Aplastic Anemia
Aplastic anemia is a medical condition in which the body does not produce sufficient new blood cells. It causes fatigue and makes you more susceptible to infections as well as bleeding that is out of control.
Aplastic anemia is a rare but serious and life-threatening disorder caused by an unexplained bone marrow failure to produce blood cells. Damage to the stem cells or certain environmental factors can cause the production of bone marrow cells to fail. As a result, one develops aplastic anemia.
Moreover, aplastic anemia can strike at any age. It can happen suddenly or gradually and tend to worsen with time. It can also range from mild to serious.
Signs and Symptoms of Aplastic Anemia
Aplastic anemia can be asymptomatic. However, the signs and symptoms of aplastic anemia that may be present if the levels of the blood cells drop to dangerously low levels:
- Bleeding nose and gums
- Breathing difficulty
- Bruising that is unexplained or occurs easily
- Dizziness and headache
- Excessive bleeding from cuts
- Fatigue
- Fever
- Infections that occur frequently or for an extended period
- Pale skin tone
- Rapid or erratic heart rhythm
- Rashes on the skin
Causes of Aplastic Anemia
Blood cells, including white blood cells, red blood cells, and platelets, are produced by stem cells within the bone marrow. However, these stem cells are damaged in patients with aplastic anemia. Hence, the bone marrow either remains empty or has a limited number of blood cells.
One of the common aplastic anemia causes involves the attack of the immune system by the bone marrow stem cells. Other factors that can affect or damage the bone marrow and impair the production of blood cells are:
Chemotherapy and radiation therapy: These cancer-fighting treatments destroy the cancerous cells. On the other hand, they can also affect healthy cells, such as the bone marrow stem cells. These treatments may cause aplastic anemia as a temporary side effect.
Certain drugs: Aplastic anemia can occur due to certain medications, including rheumatoid arthritis drugs and some antibiotics.
Toxic chemical exposure: Certain toxic chemicals, including those present in pesticides and insecticides, as well as benzene, a component of gasoline, is associated with aplastic anemia. However, this condition may get better if you keep off the chemicals that trigger the illness.
Autoimmune diseases: The autoimmune disorder whereby the body immune system strikes the healthy cells may include the bone marrow stem cells. Hence, aplastic anemia can occur.
Pregnancy: During pregnancy, your body's immune system may attack the bone marrow, causing aplastic anemia.
A viral infection: Certain viral infections of the bone marrow can contribute to the occurrence of aplastic anemia. Hepatitis, cytomegalovirus, Epstein-Barr virus, and parvovirus B19 are the viruses that are associated with aplastic anemia.
Aplastic Anemia Diagnosis
Your doctor or hematologist can conduct the following tests and procedures during aplastic anemia diagnosis:
- Blood tests
White blood cells, red blood cells, and platelet levels are normally in a particular range. However, all these levels of blood cells are normally low in patients with aplastic anemia.
- Biopsy of the bone marrow
During a bone marrow biopsy, the medical provider extracts a small bone marrow sample using a needle from the bigger bone in the body, like a hipbone. To rule out other conditions related to blood cells, the doctor examines the sample under a microscope. Aplastic anemia causes bone marrow to have fewer blood cells, unlike usual. A bone marrow biopsy is necessary to confirm an aplastic anemia diagnosis.
Aplastic Anemia Treatment
Aplastic anemia treatments usually vary from one person to another depending on the seriousness of the condition and age. Severe aplastic anemia, characterized by very low blood cell counts, can be life-threatening and necessitates immediate hospitalization.
In general, the treatment options for aplastic anemia can include;
- Blood transfusions
Blood transfusions, though not a cure for aplastic anemia, can help manage bleeding and alleviate symptoms. It involves replacing blood cells that the bone marrow is not sufficiently producing. You can either receive red blood cells or platelets.
Red blood cells increase the red blood cell counts and aid in the treatment of anemia and tiredness. On the other hand, platelets aid in the prevention of excessive bleeding.
Whereas there is no general limit to the number of blood transfusions you can receive, complications with multiple transfusions can at times occur. Transfused red blood cells have iron, which can build up in the body and harm vital organs if not treated. Luckily, medications can help the body eliminate excess iron.
- Stem cell transplantation
For patients with severe aplastic anemia, transplantation to restore bone marrow stem cells with the donor’s may be the only effective treatment choice. A stem cell transplant is also known as a bone marrow transplant. It is usually the treatment option for individuals who are young and have a matching donor, usually a sibling.
Once the stem cells donor is found, the damaged bone marrow is depleted first using radiation therapy or chemotherapy. The blood is then filtered to remove the healthy stem cells from the donor. After that, the healthy stem cells are intravenously injected into the bloodstream. From there, they travel to bone marrow cavities and start producing new blood cells.
A prolonged hospital stay is necessary during this procedure. You will be given drugs to help stop or prevent the donated stem cells from being rejected following the transplant.
However, a stem cell transplant is associated with some risks and complications. The body might reject the transplantation, resulting in potentially fatal complications. Furthermore, not every patient qualifies for transplantation or finds an appropriate donor.
- Antibiotics and antivirals
Aplastic anemia tends to weaken the body's immune system, making you more susceptible to infections.
People who have aplastic anemia need to see their doctor as soon as they notice any infection signs, like a fever. This causes the infection to become worse, and this could be fatal. To help avoid infections, the doctor may recommend antibiotics or antiviral drugs for people with severe aplastic anemia.
- Bone marrow stimulants
Some medications and colony stimulation factors like filgrastim (Neupogen) and pegfilgrastim (Neulasta), eltrombopag (Promacta), sargramostim (Leukine), and epoetin alfa (Epogen/Procrit) trigger the production of new blood cells from the bone marrow. Immunosuppressive drugs are frequently combined with growth factors.
- Immunosuppressants
Some patients are unable to receive a stem cell transplant or have aplastic anemia caused by an autoimmune disease. In such cases, treatment may include medications to suppress or alter the body's immune system (immunosuppressants).
Cyclosporine (Neoral, Gengraf, Sandimmune), as well as anti-thymocyte globulin, inhibit the activity of the immune cells that harms the bone marrow. This aids in the recovery of your bone marrow and the production of new blood cells. Cyclosporine and anti-thymocyte globulin are frequently used in conjunction. Corticosteroids drugs, including methylprednisolone (Medrol and Solu-Medrol), are commonly used in conjunction with these medications.
While they are effective, these medications weaken the immune system even more. It's also possible that anemia will recur once you stop taking these medications.
- Supportive care
Supportive care, as well as the continuing follow-up, is essential in the control and treatment of aplastic anemia. Patients with aplastic anemia who need regular transfusions or infused drugs may benefit from a central venous catheter. This is a tube that transports medications to the vein within the chest.
Patients who are deficient in particular blood elements might require immediate assistance with infused blood products. These include packed red blood cells to address or prevent cardiopulmonary complications. Platelet therapy should aim to keep platelet counts stable in order to avoid spontaneous bleeding.
Complications of Aplastic Anemia
Aplastic anemia patients may experience complications as a result of their condition and their treatment. The patient's body may reject the new bone marrow transplant at times. This is known as graft-versus-host disease or GVHD.
This condition could make a person extremely sick and trigger symptoms such as:
- Skin blisters
- Nausea and vomiting
- Diarrhea
- Damage to the liver
According to a recent study, approximately 15 percent of patients with aplastic anemia who undergo immunosuppressive therapy get myelodysplastic syndromes or acute myeloid leukemia. These disorders can manifest themselves years following the initial diagnosis of the patient.
Other people may fail to respond to treatments for aplastic anemia. If this occurs, they become much susceptible to infections that may be fatal.
Living with Aplastic Anemia
Closely working with your medical provider and adhering to the treatment schedule is essential when it comes to controlling aplastic anemia. Inform your provider of any symptoms that you are experiencing. Because you are more susceptible to infections, you need to do the following;
- Keep a safe distance from sick people.
- Stay away from large crowds.
- Wash your hands frequently.
- Refrain from eating foods that have not been thoroughly cooked.
- Brush your teeth on a regular basis.
- Get your flu shot at least every year.
- Create an effective fitness plan with your medical provider.
Conclusion
Aplastic anemia is a medical condition that affects stem cells in the bone marrow. The bone marrow produces red blood cells, white blood cells, and platelets, all of which are vital in the body.
A person who has aplastic anemia might have severe symptoms of anemia. Chemotherapy and radiation therapy, stem cell transplants, and immunotherapy are some of the treatments.