private practice specializing in hematology and medical oncology, Longstreet Cancer Center, Gainesville, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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