What Is Aplastic Anemia?

Aplastic anemia (a-PLAS-tik uh-NEE-me-uh) is a blood disorder in which the body's bone marrow
doesn't make enough new blood cells. Bone marrow is a sponge-like tissue inside the bones. It makes
stem cells that develop into red blood cells, white blood cells, and platelets (PLATE-lets).
Red blood cells carry oxygen to all parts of your body. They also carry carbon dioxide (a waste
product) to your lungs to be exhaled. White blood cells help your body fight infections. Platelets are
blood cell fragments that stick together to seal small cuts or breaks on blood vessel walls and stop
bleeding.
It's normal for blood cells to die. The lifespan of red blood cells is about 120 days. White blood cells
live less than a day. Platelets live about 6 days. As a result, your bone marrow must constantly make
new blood cells.
If your bone marrow can't make enough new blood cells, many health problems can occur. These
problems include irregular heartbeats called arrhythmias (ah-RITH-me-ahs), an enlarged heart, heart
failure, infections, and bleeding. Severe aplastic anemia can even cause death.
Overview
Aplastic anemia is a type of anemia. The term "anemia" usually refers to a condition in which your
blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells
don't contain enough hemoglobin (HEE-muh-glow-bin). This iron-rich protein helps carry oxygen to
your body.
In people who have aplastic anemia, the body doesn't make enough red blood cells, white blood cells,
and platelets. This is because the bone marrow's stem cells are damaged. (Aplastic anemia also is
called bone marrow failure.)
Many diseases, conditions, and factors can damage the stem cells. These conditions can be acquired
or inherited. "Acquired" means you aren't born with the condition, but you develop it. "Inherited"
means your parents passed the gene for the condition to you.
In many people who have aplastic anemia, the cause is unknown.
Outlook
Aplastic anemia is a rare but serious disorder. It can develop suddenly or slowly. The disorder tends to
get worse over time, unless its cause is found and treated. Treatments for aplastic anemia
include blood transfusions, blood and marrow stem cell transplants, and medicines.
With prompt and proper care, many people who have aplastic anemia can be successfully treated.
Blood and marrow stem cell transplants may offer a cure for some people who have aplastic anemia.
Diagnosis
Your doctor will diagnose aplastic anemia based on your medical and family histories, a physical exam,
and test results.
Once your doctor knows the cause and severity of the condition, he or she can create a treatment plan
for you.
Specialists Involved
If your primary care doctor thinks you have aplastic anemia, he or she may refer you to a
hematologist. A hematologist is a doctor who specializes in treating blood diseases and disorders.
Medical and Family Histories
Your doctor may ask questions about your medical history, such as whether:
You've had anemia or a condition that can cause anemia
You have shortness of breath, dizziness, headaches, or other signs and symptoms of
anemia
You've been exposed to certain toxins or medicines
You've had radiation or chemotherapy (treatments for cancer)
You've had infections or signs of infections, such as fever
You bruise or bleed easily
Your doctor also may ask whether any of your family members have had anemia or other blood
disorders.
Physical Exam
Your doctor will do a physical exam to check for signs of aplastic anemia. He or she will try to find out
how severe the disorder is and what's causing it.
The exam may include checking for pale or yellowish skin and signs of bleeding or infection. Your
doctor may listen to your heart and lungs for abnormal heartbeats and breathing sounds. He or she
also may feel your abdomen to check the size of your liver and feel your legs for swelling.
Diagnostic Tests
Many tests are used to diagnose aplastic anemia. These tests help:
Confirm a diagnosis of aplastic anemia, look for its cause, and find out how severe it
is
Rule out other conditions that may cause similar symptoms
Check for paroxysmal nocturnal hemoglobinuria (PNH)
Complete Blood Count
Often, the first test used to diagnose aplastic anemia is a complete blood count(CBC). The CBC
measures many parts of your blood.
This test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich
protein in red blood cells. It carries oxygen to the body. Hematocrit is a measure of how much space
red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia.
The normal range of these levels varies in certain racial and ethnic populations. Your doctor can
explain your test results to you.
The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood.
Abnormal results may be a sign of aplastic anemia, an infection, or another condition.
Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the
average size of your red blood cells. The results may be a clue as to the cause of your anemia.
Reticulocyte Count
A reticulocyte (re-TIK-u-lo-site) count measures the number of young red blood cells in your blood.
The test shows whether your bone marrow is making red blood cells at the correct rate. People who
have aplastic anemia have low reticulocyte levels.
Bone Marrow Tests
Bone marrow tests show whether your bone marrow is healthy and making enough blood cells. The
two bone marrow tests are aspiration (as-pih-RA-shun) and biopsy.
Bone marrow aspiration might be done to find out if and why your bone marrow isn't making enough
blood cells. For this test, your doctor removes a small amount of bone marrow fluid through a needle.
The sample is looked at under a microscope to check for faulty cells.
A bone marrow biopsy might be done at the same time as an aspiration or afterward. For this test,
your doctor removes a small amount of bone marrow tissue through a needle.
The tissue is checked for the number and types of cells in the bone marrow. In aplastic anemia, the
bone marrow has a lower than normal number of all three types of blood cells.
Other Tests
Other conditions can cause symptoms similar to those of aplastic anemia. Thus, other tests might be
needed to rule out those conditions. These tests may include:
X ray, computed tomography (CT) scan, or an ultrasound imaging test. These tests
can show enlarged lymph nodes in your abdomen. Enlarged lymph nodes may be a
sign of blood cancer. Doctors also may use these tests to look at the kidneys and the
bones in the arms and hands, which are sometimes abnormal in young people who
have Fanconi anemia. This type of anemia can lead to aplastic anemia.
Chest x ray. This test creates pictures of the structures inside your chest, such as
your heart, lungs, and blood vessels. A chest x ray may be used to rule out
infections.
Liver tests and viral studies. These tests are used to check for liver diseases and
viruses.
Tests that check vitamin B12 and folate levels in the blood. These tests can help rule
out anemia caused by vitamin deficiency.
Your doctor also may recommend blood tests for PNH and to check your immune system for proteins
called antibodies. (Antibodies in the immune system that