Aplastic anemia

Description

Aplastic anemia is a condition that occurs when the bone marrow stops producing enough new blood cells. The condition leaves you tired and more prone to infections and bleeding.

A rare and serious condition, aplastic anemia can develop at any age. It may occur suddenly, or it can occur slowly and get worse over time. It can be mild or severe.

The treatment for aplastic anemia may include medications, blood transfusions or a stem cell transplant, also known as a bone marrow transplant.

Symptoms

Aplastic anemia may have no symptoms. When present, symptoms may include:

  • Fatigue.
  • Shortness of breath.
  • Fast or irregular heart beat.
  • Frequent or prolonged infections.
  • Unexplained or easy bruising.
  • Epistaxis and bleeding gums.
  • Prolonged bleeding from cuts.
  • Pale skin.
  • Rash on the skin.
  • Fever.

Aplastic anemia may be short-lived, or it can become chronic. It can be serious and even fatal.

Causes

The bone marrow is a red, spongy material inside the bones. The stem cells in the bone marrow to make blood cells — red blood cells, white blood cells, and platelets. In aplastic anemia, the stem cells are damaged. As a result, the bone marrow produces a lower number of new blood cells.

The most common cause of aplastic anemia is your immune system attacks the stem cells in your bone marrow. Other factors that can damage the bone marrow and affect the production of blood cells are:

  • The radiation and chemotherapy. While these anti-cancer therapies kill cancer cells, they can also damage healthy cells, including the stem cells in the bone marrow. Aplastic anemia can be a temporary side effects of these treatments.
  • Exposure to toxic chemicals. Toxic chemicals, such as some of those used in pesticides and insecticides, and benzene, an ingredient in gasoline, have been linked to aplastic anemia. This type of anemia can improve if you avoid repeated exposure to chemicals that cause disease.
  • The use of certain drugs. Some medications, including those used to treat rheumatoid arthritis and some antibiotics, can cause aplastic anemia.
  • Autoimmune disorders. An autoimmune disorder, in which your immune system attacks healthy cells, it may imply that the stem cells in the bone marrow.
  • A viral infection. Viral infections that affect the bone marrow may play a role in the development of aplastic anemia. Viruses that have been linked to aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV.
  • Pregnancy. Your immune system may attack your bone marrow during pregnancy.
  • Unknown factors. In many cases, doctors are not able to identify the cause of aplastic anemia. This is called idiopathic aplastic anemia.

Connections with other rare diseases

Some people with aplastic anemia also have a rare condition known as paroxysmal nocturnal hemoglobinuria, which causes red blood cells to break down too soon. This condition can lead to aplastic anemia or aplastic anemia may evolve in the paroxysmal nocturnal hemoglobinuria.

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

Risk factors

Aplastic anemia is rare. Factors that may increase the risk include:

  • The treatment with high doses of radiation or chemotherapy for cancer.
  • Exposure to toxic chemicals.
  • The use of some prescription drugs such as chloramphenicol, which is used to treat bacterial infections, and gold compounds are used to treat rheumatoid arthritis.
  • In the blood of diseases, autoimmune disorders and severe infections.
  • Pregnancy, rarely.

Prevention

There is no known way to prevent most cases of aplastic anemia. Avoid exposure to insecticides, herbicides, organic solvents, paint strippers, and other toxic chemicals can lowers, your risk of the disease.

Aplastic anemia

Diagnosis

The following tests can help to diagnose aplastic anemia:

  • Blood tests. Normally, red blood cells, white blood cells and platelet levels stay within certain ranges. In aplastic anemia, all three of these blood cell levels are low.
  • Bone marrow biopsy. A needle is used to remove a small sample of bone marrow from a large bone, such as your hip bone. The sample is examined under a microscope to rule out other diseases related to blood. In aplastic anemia, the bone marrow contains a lower number of blood cells than normal. Confirming a diagnosis of aplastic anemia, requires a bone marrow biopsy.

Once you have received a diagnosis of aplastic anemia, you might need other tests to determine the cause.

Once you have received a diagnosis of aplastic anemia, you might need other tests to determine the cause.

Treatment

Treatments for aplastic anemia depends on your symptoms and your age and general health. Treatment options may include observation, blood transfusions, medications, or bone marrow transplantation. Severe aplastic anemia, in which your blood cell counts are extremely low, and is potentially fatal and requires immediate hospitalization.

Blood transfusions

Although it is not a cure for aplastic anemia, blood transfusions may provide blood to the cells of your bone marrow is not producing. This can help to control the bleeding and relieve the symptoms. You may receive:

  • Red blood cells. These raise red blood cell counts and helps to relieve the anemia and fatigue.
  • Platelets. These help prevent excessive bleeding.

Although there is generally no limit to the number of blood transfusions that can have complications sometimes arise with multiple transfusions. The transfusion of red blood cells contain iron that can accumulate in your body, and damage to vital organs if iron overload is not treated. Medications can help to rid your body of exaggerateds of iron.

With time, your body may develop antibodies against the transfused blood to the cells, making them less effective in the relief of symptoms. The use of immunosuppressant medication makes this complication less likely.

Stem cell transplantation

A stem cell transplantation to rebuild the bone marrow with stem cells from a donor might be the only successful option for treatment for people with severe aplastic anemia. A stem cell transplant, also called a bone marrow transplant, is usually the treatment of choice for people who are younger and have a compatible donor — most often a brother.

If the donor is found, your diseased bone marrow is the first depleted with radiation or chemotherapy. The healthy stem cells from the donor are filtered out of the blood. The healthy stem cells are injected turing a vein in your bloodstream. The healthy, the cells migrate to the bone marrow, tooth decay, and start to create new blood cells.

The procedure requires a long stay in the hospital. After the transplant, you will receive drugs to help prevent rejection of the donated stem cells.

A stem cell transplant involves risks. Your body may reject the transplant, leading to life-threatening complications. In addition, not everyone is a candidate for transplant or you can find a suitable donor.

Immunosuppressive

For the people whor unable to undergo a bone marrow transplant, or for those whose aplastic anemia is due to an autoimmune disorder, treatment may include medications that alter or suppress the immune system, called immunosuppressants.

Drugs such as cyclosporine (Neoral, Sandimmune), and antithymocyte globulin suppress the activity of immune cells that are damaging your bone marrow. This helps the bone marrow to recover and generate new blood cells. Cyclosporine and antithymocyte globulin are often used together.

Corticosteroids, such as methylprednisolone (Medrol), are often used with these drugs.

Although effective, these medications will further weaken your immune system. It is also possible that the anemia to return after you stop these drugs.

Bone marrow stimulants

Your hematologist may prescribe medicines to stimulate the bone marrow to produce new blood cells. These drugs are called growth factors or colony-stimulating factors. Each drug that stimulates the production of a different type of blood cells. Sargramostim (Leukine), filgrastim (Neupogen), pegfilgrastim (Neulasta®), epoetin alfa (Epogen/Procrit) and eltrombopag (Promacta) help to stimulate the bone marrow to produce new red blood cells, white blood cells, and platelets. Growth factors are often used with immunosuppressive drugs.

Antibiotics, antivirals

Having aplastic anemia weakens your immune system, which makes it more prone to infections.

If you have aplastic anemia, talk to your health professional at the first sign of infection, such as fever. You do not want the infection to get worse because could prove that the life in danger. If you have severe aplastic anemia, your doctor may prescribe antibiotics or antiviral medications to help prevent infections.

Other treatments

Aplastic anemia caused by radiation and chemotherapy for the cancer usually Improves after the treatments stop. The same is true for most other drugs that can cause aplastic anemia.

Pregnant women with aplastic anemia treated with transfusion of blood. For many women, pregnancy-related aplastic anemia improves once the pregnancand ends. If this does not happen, the treatment is still necessary.

Self-care

If you have aplastic anemia, take care of yourself:

  • Rest when you need it. Anemia can cause fatigue and shortness of breath, even with mild exertion. Take a break and rest when needed.
  • Avoid contact sports. Due to the risk of bleeding associated with a low platelet count, avoid activities that can cause a cut or fall.
  • The way to protect yourself from germs. Wash your hands often and avoid people who are sick. If you develop a fever or other indicators of an infection, see your health professional for treatment.

Coping and support

Tips to help you and your family to better cope with their disease include:

  • The investigation of their disease. The more you know, the better prepared you'll be for the treatment of decisions.
  • Ask questions. Be sure to ask your health care team about any thing related with the disease or the treatment that you do not understand. It can help you to record or write what you say.
  • Be vocal. Do not be afraid to express your concerns to your hematologist or other health professionals to treat.
  • Seek support. Ask your family and friends for emotional support. Ask them to consider becoming donors of blood or bone marrow of donors. It might help to talk to others, to cope with the disease. Ask your health care team if you know of any local support groups or contact the Aplastic Anemia and MDS International Foundation. It offers a peer support network and can be reached at 800-747-2820.
  • Take care of yourself. Proper nutrition and sleep are important to maximize the production of blood.

Preparing for your appointment

Start by making an appointment with your primary care physician health professional. You could then refer you to a doctor who specializes in the treatment of blood disorders called a hematologist. If aplastic anemia occurs suddenly, the treatment can begin in the emergency room.

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your symptoms and when they began.
  • Key personal information, including any recent changes in life, such as a new job, especially one that is exposed to chemical substances.
  • The drugs, vitamins, and other supplements that you take, including over-dose.
  • Questions to ask your health care team.

Have a family member or a friend with you to your appointment, if possible, to help you remember the information they give you.

For aplastic anemia, questions to ask your hematologist include:

  • What is the most likely cause of my symptoms?
  • There are other possible causes for my symptoms?
  • What is my prognosis?
  • What treatments are available, and which do you recommend?
  • There are alternatives to the primary approach you're suggesting?
  • I have another health condition. How can I best manage them together?
  • Do you have brochures or other the printed material I can have? What sites do you recommend?

What to expect from your doctor

Your health care team is likely to ask you questions, such as:

  • Has had recent infections?
  • Have you bled unexpectedly?
  • You're more tired than usual?
  • Does anyelse seems to improve the symptoms?
  • Is there something that seems to make your symptoms worse?
Symptoms and treatment of Aplastic anemia