Aplastic Anaemia

Aplastic Anaemia - What it is

What is aplastic anaemia?

Aplastic anaemia is a rare and potentially very serious condition that is the consequence of a reduction in the blood forming cells in the bone marrow. People with aplastic anaemia have low haemoglobin (anaemia), low white blood cells (immune system cells which fight infection) and low platelets (small cells which stop bruising & bleeding).

comparison of the blood between someone with normal condition and someone with aplastic anaemia

What are the types of aplastic anaemia?

Aplastic anaemia is classified into three main types:

Acquired aplastic anaemia: This is the most common type and develops after birth. It can be caused by factors such as exposure to radiation, chemotherapy, toxins, certain medications or viral infections.
Inherited aplastic anaemia: Also known as congenital aplastic anaemia, this type is present at birth and results from genetic mutations. The most common form is Fanconi anaemia.
Idiopathic aplastic anaemia: In this type, the cause is unknown. It is diagnosed when no specific underlying factor can be identified.

Aplastic Anaemia - Symptoms

What are the symptoms of aplastic anaemia?

People with aplastic anaemia may look pale, feel more tired than usual and get breathless easily. As their white blood cells are low, they will be prone to severe infections and a low platelet count will increase the risk of bruising and bleeding.

Aplastic Anaemia - How to prevent?

How is aplastic anaemia prevented?

There is no effective prevention for most cases of aplastic anaemia.

Some chemicals and toxins, such as herbicides and organic solvents, can predispose certain individuals to developing aplastic anaemia. Reducing exposure to these substances may help lower this risk. When exposure to such chemical cannot be avoided, safe handling practices should be employed.

Aplastic Anaemia - Causes and Risk Factors

What causes aplastic anaemia?

Most aplastic anaemia cases are due to suppression of the bone marrow by the immune system.

A small minority of cases may be due to genetic predisposition or medications and toxins. Other causes can include:

Viral infections: Certain viruses, such as hepatitis, Epstein-Barr virus and HIV, can lead to aplastic anaemia by damaging the bone marrow.
Radiation and chemotherapy: Treatment for cancer and other conditions can harm the bone marrow, potentially leading to aplastic anaemia.

What are the risk factors for aplastic anaemia?

Autoimmune conditions: People with autoimmune disorders like lupus may be at higher risk due to immune system dysregulation.
Exposure to industrial chemicals: Contact with chemicals like benzene or pesticides can increase the risk of developing aplastic anaemia.

Aplastic Anaemia - Diagnosis

How is aplastic anaemia diagnosed?

A diagnosis of aplastic anaemia may be suspected from the history, physical examination and routine blood tests. A bone marrow biopsy is required to confirm the diagnosis of aplastic anaemia and further investigations are usually carried out to try to determine a cause.

bone marrow of someone with aplastic anaemia

Aplastic Anaemia - Treatments

How is aplastic anaemia treated?

Patients with mild aplastic anaemia and have no symptoms will be managed with close observation.

A person with more severe aplastic anaemia may require regular transfusions of red blood cells and platelets, and may need to take medications to reduce the risk of infection. Some patients may receive treatment with drugs called androgens to try to stimulate their bone marrow, whilst others may require treatment with medications to suppress the immune system (e.g. ciclosporin, anti-thymocyte globulin) and specific drugs to stimulate blood cell production (e.g. eltrombopag).

In certain circumstances where the aplastic anaemia is severe and there is a full-matched donor, a haemopoietic stem cell transplant may be recommended.

Regardless of the treatment, most patients with aplastic anaemia will be followed-up lifelong in our Specialist Clinic to monitor for relapses and treat long term complications of the condition.

Aplastic Anaemia - Other Information

What are the signs of aplastic anaemia?

People with aplastic anaemia may experience extreme tiredness, breathlessness, frequent infections, unexplained bruising or bleeding and a noticeably pale complexion. These symptoms are due to a reduced production of blood cells.

How is aplastic anaemia identified?

Aplastic anaemia is typically identified through blood tests revealing low counts of red blood cells, white blood cells and platelets. A bone marrow biopsy may also be needed to assess the condition of the bone marrow.

Is there treatment available for aplastic anaemia?

Treatment varies depending on the severity but may include blood transfusions, medications to suppress the immune system or a bone marrow transplant in more critical cases. Early diagnosis is crucial for effective management of the condition.

References

The aplastic anaemia trust. The Aplastic Anaemia Trust. (n.d.). https://www.theaat.org.uk/
Aplastic anaemia. Leukaemia Foundation. (2024, May 22). https://www.leukaemia.org.au/blood-cancer/types-of-blood-cancer/aplastic-anaemia/
Moore, C. A. (2023, July 17). Aplastic anemia. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK534212/
U.S. Department of Health and Human Services. (n.d.). Aplastic anemia. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/anemia/aplastic-anemia
Ashraf, S., Rashid, A., Mughal, Z., Babar, H., Sheikh, H., & Naveed, M. A. (2022). Spectrum of aplastic anaemia; presentation, etiology and overall survival: aspectrum of aplastic anaemia: Presentation, etiology and overall survival-A tertiary care hospital experience tertiary care hospital experience. Pakistan BioMedical Journal, 330–334. https://doi.org/10.54393/pbmj.v5i5.437

Overview

Haematopoietic Stem Cell Transplant,

Antithymocyte Immunoglobulin (horse),

Ciclosporin (Cyclosporine),

Etrombopag

Article contributed by Haematology, Singapore General Hospital

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

Dr Jason Chay Wai Mun

Senior Consultant

MBBS (Singapore), MRCP (UK), FRCPath Haematology (UK), FAMS (Singapore), GDFM (Singapore)

Clinical Interests: Transfusion Medicine, Laboratory Haematology

Dr Denise Tan Yan

Senior Consultant

MBBS (Singapore), MRCP (UK), MMed (Internal Medicine), FRCPath (UK)

Clinical Interests: General Haematology, Myeloproliferative Neoplasm

Dr Tan Yan Chin

Consultant

MD(UKM), MMed(NUS), MRCP(UK), FRCPath(UK)

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