Charlotte, NC
Nimesh Adhikari, MD
Om Kumar, MS3
Bill is a 28-year-old man with no past medical history. He goes to college and enjoys playing football. Recently, he has been getting tired quickly and having frequent nose bleeds. His primary care physician referred him to a blood specialist after he had a low platelet count in routine blood tests. His brother has aplastic anemia and has similar symptoms. What information does he need if he gets diagnosed with aplastic anemia?
Aplastic anemia is a problem with your blood factory. It occurs when your bone marrow (the spongy stuff inside your bones) cannot make enough new blood cells. Sometimes, it is just one type of blood cell that’s affected. However, you often become low on all three types: red blood cells, white blood cells, and platelets. It can develop slowly over time or rapidly, and it can be mild or severe. If your blood count gets very low, it can be life-threatening.
Aplastic anemia is caused by damage to the stem cells inside your bone marrow. It can occur at any time but is more common among teenagers and adults.
Aplastic anemia has many causes. Sometimes, it can occur for no known reason. The most common cause of marrow failure is your immune system attacking and destroying the stem cells in your bone marrow. Typically, your immune system attacks only foreign substances, but it can sometimes attack your body cells. This happens if you have an autoimmune disease; aplastic anemia is one example. You might get aplastic anemia from these causes:
The symptoms of aplastic anemia depend on which blood cells are low in your body. Each of the three blood cell types has a different role:
If you have a low red blood cell count, you may experience the following:
If you have a low white blood cell count, you may experience the following:
If you have a low platelet count, you may experience the following:
In the case of aplastic anemia, your doctor will ask you about your symptoms. You might be asked if you have had a fever recently or have undergone chemotherapy or radiation treatments. Your doctor will also inquire about any medications or herbal supplements you have been taking or if you have been exposed to harmful chemicals.
Your doctor can order tests to find out whether you have a low cell count in your blood or bone marrow. They may start with a complete blood count (CBC) test or examine the blood under the microscope (blood smear). The bone marrow test involves a biopsy of your bone marrow to check if you have this disorder. If you have aplastic anemia, the tests will show a few new blood cells being formed. Examining the bone marrow also helps distinguish aplastic anemia from other bone marrow disorders, such as myelodysplastic disorder or leukemia.
If you are diagnosed with aplastic anemia, you might need to get a CBC count regularly. Your doctor will monitor your blood cell count over time and compare them with your previous results to see the drop in your blood count.
Your doctor may order further tests that include: A reticulocyte count (the number of young red blood cells in your blood), erythropoietin (protein made by your kidneys which boosts the bone marrow to make more red blood cells) levels, Iron levels, levels of vitamin B12, and folate (folic acid). A shortage of these vitamins can create abnormal blood cells.
A bone marrow test is used to confirm a diagnosis of aplastic anemia. Bone marrow biopsy starts with removing your bone marrow with a hollow needle, typically from the pelvic or breastbone. Your doctor will look at your liquid bone marrow under a microscope and send a sample of your bone marrow to a lab to test for chromosomal (DNA) abnormalities. These tests will help your doctor understand how well or poorly your bone marrow has been making blood cells.
If you have mild or moderate anemia, you may monitor your blood cell count by getting regular blood work and might not need treatment as long as the condition does not get worse.
If you have severe aplastic anemia, you will need medical treatment and a follow-up to prevent complications resulting in emergency medical care in a hospital. Remember, severe aplastic anemia can be fatal if not treated immediately. Removing the toxin from your surroundings may cure your condition if you have aplastic anemia from exposure to a toxin.
Your doctor will assess your risk factors, ensure you have adequate nutrition, and comply with your prescribed treatment regimen. You will be provided a care plan based on your age, overall health, medical history, and severity of the condition. Your treatment plan will depend on how well you can handle specific medicines and therapies, depending on your preferred options.
A bone marrow transplant is a procedure that replaces unhealthy blood-forming cells in the bone marrow with healthy ones. This test can offer some patients the possibility of a cure, especially those with severe aplastic anemia.
During a bone marrow transplant, Your doctor will use healthy blood-forming cells donated by someone else (donor) to place it inside your bones. These healthy blood-forming cells can be donated by a family member, an unrelated donor, or even from the blood in an umbilical cord. Your doctor will destroy your unhealthy bone cells with chemotherapy or radiation. The healthy cells will then be injected into you through an intravenous catheter. The new cells will travel inside your bones and begin making healthy blood cells. Your transplant team will follow up with you closely to prevent and treat any side effects or complications of the marrow transplant.
Managing your aplastic anemia involves working closely with your healthcare provider and strictly following your treatment plan. Be sure to tell your healthcare provider about any symptoms you show. Since you have more risk of infections, you should:
Do not take a diagnosis of aplastic anemia lightly. Regularly following up with your doctor and a treatment plan tailored to your needs and preference is vital. Seek medical attention if you develop anemia symptoms or fever. Prompt treatment can help lower the symptoms of aplastic anemia and make you feel well again.
