Table of Contents
What is Aplastic Anaemia?
Aplastic anaemia is a rare and serious condition that occurs when inadequate blood cells are being produced in the body. This causes the body to feel fatigued and may increase the risk of uncontrolled bleeding and infections..
Aplastic anaemia is known to affect people of all ages, but it is most common in those between 10 to 20 years old or 60 to 65 years old. It can occur suddenly, or it can develop slowly and progress over some time. It can be mild or severe.
Treatment for aplastic anaemia may include medications, blood transfusions, and a bone marrow transplant also called a stem cell transplant.
What causes Aplastic Anaemia?
The most common cause of aplastic anaemia is from the body’s immune system attacking and damaging the stem cells in its bone marrow..
As a result, these damaged stem cells are not able to produce blood cells properly and cause the bone marrow to be either empty (aplastic) or contain inadequate blood cells (hypoplastic)..
Other factors that may affect the functions of the bone marrow and increase the risk of aplastic anaemia include:
- Exposure to toxic chemicals: Exposure to insecticides, pesticides, and an ingredient in gasoline called benzene has been linked to a higher risk of aplastic anaemia.
- Side effects of certain drugs: Some antibiotics and medications may cause aplastic anaemia.
- Chemotherapy and radiation: These are cancer treatments that help to kill cancer cells. However, these therapies may also cause damage to healthy cells including the stem cells in the bone marrow resulting in aplastic anaemia. However, these side effects are temporary and tend to resolve once the cancer treatment is over.
- Pregnancy: During pregnancy, the immune system may attack the bone marrow, thereby reducing its ability to produce blood cells.
- Viral infections: Viral infections affecting the bone marrow may trigger the development of aplastic anaemia. Hepatitis, cytomegalovirus, HIV, and parvovirus B19 viruses are linked to a higher risk of aplastic anaemia.
- Autoimmune disorders: Autoimmune disorders, in which the immune system attacks and destroys healthy cells may affect the stem cells causing aplastic anaemia.
- Rare disorders: Some patients with aplastic anaemia have a rare disorder called paroxysmal nocturnal haemoglobinuria. This condition occurs due to the premature breakdown of the red blood cells resulting in aplastic anaemia. In some cases, aplastic anaemia may occur in patients with a rare, inherited disease called Fanconi’s anaemia. Children born with Fanconi’s anaemia tend to have congenital disabilities such as abnormal growth and underdeveloped limbs.
- Unknown factors: In the majority of cases however, the exact cause of aplastic anaemia cannot be identified (Idiopathic Aplastic Anaemia).
What are the signs and symptoms of Aplastic Anaemia?
A person may not display any symptoms. If there are symptoms, they may include:
- Fatigue, shortness of breath, dizziness, headaches
- Rapid and irregular heart rate
- Pale skin or skin rash
- Frequent or persistent infections
- Unexplained bruising, nosebleeds, bleeding gums or excessive bleeding from minor cuts.
Aplastic anaemia can be temporary or chronic. If not managed properly, it may escalate and cause fatal complications.
How is Aplastic Anaemia diagnosed?
Aplastic anaemia is diagnosed by examining samples of your blood and bone marrow.
- Blood tests: In aplastic anaemia, the levels of white cells, red cells, and platelets are lower than the normal range.
- Bone marrow biopsy: A bone marrow sample is drawn from a big bone and examined in a laboratory. In aplastic anaemia, the bone marrow contains fewer blood cells than normal.
How is Aplastic Anaemia treated?
The treatment for aplastic anaemia depends on the age and severity of the patient’s condition. The aim of treatment is to restore blood cell production. If the condition is mild, it may resolve spontaneously without the need for treatment although this is not very common. Patients are likely need blood and platelet transfusions, and treatment to prevent and control infections.
Although blood transfusions are not a cure for aplastic anaemia, it can relieve the symptoms by supplementing the body with blood cells that the bone marrow cannot produce. A blood transfusion may involve the administration of red blood cells or platelets.
- Red blood cells: This will improve the red cell counts and relieve the symptoms of anaemia including pale skin and fatigue.
- Platelets: This will help to prevent excessive bleeding and bruising.
Although there is no limit to the number of blood transfusions a person can undergo, repeated transfusions might lead to complications such as:
- Iron Overload: The excess iron from the blood transfusions may accumulate in the body and cause damage to vital organs if left untreated. If required, medications to help remove the excess iron from the body can be given.
- Development of antibodies against transfused blood products: After repeated transfusions, the body’s immune system may develop antibodies against the transfused blood products making them less effective. An immunosuppressant medication may be recommended to reduce the risk of this happening.
Bone marrow stimulants
This treatment involves the use of drugs (also known as growth factors or colony-stimulating factors) to stimulate the bone marrow to form new blood cells. Different growth factors help stimulate the bone marrow to react differently:
- Filgrastim (G-CSF), Pegfilgrastim (G-CSF) and Sargramostim (GM-CSF) boosts white blood cell production
- Epoetin Alfa boosts red blood cell production
- Eltrombopag helps to boosts platelet production
These growth factors are often used with immunosuppressants to improve outcome.
Immunosuppressants such as cyclosporine and anti-thymocyte globulin (ATG), are drugs used to suppress or control the activities of the body’s immune system which reduces the damage done to the bone marrow stem cells. This will allow the bone marrow to recover and produce new blood cells to relieve the anaemia symptoms..
Corticosteroids such as methylprednisolone are often used in combination with immunosuppresants..
This treatment is suitable for patients who cannot undergo a stem cell transplant or when the aplastic anaemia is the result of an autoimmune disorder. Although this treatment is effective, it may further weaken your immune system, and it is also possible for the anaemia to relapse when the patient stops taking these drugs.
Stem cell transplant
A stem cell transplant involves the transplant of healthy stem cells from a compatible donor to replace the patient’s damaged stem cells to rebuild the bone marrow..
At present, this may be the only successful treatment for aplastic anaemia. This treatment is recommended for younger patients suffering from severe aplastic anaemia, who have a matching donor, preferably a sibling. In recent years with improved technologies in transplantation, increasingly successful results are also seen in older patients, as well as those with mis-matched family members (haplo-identical transplantation) or unrelated matched donors.
FAQs on Aplastic Anaemia
Aplastic Anaemia is a life-threatening blood condition with high death rates if untreated. It is an autoimmune condition where the body’s immune system turns around and destroys the bone marrow. As a result, patients can present with very low blood counts with symptoms related to this, including fatigue, heart failure, infections and bleeding or bruising.
The overall five-year survival rate is about 70-80%. However, in recent years, the long-term outcomes of Aplastic Anaemia patients have been continuously improving.
While Aplastic Anaemia may not always present with symptoms. However, some early signs are indicative of the condition due to the falling blood counts from the suppression of the bone marrow. These include fatigue, shortness of breath, unexplained bruising, and prolonged bleeding from cuts.
Aplastic Anaemia is an autoimmune condition in which the body’s immune system attacks and damages the stem cells in its bone marrow. As a result, these damaged stem cells cannot produce blood cells properly and cause the bone marrow to be either empty (Aplastic) or contain inadequate blood cells (hypoplastic).
In the majority of cases (75-80% of the time), the cause of aplastic anaemia is unknown (called Idiopathic Aplastic Anaemia). There are causes that can trigger Aplastic Anaemia, including chemotherapy and radiation, autoimmune disorders, pregnancy, and some viral infections.
There is a rare group of disorders known as bone marrow failure syndromes where Aplastic Anaemia can be sometimes passed down from one generation to the next.
Anaemia is a blood condition due to low red blood cells. This can be due to causes such as blood loss from surgery or bleeding or could be due to dietary deficiency (most commonly as a result of iron deficiency). Anaemia could also result from bone marrow disorders that suppress the production of red cells, such as Blood Cancers or Aplastic Anaemia.
Aplastic Anaemia is an autoimmune condition resulting in the suppression of cells in the bone marrow which produce healthy blood cells. This usually causes Anaemia and lowers the other blood counts (white cells and platelets).
Aplastic Anaemia is a serious illness. However, depending on the severity of the condition, different forms of treatment are available. Treatments for Aplastic Anaemia are based around the use of immunosuppressive agents to suppress the destruction of the bone marrow by the body’s immune system.
In severe cases of Aplastic Anaemia or in patients who have relapsed Aplastic Anaemia, allogeneic haematopoietic stem cell transplantation may be required.
However, even with the success rates of present treatments, there remains a risk of relapse of Aplastic Anaemia.
Aplastic Anaemia is a serious blood condition. If untreated, patients will suffer from the ongoing side effects of an ineffective bone marrow. Patients may require ongoing blood and platelet transfusions or experience recurrent infections and/or bleeding or easy bruising.
In severe cases of Aplastic Anaemia, the lack of early treatment is associated with a high risk of serious complications, including death.
The majority of cases of Aplastic Anaemia are not hereditary (i.e. they are not passed down from one generation to the next).
However, there is a small proportion of cases where Aplastic Anaemia may be passed down through the genes from parent to child. It is usually diagnosed during childhood and is much less common than acquired Aplastic Anaemia.
This is usually part of a rare group of conditions known as Bone Marrow Failure Syndromes. People who develop hereditary Aplastic Anaemia usually have other genetic or developmental abnormalities associated with the Aplastic Anaemia.
As Aplastic Anaemia requires treatments with drugs that suppress the immune system, it is usually recommended that couples do not try to get pregnant while on treatment for Aplastic Anaemia.
Pregnancy can sometimes trigger Aplastic Anaemia or worsen the condition. Hence, you should consult with our haematologist if considering pregnancy with a background of Aplastic Anaemia.
FAQs on Aplastic Anaemia Treatments
The treatment for Aplastic Anaemia depends on the age and severity of the patient’s condition. The aim of treatment is to restore blood cell production. If the condition is mild, it may resolve spontaneously without the need for treatment, although this is not very common.
Patients likely need supportive care in the form of blood and platelet transfusions and antibiotics, and antivirals to prevent and control infections.
Treatment of Aplastic Anaemia involves the use of immunosuppressive drugs such as ATG (anti-thymocyte globulin) or cyclosporine A. Platelet-supporting drugs such as eltrombopag are increasingly used to support the blood count to reduce the need for transfusion.
In patients with more severe forms of Aplastic Anaemia, an allogeneic haematopoietic stem cell transplantation may be considered if a suitable donor is identified.
Patients may develop iron overload which may result in damage to the heart, liver, and other vital organs. Iron chelation therapy that involves the removal of excess iron from the body can help to minimise the risk of such iron toxicity.
Blood transfusions can relieve the symptoms of Aplastic Anaemia by supplementing the body with blood cells that the bone marrow cannot produce.
Not all patients with Aplastic Anaemia require a bone marrow transplantation (Allogeneic haematopoietic stem cell transplantation). Patients with more severe forms of aplastic anaemia who have not responded to conventional immunosuppressive therapy or those who have a readily available matched sibling or unrelated donor are often considered for transplantation.
There are a number of complications that can occur after a stem cell transplant. These include both short term and long term complications.
Patients may experience short term complications such as mouth and throat pain, vomiting or nausea, infection, or graft-versus-host-disease (GVHD). Longer-term complications include disease relapse, GVHD, cardiac and hormonal changes, as well as secondary cancers.
Our transplant team will work closely with you through the different phases of your transplant to monitor, prevent and manage any such complications.
The first stage of recovery after a bone marrow transplant typically takes 4 to 6 weeks. This is the period in which our transplant team will monitor you to see if engraftment has occurred.
Typically, patients remain in the hospital until their blood counts stabilise and the patient is fit and independent without any infective complications.
Full recovery after a bone marrow transplant can take between 6 months to a year.
A bone marrow transplant can fail if the body does not accept the new donor cells. This is known as graft failure and is suspected in patients whose counts do not increase after three to four weeks following a bone marrow transplant.
Graft failure can result in severe bleeding and infection and is more likely to occur in patients who receive a lower number of stem cells or when the patient and donor are not well matched.
Should a patient’s graft fail, they can receive a second dose of stem cells from the original donor. Sometimes a second transplant from a different donor is required.
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Monday to Friday : 8.30am – 5.30pm
Saturday : 8.30am – 12.30pm
Closed on Sunday & Public Holidays
Find us on Facebook
Drop a Line
© Centre for Clinical Haematology | 2023