Aplastic anemia
Hypoplastic anemia; Bone marrow failure - aplastic anemiaAplastic anemia is a condition in which the bone marrow does not make enough blood cells. Bone marrow is the soft, tissue in the center of bones that is responsible for producing blood cells and platelets.
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...
Read Article Now Book Mark ArticleCauses
Aplastic anemia results from damage to the blood stem cells. Stem cells are immature cells in the bone marrow that give rise to all blood cell types (red blood cells, white blood cells, and platelets). Injury to the stem cells leads to a decrease in the number of these blood cell types.
Aplastic anemia can be caused by:
- Use of certain medicines or exposure to toxic chemicals (such as chloramphenicol, benzene)
- Exposure to radiation or chemotherapy
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
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Autoimmune disorders
Autoimmune disorders
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 autoimmune d...
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- Viruses
Sometimes, the cause is unknown. In this case, the disorder is called idiopathic aplastic anemia.
Symptoms
Symptoms are due to the underproduction of red cells, white cells, and platelets. Symptoms may be severe from the start or gradually worsen over time as the disease progresses.
Low red cell count (anemia) can cause:
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Fatigue
Fatigue
Fatigue is a feeling of weariness, tiredness, or lack of energy.
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Pallor (paleness)
Pallor
Paleness is an abnormal loss of color from normal skin or mucous membranes.
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Rapid heart rate
Rapid heart rate
A bounding pulse is a strong throbbing felt over one of the arteries in the body. It is due to a forceful heartbeat.
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Shortness of breath with exercise
Shortness of breath
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
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- Lightheadedness upon standing
Low white cell count (leukopenia) causes an increased risk for infection.
Low platelet count (thrombocytopenia) can result in bleeding. Symptoms include:
Thrombocytopenia
Thrombocytopenia means there is an abnormally low amount of platelets. Platelets are parts of the blood that help blood to clot. This condition is ...
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Bleeding gums
Bleeding gums
Bleeding gums can be a sign that you have or may develop gum disease. Ongoing gum bleeding may be due to plaque buildup on the teeth. It can also b...
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Nose bleeds
Nose bleeds
A nosebleed is loss of blood from the tissue lining the nose. Bleeding most often occurs from one nostril only.
Read Article Now Book Mark Article - Rash, small pinpoint red marks on the skin (petechiae)
- Frequent or severe infections (less common)
Exams and Tests
Blood tests will show:
- Low red blood cell count (anemia)
Red blood cell count
An RBC count is a blood test that measures how many red blood cells (RBCs) you have. RBCs contain hemoglobin, a protein which carries oxygen. How mu...
Read Article Now Book Mark Article - Low white blood cell count (leukopenia)
White blood cell count
A WBC count is a blood test to measure the number of white blood cells (WBCs) in the blood. It is a part of a complete blood count (CBC). WBCs are a...
Read Article Now Book Mark Article - Low reticulocyte count (reticulocytes are the youngest red blood cells)
Reticulocyte count
Reticulocytes are slightly immature red blood cells. A reticulocyte count is a blood test that measures the amount of these cells in the blood....
Read Article Now Book Mark Article - Low platelet count (thrombocytopenia)
Platelet count
A platelet count is a lab test to measure how many platelets you have in your blood. Platelets are particles in the blood that help the blood clot. ...
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A bone marrow biopsy shows fewer-than-normal blood cells and an increased amount of fat.
Bone marrow biopsy
A bone marrow biopsy is the removal of marrow from inside one of your bones. Bone marrow is the soft tissue inside bones that helps form blood cells...
Read Article Now Book Mark ArticleTreatment
Mild cases of aplastic anemia that do not have symptoms may not require treatment.
As blood cell counts become lower and symptoms develop, blood and platelets may be given through transfusions. Over time, transfusions may stop working, resulting in very low blood cell counts. This is a life-threatening condition.
Bone marrow, or stem cell transplant may be recommended for younger people. It is more likely to be recommended for those 50 years and younger, but people over 50 may receive a transplant if they are healthy enough. This treatment works best when the donor is a fully-matched brother or sister. This is called a matched sibling donor..
Bone marrow
A bone marrow transplant is a procedure to replace damaged or diseased bone marrow with healthy bone marrow stem cells. Bone marrow is the soft, fatt...
Read Article Now Book Mark ArticleOlder people and those who do not have a matched sibling donor are given medicine to suppress the immune system. These medicines may allow the bone marrow to once again make healthy blood cells. But the disease may return (relapse). A bone marrow transplant with an unrelated donor may be tried if these medicines do not help or if the disease comes back after getting better.
Outlook (Prognosis)
Untreated, severe aplastic anemia leads to rapid death. Bone marrow transplant can be very successful in young people. A transplant is also used in older people or when the disease comes back after medicines have stopped working.
Possible Complications
Complications may include:
- Severe infections or bleeding
- Complications of bone marrow transplant
- Reactions to medicines
- Hemochromatosis (buildup of too much iron in the body tissues from many red cell transfusions)
When to Contact a Medical Professional
Contact your health care provider or go to the emergency room if bleeding occurs for no reason, or if bleeding is hard to stop. Contact your provider if you notice frequent infections or unusual fatigue.
References
Culligan D, Watson HG. Blood and bone marrow. In: Cross SS, ed. Underwood's Pathology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 23.
DeZern AE, Brodsky RA. Aplastic anemia and related bone marrow failure states. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 151.
Young NS, Maciejewski JP. Aplastic anemia. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 31.
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Anemia
Animation
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Bone marrow aspiration - illustration
A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.
Bone marrow aspiration
illustration
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Bone marrow aspiration - illustration
A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.
Bone marrow aspiration
illustration
Review Date: 3/31/2024
Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.