What is aplastic anemia?

Aplastic anemia is a rare and serious condition. It occurs when your bone marrow doesn’t make enough red and white blood cells, and platelets. Having fewer red blood cells causes hemoglobin to drop.

Hemoglobin is the part of blood that carries oxygen through your body. Having fewer white blood cells makes you more likely to get an infection. Having fewer platelets makes it hard for the blood to clot. This means you can bleed more easily.

What causes aplastic anemia?

Aplastic anemia has many causes. Sometimes it occurs for no known reason. Other causes are linked to a past illness or disorder. Risk factors may include:

• History of certain infectious diseases, such as hepatitis, HIV, Epstein-Barr virus, or CMV).

• History of taking certain medicines, such as antibiotics and anticonvulsants.

• Exposure to certain toxins, such as heavy metals.

• Receiving chemotherapy or radiation therapy treatment.

• History of an autoimmune disease, such as lupus.

• Pregnancy.

• An inherited condition.

Who is at risk for aplastic anemia?

Aplastic anemia can occur at any age. But it's more common among teens, young adults, and older adults. Your risk increases if you:

• Are exposed to toxins.

• Take certain medicines.

• Have a disease, such as hepatitis or HIV.

What are the symptoms of aplastic anemia?

Each person’s symptoms may vary. Symptoms may include:

• Headache.

• Dizziness.

• Upset stomach (nausea).

• Shortness of breath.

• Bruising.

• Lack of energy or tiring easily (fatigue).

• Fast or irregular heart rate.

• Abnormal paleness or lack of color in the skin.

• Blood in stool.

• Nosebleeds.

• Bleeding gums.

• Fevers.

• Sore sinuses.

• Enlarged liver or spleen.

• White patches in the mouth (oral thrush).

These symptoms may look like other blood disorders or health problems. Always see your health care provider for a diagnosis.

How is aplastic anemia diagnosed?

Your provider will take your health history and give you a physical exam. You may also have tests, such as:

• Blood tests. These may include blood chemistries, evaluation of liver and kidney functions, and genetic studies.

• Bone marrow aspiration or biopsy.  This involves taking a small amount of bone marrow fluid (aspiration) or solid bone marrow tissue (core biopsy). These are often taken from the hip bones. They are checked for the number, size, and maturity of blood cells or abnormal cells.

How is aplastic anemia treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how bad the condition is.

Aplastic anemia is a serious illness. Treatment often depends on the underlying cause. For certain causes, you may get better after treatment. But the condition can come back. To treat the low blood counts, early treatment may include:

• Medicines to stimulate the bone marrow to make cells.

• Treatment to reduce your body’s immune system response.

• Hormone therapy.

• Blood transfusion (both red blood cells and platelets).

• Antibiotic therapy.

In certain people, a bone marrow transplant may cure aplastic anemia.

Living with aplastic anemia

Managing aplastic anemia includes working closely with your provider and following your treatment plan. Tell your provider about any symptoms you are having. You are more at risk of infections so you should:

• Stay away from people who are sick.

• Not be around large crowds.

• Wash your hands often. Use soap and clean, running water (warm or cold) and scrub your hands for at least 20 seconds.

• Not eat foods that are not cooked all the way through.

• Brush your teeth regularly.

• Get your annual flu shot and other vaccines as directed by your provider.

You may be at higher risk of bleeding if you have a low platelet count. Stay away from activities that could cause an injury. Ask your provider what physical activities are safe for you. You may need to stay away from contact sports.

Key points about aplastic anemia

• Aplastic anemia occurs when your bone marrow doesn't make enough red and white blood cells, and platelets.

• This condition can make you feel tired, raise your risk of infections, and make you bruise or bleed more easily.

• To treat low blood counts, early treatment involves easing symptoms.

• Treatments may include medicines to stimulate bone marrow production, blood transfusions, antibiotics, and other therapies.

• In some cases, a bone marrow transplant may cure aplastic anemia.

Next steps

Tips to help you get the most from a visit to your provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions, especially after office hours or on weekends.