16747 Aplastic Anemia

Overview

Aplastic anemia is a rare and serious blood condition where the bone marrow — the spongy tissue inside your bones — stops making enough new blood cells. This means your body has too few red blood cells (which carry oxygen), white blood cells (which fight infection), and platelets (which help blood clot). It is not cancer, but it can be life-threatening if left untreated.

No. Aplastic anemia is rare. It affects about two to three people per million each year worldwide.

It can affect anyone at any age. It is often diagnosed in children, teenagers, and young adults, but older adults can develop it too. The cause and severity vary from person to person.

Symptoms

Common symptoms

• Feeling very tired, weak, or short of breath with little activity
• Pale or unusually pale skin
• Frequent or long-lasting infections
• Easy bruising or tiny red or purple spots on the skin
• Nosebleeds or bleeding gums
• Heavy or long periods
• Slow healing or prolonged bleeding from small cuts

Symptoms in children

• Children may have the same symptoms as adults, such as tiredness, paleness, bruising, and frequent infections.
• They may also have poor appetites or be less active than usual.
• Parents may first notice unusual bruises, nosebleeds, or a child who is much more tired than expected.

Symptoms in older adults

• Older adults may feel increasingly tired, weak, or short of breath, and may mistake these for normal signs of aging.
• They may have more frequent infections or unexplained bruising and bleeding.
• Existing health conditions can make some symptoms harder to notice, so any new change should be checked.

Causes

Main causes

• Autoimmune disease: the immune system mistakenly attacks the bone marrow.
• Chemotherapy or radiation therapy for cancer, which can damage bone marrow.
• Exposure to certain chemicals, such as benzene or some pesticides.
• Certain medications that can harm the bone marrow.
• Viral infections, including some forms of hepatitis or Epstein-Barr virus.
• Inherited conditions, such as Fanconi anemia, that affect bone marrow function.

Risk factors

• Previous treatment with high-dose chemotherapy or radiation.
• Long-term exposure to industrial chemicals or toxins.
• A history of certain viral infections.
• A family history of inherited bone marrow failure disorders.
• Being a child, teenager, or young adult makes some types of aplastic anemia more likely.

When to see a doctor

See a doctor urgently if:

• A fever or signs of infection, especially if you know your blood counts are low.
• Unexpected bruising, bleeding, or a rash of tiny red spots.
• Shortness of breath or feeling your heart pounding with little activity.

Book a routine appointment if:

• You have been feeling exhausted, pale, or more short of breath than usual for more than a week.
• You bruise easily or bleed for a long time after small cuts.
• You keep getting infections that take a long time to clear.

Diagnosis

Aplastic anemia is diagnosed through a combination of blood tests and a bone marrow test. Your doctor may also review your medical history, medicines, and possible chemical exposures.

Tests that may be done

• Complete blood count (CBC): a blood test that measures red blood cells, white blood cells, and platelets.
• Reticulocyte count: a blood test that checks whether your bone marrow is making new young red blood cells.
• Peripheral blood smear: looking at a sample of your blood under a microscope.
• Bone marrow biopsy and aspiration: taking a small sample of bone marrow from the back of your hip bone to see how well it is producing cells.
• Additional tests for viruses, immune system problems, chromosome changes, or inherited causes.

What to expect at your appointment

These tests usually happen over a few days. The bone marrow biopsy can feel uncomfortable but is done with a numbing medicine. You may be referred to a haematologist, a doctor who specialises in blood conditions.

Treatment

Treatment for aplastic anemia depends on how severe it is, your age, your general health, and the cause. It may include blood transfusions to restore blood counts, medicines that calm the immune system, and in some cases a stem cell transplant to replace the damaged bone marrow. The plan will be tailored to you.

Self-care at home

• Follow your care team's advice about avoiding infections, including hand washing and avoiding crowded places when your white blood cells are very low.
• Use a soft toothbrush and an electric razor to lower bleeding risk.
• Apply firm pressure for at least ten minutes to any small cut that is bleeding.
• Avoid contact sports or activities that could cause bruises or internal injury.
• Keep all your healthcare appointments and have your regular blood tests as planned.

Medical treatments

Blood transfusions can slowly replace red blood cells and platelets and help you feel better quickly. Medicines to suppress the immune system may be used to stop the body from attacking the bone marrow. Other medicines may help the bone marrow produce more blood cells. Antibiotics can treat or prevent infections. These treatments are given under the supervision of a specialist team. A stem cell transplant, also called a bone marrow transplant, is a treatment that aims to replace the faulty bone marrow with healthy donor stem cells. It is a major procedure and is not right for everyone.

When is surgery considered?

Surgery is not a treatment for aplastic anemia itself. However, if a stem cell transplant is planned, a small operation or procedure may be needed to place a central line — a thin tube that allows medicines, fluids, and transfusions to be given safely.

Living with this condition

Living with aplastic anemia means being aware of your energy levels, avoiding infection, and managing bleeding risks. Let family, friends, and employers know what you are going through so they can support you. Follow your care team's instructions about when it is safe to work, study, travel, or exercise.

Lifestyle tips

• Get enough rest, but try to stay lightly active when you feel well.
• Wash your hands regularly and stay away from people with colds or flu.
• Protect your skin from cuts and avoid activities that could cause you to fall.
• Stop smoking and avoid alcohol, or ask your doctor for support to cut down.
• Ask your pharmacist or doctor before taking any over-the-counter remedies, supplements, or herbal products, as some can affect blood cells.

Diet and exercise

Eat a well-balanced diet with plenty of fruit, vegetables, lean protein, and whole grains. If eating is hard or you have mouth sores, choose soft foods and small frequent meals. Gentle exercise such as walking can help energy, but avoid rough sports or heavy lifting when your platelet count is low. Check with your care team before making big changes.

Mental health and emotional wellbeing

A diagnosis of aplastic anemia can be frightening and stressful. It is normal to feel anxious, sad, or overwhelmed at times. Talk to your healthcare team about how you are feeling, and consider seeing a counsellor or psychologist. If you or someone close to you has thoughts of self-harm, seek help immediately from local emergency services or crisis support.

Prevention

Most cases of aplastic anemia cannot be prevented because they are caused by an immune system problem or unknown factors. Some exposure-related cases may be avoided by reducing contact with harmful chemicals and following safety rules at work.

Vaccines

Keeping up with recommended vaccines can reduce infections that could complicate illness. However, if your immune system is weak, some live vaccines may not be safe. Ask your doctor which vaccinations are right for you.

Screening programmes

There is no routine screening test for aplastic anemia in the general population. Blood tests are usually done only after symptoms appear. People with a known family condition that increases risk should be looked after by a genetic specialist.

Complications

If left untreated

• Severe and repeated infections that can spread through the body.
• Uncontrolled bleeding, including internal bleeding.
• Severe anaemia, which can strain the heart and lungs.
• Life-threatening organ damage.

Long-term outlook

Aplastic anemia is a serious condition, but the outlook has improved greatly with modern treatment. Many people, particularly those who have a successful stem cell transplant, can make a good recovery. Others manage the condition over the long term with medicines, support, and regular monitoring. Every case is different, so ask your care team about what is realistic for you.

Find support

International organisations

• Aplastic Anemia and MDS International Foundation ↗

Local organisations

• NHS website (UK) – Aplastic anaemia ↗ · United Kingdom

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