Aplastic Anemia Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Aplastic Anemia Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies


What Is Aplastic Anemia?


Aplastic anemia is a type of anemia. The term "anemia" usually refers to a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don't contain enough hemoglobin. This iron-rich protein helps carry oxygen to your body.

Aplastic anemia is a rare but extremely serious disorder that results from the unexplained failure of the bone marrow to produce blood cells. Failure of the bone marrow cell production can result from damage to the stem cells or to the environment. The result is aplastic anemia.

The diagnosis of aplastic anemia begins with a blood test. Blood cell levels are normally maintained within certain ranges. The diagnosis of aplastic anemia is suspected when all three blood cell levels are very low.

Aplastic anemia can develop at any age. Aplastic anemia may occur suddenly, or it can occur slowly and get worse over a long period of time. Treatment for aplastic anemia may include medications, blood transfusions or a stem cell transplant.

What Causes Aplastic Anemia?


Damage to the bone marrow's stem cells causes aplastic anemia. When stem cells are damaged, they don't grow into healthy blood cells.

The cause of the damage can be acquired or inherited. "Acquired" means you aren't born with the condition, but you develop it. "Inherited" means your parents passed the gene for the condition to you.

Acquired aplastic anemia is more common, and sometimes it's only temporary. Inherited aplastic anemia is rare.

In many people who have aplastic anemia, the cause is unknown. Some research suggests that stem cell damage may occur because the body's immune system attacks its own cells by mistake.

Acquired Causes Aplastic Anemia


Many diseases, conditions, and factors can cause aplastic anemia, including:

  • Radiation and chemotherapy treatments. While these cancer-fighting therapies kill cancer cells, they can also damage healthy cells, including stem cells in bone marrow. Aplastic anemia can be a temporary side effect of these treatments.
  • Exposure to toxic chemicals. Exposure to toxic chemicals, such as some used in pesticides and insecticides, may cause aplastic anemia. Exposure to benzene — an ingredient in gasoline — also has been linked to aplastic anemia. This type of anemia sometimes gets better on its own if you avoid repeated exposure to the chemicals that caused your initial illness.
  • Use of certain drugs. Some medications, such as those used to treat rheumatoid arthritis and some antibiotics, can cause aplastic anemia.
  • Autoimmune disorders. An autoimmune disorder, in which your immune system begins attacking healthy cells, may involve stem cells in your bone marrow.
  • A viral infection. Viral infections that affect bone marrow may play a role in the development of aplastic anemia in some people. Viruses that have been linked to the development of aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV.
  • Pregnancy. Aplastic anemia that occurs in pregnancy may be related to an autoimmune problem — your immune system may attack your bone marrow during pregnancy.
  • Unknown factors. In many cases, doctors aren't able to identify the cause of aplastic anemia. This is called idiopathic aplastic anemia.

Inherited Causes Aplastic Anemia


Certain inherited conditions can damage the stem cells and lead to aplastic anemia.

Some people with aplastic anemia also have a rare disorder known as paroxysmal nocturnal hemoglobinuria. This disorder causes red blood cells to break down too soon. Paroxysmal nocturnal hemoglobinuria can lead to aplastic anemia, or aplastic anemia can evolve into paroxysmal nocturnal hemoglobinuria.

Fanconi's anemia is a rare, inherited disease that leads to aplastic anemia. Children born with it tend to be smaller than average and have birth defects, such as underdeveloped limbs. The disease is diagnosed with the help of blood tests.

Who Is at Risk for Aplastic Anemia?


Aplastic anemia is a rare but serious blood disorder. People of all ages can develop aplastic anemia. However, it's most common in adolescents, young adults, and the elderly. Men and women are equally likely to have aplastic anemia.

The disorder is two to three times more common in Asian countries.

Your risk of aplastic anemia is higher if you:

  • Have been exposed to toxins
  • Have taken certain medicines or had radiation or chemotherapy (treatments for cancer)
  • Have certain infectious diseases, autoimmune disorders, or inherited conditions

What Are the Signs and Symptoms of Aplastic Anemia?


Aplastic anemia symptoms result from a shortage of one or more types of blood cells. Because of fewer RBCs present, people may have pale skin and feel tired, weak, or short of breath. The low platelet count may cause bruising and bleeding to easily occur. And people with aplastic anemia may be more likely to get bacterial infections because of the low number of WBCs, which fight infection. Cases of infection and hemorrhaging (excessive bleeding) are emergencies and must be treated quickly. Signs and symptoms may include:

  • Fatigue
  • Shortness of breath with exertion
  • Rapid or irregular heart rate
  • Pale skin
  • Frequent or prolonged infections
  • Unexplained or easy bruising
  • Nosebleeds and bleeding gums
  • Prolonged bleeding from cuts
  • Skin rash
  • Dizziness
  • Headache
Aplastic anemia can progress slowly over weeks or months, or it may come on suddenly. The illness may be brief, or it may become chronic. Aplastic anemia can be very severe and even fatal.

Diagnosing Aplastic Anemia


Your doctor will review your medical history and ask you to describe your symptoms. Other questions may include:

  • Do you live or work in an area where you are exposed to toxic chemicals or radiation?
  • What medications do you take?
  • Have you ever had hepatitis, mononucleosis or another viral infection?
  • Is there a family history of aplastic anemia or other blood disorders?
On occasion, the presence of aplastic anemia can predate the development of some forms of leukemia.

Your doctor will examine you to look for the signs of aplastic anemia. This will be followed by blood tests to measure levels of red blood cells, white blood cells and platelets. Aplastic anemia is suspected when the tests show that levels of all three blood cell types are extremely low, but the cells themselves look normal. A test called a bone marrow biopsy is needed to confirm the diagnosis.

During a bone marrow biopsy, a small sample of bone marrow is taken by inserting a needle into the large pelvic bone just below the waist on either side of the spine. This bone marrow sample is examined in a laboratory. A hematologist (doctor who specializes in blood disorders) usually will confirm the diagnosis based on the results of bone marrow findings and basic blood tests.

How Is Aplastic Anemia Treated?


Treatments for aplastic anemia may include observation for mild cases, blood transfusions and medications for more serious cases, and, in severe cases, bone marrow transplantation. Severe aplastic anemia, in which your blood cell counts are extremely low, is life-threatening and requires immediate hospitalization for treatment.

Blood transfusions


Treatment for aplastic anemia usually involves blood transfusions to control bleeding and relieve anemia symptoms. Blood transfusions aren't a cure for aplastic anemia. But they do relieve signs and symptoms by providing blood cells that your bone marrow isn't producing. A transfusion may include:

  • Red blood cells. Transfusions of red blood cells raise red blood cell counts. This helps relieve anemia and fatigue.
  • Platelets. Transfusions of platelets help prevent excessive bleeding.
While there's generally no limit to the number of blood cell transfusions you can have, complications can sometimes arise with multiple transfusions. Transfused red blood cells contain iron that can accumulate in your body and can damage vital organs if an iron overload isn't treated. Medications can help your body get rid of excess iron. Another possible complication is that over time, your body may develop antibodies to transfused blood cells, making them less effective at relieving symptoms.

Stem cell transplant


A stem cell transplant to rebuild the bone marrow with stem cells from a donor may offer the only successful treatment option for people with severe aplastic anemia. A stem cell transplant, which is also called a bone marrow transplant, is generally the treatment of choice for people who are younger and have a matching donor — most often a sibling.

If a donor is found, your diseased bone marrow is first depleted with radiation or chemotherapy. Healthy stem cells from the donor are filtered from the blood. The healthy stem cells are injected intravenously into your bloodstream, where they migrate to the bone marrow cavities and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells.

A stem cell transplant carries risks. There's a chance that your body may reject the transplant, leading to life-threatening complications. In addition, not everyone is a candidate for transplantation or can find a suitable donor.

Immunosuppressants


For people who can't undergo a bone marrow transplant or for those whose aplastic anemia may be due to an autoimmune disorder, treatment may involve drugs that alter or suppress the immune system (immunosuppressants).

Drugs such as cyclosporine (Gengraf, Neoral, Sandimmune) and anti-thymocyte globulin (Thymoglobulin) are examples. These drugs suppress the activity of immune cells that are damaging your bone marrow. This helps your bone marrow recover and generate new blood cells. Cyclosporine and anti-thymocyte globulin are often used in combination.

Corticosteroids, such as methylprednisolone (Medrol, Solu-Medrol), are often given at the same time as these drugs.

Immune-suppressing drugs can be very effective at treating aplastic anemia. The downside is that these drugs further weaken your immune system. It's also possible that after you stop taking these drugs, aplastic anemia may return.

Bone marrow stimulants


Certain drugs — including colony-stimulating factors, such as sargramostim (Leukine), filgrastim (Neupogen) and pegfilgrastim (Neulasta), and epoetin alfa (Epogen, Procrit) — may help stimulate the bone marrow to produce new blood cells. Growth factors are often used in combination with immune-suppressing drugs.

Antibiotics, antivirals Having aplastic anemia weakens your immune system. You have fewer white blood cells in circulation to fight off germs. This leaves you susceptible to infections.

At the first sign of infection, such as a fever, see your doctor. You don't want the infection to get worse, because it could prove life-threatening. If you have severe aplastic anemia, your doctor may give you antibiotics or antiviral medications to help prevent infections.

Other treatments for Aplastic Anemia


Aplastic anemia caused by radiation and chemotherapy treatments for cancer usually improves once you complete those treatments. The same is true for most other drugs that induce aplastic anemia.

Pregnant women with aplastic anemia are treated with blood transfusions. For many women, pregnancy-related aplastic anemia improves once the pregnancy ends. If that doesn't happen, treatment is still necessary.

Prevention for Aplastic Anemia


There's no prevention for most cases of aplastic anemia. However, avoiding exposure to insecticides, herbicides, organic solvents, paint removers and other toxic chemicals may lower your risk of the disease.. To avoid being infected with hepatitis B virus (which can cause aplastic anemia), you can get the hepatitis B vaccine. HIV and hepatitis B can be prevented by practicing safe sex and not using intravenous drugs.

Some forms of aplastic anemia cannot be prevented.

Home remedies for Aplastic Anemia


If you have aplastic anemia, take care of yourself by:

  • Avoid alcohol.
  • Check with your doctor about B vitamin supplements. Some people may benefit from B vitamins.
  • Resting when you need to. Anemia can cause fatigue and shortness of breath with even mild exertion. Take a break and rest when you need to.
  • Avoiding contact sports. Because of the risk of bleeding associated with a low platelet count, avoid activities that may result in a cut or fall.
  • Protecting yourself from germs. You can reduce your risk of infections with frequent hand-washing and by avoiding sick people. If you develop a fever or other indicators of an infection, see your doctor for treatment.

Living With Aplastic Anemia


With prompt and proper care, most people who have aplastic anemia can be successfully treated, and some may be cured.

Most people who have the disorder are able to go back to their normal routines after treatment. However, it may take some time to get good results from treatment. You may need repeated treatments, or you may need to try several treatments to find one that works.

Get ongoing medical care to make sure the disorder doesn't worsen and to check for possible complications.

Ongoing Care


Treatment for aplastic anemia may cause side effects or complications. Talk with your doctor about how to cope with these issues.

People who have aplastic anemia might be at higher risk for infections due to low white blood cell counts. Ask your doctor about ways to lower your risk for infection. For example, you may want to:

  • Stay away from people who are sick and avoid large crowds of people.
  • Avoid certain foods that can expose you to bacteria, such as uncooked foods.
  • Wash your hands often.
  • Brush and floss your teeth and get regular dental care to reduce the risk of infections in your mouth and throat.
  • Get a yearly flu shot and pneumonia vaccine. Ask your doctor whether these shots will benefit you.
Know the signs of infection, such as fever. Call your doctor right away if you think you have an infection.

Physical Activity


Talk with your doctor about what types and amounts of physical activity are safe for you. You may want to avoid activities that cause chest pain or shortness of breath. You also may want to stay away from activities that could result in injuries and bleeding, such as contact sports.

Support Groups


You or your family members may find it helpful to know about resources that can give you emotional support and information about aplastic anemia.

Your doctor or hospital social worker may have information about counseling and support services. They also may be able to refer you to support groups that offer help with financial planning, because treatment for aplastic anemia can be costly.

Prognosis of Aplastic Anemia


The outlook for aplastic anemia depends on its cause and severity, as well as the health and age of the patient. Cases that are caused by certain medications, pregnancy, low-dose radiation or infectious mononucleosis often are short term, and any complications (anemia, bleeding, increased infections) usually can be treated. Women who develop aplastic anemia during pregnancy may have the problem during future pregnancies as well.

Aplastic anemia can be fatal when it is severe and long lasting. Between 70% and 90% of patients who receive a bone marrow transplant from a sibling survive. The survival rates are much lower for patients treated with a bone marrow transplant from an unrelated donor. When a bone marrow transplant is not possible, about 50% of patients will respond well to immunosuppressive therapy alone. However, long-term survivors receiving immunosuppressive therapy are more likely to develop cancer, especially acute leukemia.

Patients with severe, chronic aplastic anemia that does not respond to available treatments have an 80% chance of dying within 18 to 24 months.

People with aplastic anemia are at higher than average risk for developing leukemia.