3.12 Aplastic Anemia
Aplastic anemia is a relatively rare but serious medical condition characterized by a significant reduction or absence of all three major blood cell types: red blood cells (RBCs), white blood cells (WBCs), and platelets. A reduction in all three major blood cell types is known as pancytopenia. Pancytopenia occurs when the bone marrow fails to produce an adequate number of blood cells, leading to a decrease in circulating levels in the bloodstream. In aplastic anemia, the bone marrow fails to produce enough cells. It can also stop producing cells completely. This deficiency of blood cells can lead to severe and life-threatening complications.[1],[2]
There are two main types of aplastic anemia: acquired or inherited. Acquired aplastic anemia is the most common form of the disease. It often occurs without an identifiable cause and is believed to be the result of an autoimmune reaction in which the body’s own immune system attacks the bone marrow. Exposure to toxins, viral infections, and radiation therapy can also lead to acquired aplastic anemia.
Inherited aplastic anemia is a rare form of the disease. In inherited aplastic anemia, the body has genetic mutations that impact bone marrow production and function. This is also referred to as Fanconi anemia.
Aplastic anemia can occur in any population, but is more common in young adults and adolescents. The onset of the disease can be either sudden or slowly progress and is often identified as symptoms emerge.[3],[4]
Assessment
Physical Examination
Early symptoms of aplastic anemia are related to fatigue, infections that last a long time, and easy bruising or bleeding. A summary of common clinical manifestations of aplastic anemia is provided in Table 3.12. Note that the clinical manifestations are primarily related to the decreased oxygen-carrying capacity due to abnormally low levels of red blood cells, increased risk of infection due to abnormally low levels of white blood cells, and increased risk of bleeding due to low levels of platelets.
Table 3.12. Clinical Manifestations of Aplastic Anemia[5],[6]
| Body System | Clinical Manifestations |
|---|---|
| Hematological | Fatigue and weakness, pallor, easy bruising and petechiae (tiny red spots on skin), excessive bleeding from minor cuts or injuries, frequent nosebleeds, bleeding gums, blood in the urine or stools, prolonged or heavy menstrual bleeding, or increased susceptibility to infections. |
| Cardiovascular | Rapid or irregular heartbeat, shortness of breath, dizziness, chest pain, cold hands and feet, or decreased blood pressure. |
| Musculoskeletal | Bone pain, muscle weakness, joint pain and stiffness, or fractures resulting from minimal trauma. |
| Respiratory | Shortness of breath, cough with or without blood, frequent respiratory infections, or wheezing or crackles in the lungs. |
| Neurological | Headaches and dizziness, difficulty concentrating, numbness or tingling in hands or feet, problems with balance and coord