What Is Aplastic Anemia?
Aplastic anemia is a rare blood disorder. When you have this serious but treatable disorder, your bone marrow — the spongy stuff inside your bones where your blood cells are made — stops making enough new blood cells. Sometimes, it stops making just one type of blood cell, but more often you become low on all three blood cell types: red blood cells, white blood cells, and platelets.
Aplastic anemia can develop slowly or it may come on suddenly. If your blood count gets low enough, it can be life-threatening.
Anyone can get aplastic anemia, but it's more likely to happen when you're in your late teens or early 20s, or when you're 60 and up. It's more common in developing countries. Each year in the U.S., about 300 to 900 people learn they have this condition.
Aplastic Anemia Causes and Types
Aplastic anemia can happen for different reasons. It may be related to another medical condition you have, the genes you've inherited, medical treatments, or exposures. Doctors will check to find out what's causing your aplastic anemia and how severe it is.
Inherited aplastic anemia. Inherited aplastic anemia is related to gene defects you were born with that cause your bone marrow to fail. If you have this type, your bone marrow won't make enough stem cells to produce enough blood cells. Some inherited conditions with links to aplastic anemia include:
- Fanconi anemia
- Dyskeratosis congenita
- Shwachman-Diamond syndrome
- Diamond-Blackfan anemia
- Pearson syndrome
Acquired aplastic anemia. This condition can be acquired if your immune system attacks your bone marrow stem cells. Other conditions, disorders, or exposures that can lead to this condition include:
- Viruses such as HIV or Epstein-Barr
- Certain medications , including some antibiotics
- Toxic chemicals
- Radiation or chemotherapy treatment for cancer
- Autoimmune disorders, such as paroxysmal nocturnal hemoglobinuria
Idiopathic aplastic anemia. If your aplastic anemia is idiopathic, it means that it doesn't have a clear cause.
Doctors also classify aplastic anemia into types based on how low your blood counts are:
Moderate. Your blood cell counts are low but not low enough to be considered severe or to cause many symptoms. You may not need treatment, but your doctor will monitor you to make sure your condition is stable.
Severe. You have very low counts of at least one blood cell type, including neutrophils (a type of white blood cell), reticulocytes (young red blood cells), or platelets.
Very severe. Your neutrophil counts are even lower than those seen in severe aplastic anemia.
Aplastic anemia vs. aplastic crisis
An aplastic crisis is a similar condition that happens if your bone marrow stops making red blood cells all of a sudden due to sickle cell anemia, another blood disorder, or infection with a common virus called parvovirus B19. Unlike aplastic anemia, people usually get better within a couple of weeks after an aplastic crisis.
Aplastic Anemia Symptoms
Each type of blood cell has a different role:
- Red cells carry oxygen around the body.
- White cells fight infections.
- Platelets prevent bleeding.
Aplastic anemia symptoms may come on gradually or appear suddenly and severely. Your symptoms may vary depending on what types of blood cells you're low on, but you may be low on all three.
Symptoms of low red blood cell count
- Tiredness
- Shortness of breath
- Dizziness
- Pale skin
- Headaches
- Chest pain
- Fast heartbeat
Symptoms of low white blood cell count
- Infections
- Fever
Symptoms of low platelet count
- Easy bruising and bleeding
- Nosebleeds
Aplastic Anemia Diagnosis
If you have symptoms that may be aplastic anemia, your doctor may order tests including:
Complete blood count. This test measures the number of each blood cell type you have.
Peripheral blood smear. A pathologist will look at your blood cells and platelets under a microscope to look for anything abnormal.
Reticulocyte count. This test measures how many immature red blood cells you have.
Bone marrow aspiration or biopsy. Your doctor will get a bone marrow sample so that a pathologist can look at it under a microscope.
Aplastic Anemia Treatments
If your doctor can identify the cause of your aplastic anemia and get rid of that exposure, the condition may go away. For instance, if your aplastic anemia is related to a treatment you're getting for another condition, changing treatments may help. But doctors can rarely pinpoint the exact cause.
If your aplastic anemia isn’t severe, you may not need treatment unless or until your blood count drops below a certain level. Your doctor may suggest you to watch and wait. If your condition is more severe, you'll have a range of treatment options.
Drug treatments
Some medicines may help increase your blood cell counts, including:
- Bone marrow stimulants. Your doctor may prescribe growth factors or medicines to help your bone marrow make more blood cells.
- Immunosuppressants. Your doctor may prescribe steroids or other immune-suppressing medicines if your aplastic anemia is caused by an autoimmune condition.
Hematopoietic stem cell transplant
If your blood count is very low and your bone marrow needs to be rebuilt, your doctor may suggest a bone marrow or stem cell transplant to boost your body’s ability to make blood cells. You would need a donor whose blood is a close match. This procedure can sometimes cure aplastic anemia, but it is most successful in younger people, with the donor marrow from a close relative.
Supportive therapy
Some treatments may help in other ways, including:
- Antibiotics, antivirals, or antifungals. Your doctor may also suggest antibiotics and antifungal medications to help you fight infection.
- Blood transfusions. You'll likely need a blood transfusion at some point to boost your low blood cell counts with donor cells.
Talk to your doctor about the risks and benefits of each treatment option, given the cause of your aplastic anemia if it's known and how severe it is.
Aplastic Anemia Complications and Treatment Side Effects
Complications of aplastic anemia may include:
- Infections that may be severe
- Excessive bleeding
- Abnormal heart rhythm (arrhythmia)
- Heart failure
- Myelodysplastic syndrome
Aplastic anemia treatments may also come with side effects including:
- Infections related to immune suppressants
- Graft-versus-host disease following a stem cell transplant
- Excess iron (hemochromatosis) from blood transfusions
Aplastic Anemia in Pregnancy
When aplastic anemia happens during pregnancy, it can come with a lot of challenges and risks for you and your fetus. If you have aplastic anemia and get pregnant or you find out you have it during pregnancy, you'll need to see a doctor who can help you manage the disease.
It isn't clear that pregnancy is a cause of aplastic anemia. But you can get pregnant when you have aplastic anemia, as it won't affect fertility. About 12%-33% of people who have this condition in pregnancy will have complications. You may need to have a blood transfusion during or after giving birth. If you are pregnant and have aplastic anemia or are worried you may have symptoms of aplastic anemia, see a doctor right away.
One study found that relapses of aplastic anemia may happen when you're pregnant. You can get pregnant and have a baby with aplastic anemia, but it's important to see a doctor who specializes in aplastic anemia and/or high-risk pregnancies.
Aplastic Anemia Outlook
With treatment or a stem cell transplant, the outlook for aplastic anemia is good today. If you find a matched donor, your chances for 5-year survival after a stem cell transplant are 75%. Your outlook will depend on other factors including your:
- Age
- Disease severity
- Response to treatment
It also will depend on what's causing your aplastic anemia. If it's related to a medicine you are taking or another condition, your aplastic anemia may stabilize after you stop taking the medicine or get better. Without treatment, you'll be at high risk for bleeding, infections, or blood cancers.
Your chances of survival with aplastic anemia today are much better with treatment. Most people who die within a year of diagnosis are those who don't get treatment to manage the condition. If you have aplastic anemia and are worried about your outlook, talk to your doctor about treatments and other steps you can take to protect and improve your health.
Living With Aplastic Anemia
If you have this disorder, there's a lot you can do to take care of yourself and stay as well as you can. Some tips include:
- Stay away from contact sports to avoid injuries and bleeding.
- Wash your hands often.
- Stay up to date on your vaccines.
- Avoid crowds or people who are sick as much as you can.
- Get rest when you need it.
- Eat a balanced diet including lean proteins, vegetables, and whole grains.
- Check with your doctor before taking a flight or going to a high elevation where there is less oxygen. You may need a blood transfusion first.
Aplastic Anemia Prevention
Aplastic anemia is a rare condition and there aren't any recommendations to prevent it. In some cases, it may happen from toxic exposures. You could take steps to avoid contact with chemicals including:
- Insecticides
- Herbicides
- Organic solvents
- Paint removers
Takeaway
Aplastic anemia is a form of anemia (low blood counts) that happens when your bone marrow can't make enough blood cells. It can affect one or many different blood cell types to cause a wide range of symptoms. You can get treatment to help address the causes of your aplastic anemia or consider a stem cell transplant to rebuild your bone marrow.
Aplastic Anemia FAQs
Is aplastic anemia genetic?
Various factors can cause aplastic anemia. In some cases, it may be related to a genetic condition or genes you carry that affect your bone marrow.
How do you test for aplastic anemia?
Your doctor may order blood tests or tests to look at your bone marrow. If you're worried about aplastic anemia or have symptoms, see your doctor.
How long does aplastic anemia last?
Your outlook with aplastic anemia will depend on the underlying causes. If a medicine is causing it, it may go away if you stop treatment or switch to another one. A stem cell transplant is the only treatment that's considered to be a cure for aplastic anemia.
What are foods to avoid for aplastic anemia?
Eating healthy is always a good idea and may help you recover if you've had a stem cell transplant. But your diet and nutrition can't prevent aplastic anemia or make it go away.
What is the life expectancy of someone with aplastic anemia?
Your life expectancy with aplastic anemia will depend on how severe it is and the treatment you get. It will also depend on your age and other factors. But with standard treatment, most people with this condition will get better.