Aplastic Anaemia: Symptoms, Causes, Pictures, Treatment

Imagine a silent battle within the body, where the bone marrow, the vital factory of blood cells, suddenly goes on strike. Aplastic anaemia is a rare and serious condition where the bone marrow does not make enough blood cells. This leaves individuals with a shortage of blood cells.

Aplastic Anaemia (AA) can arise from various causes. In most cases, medications can treat the symptoms effectively. In severe cases, bone marrow transplants may be the ultimate solution.
The following blog discusses aplastic anaemia causes, symptoms, treatment, and guidelines for better understanding the disorder. Read on to learn more.

Aplastic anaemia meaning is a rare and serious blood disorder characterised by a deficiency of blood cells in the bone marrow. It is a type of bone marrow failure syndrome.
Bone marrow is the soft tissue inside an individual’s bones where new blood cells are formed. 

In aplastic anaemia, the bone marrow does not produce enough platelets, white blood cells, and red blood cells. The condition can be life-threatening if the blood count gets extremely low.

The following are some aplastic anaemia pictures to understand better what patients can expect during this disease.

There are primarily two types of aplastic anaemia. These types are based on the differences in their underlying causes, treatment, and prognoses. They include:

1. Inherited Aplastic Anaemia: It is caused by genetic abnormalities or random gene mutations that are passed down from parents to their children.
   This type is most common in children and young adults. 

2. Acquired Aplastic Anaemia: This form of aplastic anaemia is not inherited but develops later in life. It is caused due to an immune system problem.
   It is more common in older adults but can also occur in younger adults. 

Aplastic Anaemia Stages

Aplastic anaemia does not usually have specific stages. Instead, it is classified based on the severity of the condition. The severity is determined by measuring blood cell counts and evaluating the overall bone marrow function.
The stages include:

1. Moderate Aplastic Anaemia (MAA): It includes cases where blood cell counts are reduced, but the levels are not as low as in severe or severe cases.
   Individuals with moderate aplastic anaemia may have milder or no symptoms.
   However, ongoing monitoring and treatment are still necessary.

2. Severe Aplastic Anaemia (SAA): Individuals with severe aplastic anaemia have at least two of the following:

1. Neutrophil (a type of white blood cell that helps the body fight infections) count below 500 cells per microlitre

2. Reticulocyte (immature red blood cells) count below 20,000 per microlitre

3. A platelet count below 20,000 per microlitre

3. Very Severe Aplastic Anaemia (VSAA): This is the most severe form of aplastic anaemia. Individuals with very severe aplastic anaemia have the following:

1. A neutrophil count below 200 per microlitre

2. Blood counts are like those of severe aplastic anaemia

Aplastic anaemia symptoms can vary among individuals. Symptoms may develop slowly or come suddenly.
Some individuals may experience mild, manageable symptoms, while others may have severe symptoms. Common symptoms of aplastic anaemia include:

1. Fatigue: A decrease in red blood cells results in anaemia, leading to persistent fatigue and weakness. 

2. Frequent or Prolonged Infections: A low white blood cell count can weaken the immune system, making individuals more susceptible to infections. 

3. Fever: Individuals with aplastic anaemia may have a fever due to low white blood cells. 

4. Dyspnea (Shortness of Breath): Anemia can cause a lack of haemoglobin in the blood that carries oxygen to the body.
   Reduced oxygen can lead to shortness of breath, especially when exercising or being active.

5. Easy Bleeding or Bruising: A low platelet count can cause easy bleeding or bruising. Individuals may notice frequent nosebleeds, bleeding gums, or prolonged bleeding from minor cuts. 

6. Arrhythmia (Rapid or Irregular Heart Rate): Anaemia causes the heart to pump more blood to compensate for the decreased oxygen in the blood. This can lead to problems such as a rapid or irregular heart rate. 

7. Pale Skin: The skin can turn pale without haemoglobin and oxygen. 

8. Skin Rash: Low red blood cells and platelet levels can cause petechiae (tiny red or purple dots under the skin). 

9. Dizziness or Lightheadedness: A lack of oxygen to the brain due to anaemia can cause dizziness or lightheadedness, especially when standing up. 

10. Headaches: Like dizziness, low oxygen levels in the brain can cause headaches. 

Aplastic anaemia can have various causes. In some cases, the exact cause may remain unknown. Researchers believe the most common cause is the immune system attacking the stem cells in the bone marrow.
Other possible aplastic anaemia causes include:

1. Radiation and Chemotherapy: High-dose radiation therapy and certain chemotherapeutic drugs can damage bone marrow cells. This leads to aplastic anaemia.

2. Exposure to Toxic Chemicals: Prolonged exposure to certain chemicals and toxins can increase the risk of developing aplastic anaemia. These toxins include benzene (found in gasoline), pesticides, insecticides, 

3. Autoimmune Disorders: Diseases like lupus or eosinophilic fasciitis can cause the immune system to attack and damage the bone marrow. This leads to aplastic anaemia.

4. Certain Drugs: Some medications have aplastic anaemia as a rare side effect. These medications include certain antibiotics or the ones used to treat rheumatoid arthritis. 

5. Viral Infections: Certain viral infections, like hepatitis, Epstein-Barr virus (EBV), cytomegalovirus (CMV), HIV, and parvovirus B19, have been linked to aplastic anaemia.

6. Paroxysmal Nocturnal Haemoglobinuria: It is a rare, acquired disorder in which the red blood cells break too quickly. This condition can lead to aplastic anaemia.

7. Inherited Disorders: In rare conditions, aplastic anaemia can be caused due to inherited conditions, such as Fanconi’s anaemia.  

8. Pregnancy: The immune system may attack a woman’s bone marrow during pregnancy. 

9. Unknown Factors: In many cases, the cause of aplastic anaemia is unknown. This is referred to as idiopathic aplastic anaemia. 

Aplastic Anaemia Risk Factors

While aplastic anaemia can develop in individuals without identifiable risk factors, certain factors may increase the likelihood of developing the condition.
The known risk factors for aplastic anaemia include:

1. Exposure to toxins

2. High-dose radiation or chemotherapy treatments 

3. Certain autoimmune disorders, blood diseases, and serious infections

4. Some prescription drugs like chloramphenicol (for bacterial infections) and gold compounds (for rheumatoid arthritis)

5. A family history of bone marrow failure syndrome

6. Pregnancy (rarely)

There is no guaranteed prevention for most cases of aplastic anaemia. However, certain things can help reduce the risk of developing aplastic anaemia. These preventive measures include:

1. Avoid Exposure to Toxins: Limit exposure to chemicals, herbicides, insecticides, benzene, paint removers, and other toxins by following safety protocols, using protective equipment, and avoiding high-risk environments.

2. Use Medications Carefully: Some medications can increase the risk of aplastic anaemia.
   Therefore, medications should be used responsibly and as prescribed. 

3. Practice Good Hygiene: Good hygiene can prevent infections that lead to aplastic anaemia.
   These practices may include washing hands regularly, avoiding close contact with sick people, etc.

Aplastic anaemia diagnosis may involve a series of tests and evaluations. The doctor will start by taking the individual’s medical history and doing a physical examination to assess the signs and symptoms of the disease.
They may order other tests, including:

1. Blood Tests: The doctor will use a Complete Blood Count (CBC) to measure a person’s platelets, red blood cells, and white blood cells level. Normally, these levels stay within certain ranges.
   In aplastic anaemia, all three cell types are typically reduced, causing pancytopenia (low levels of all three types of blood cells). 

2. Bone Marrow Biopsy and Aspiration: The procedure involves collecting a sample of bone marrow fluid (aspiration) or solid bone marrow tissue (biopsy) from the hipbone.
   The sample is examined under the microscope to assess the size, number, and maturity of blood cells. It also helps rule out other blood-related diseases. 

How to Prepare for a Doctor’s Consultation?

Patients must make an appointment with their primary care provider. They may refer the patient to a haemotologist (a doctor specialising in treating blood disorders). Preparing for the consultation appointment can help patients ensure that they make the most of their time with the doctor. Here are some tips to prepare:

1. Write Down the Symptoms: Individuals must note the symptoms they are experiencing, along with their duration and frequency. 

2. Note Key Personal Information: This includes a medical history and recent life changes, like a job that exposes the patient to chemicals. 

3. Make a List of Medications: It is advised to prepare a list of prescription medications, over-the-counter drugs, vitamins, and supplements that the person takes. Patients should also include the dosages of these medicines.
   This helps the doctor evaluate the potential interactions of certain drugs. 

4. Prepare Questions for the Doctor: Write down a list of questions about aplastic anaemia.
   These questions may relate to its diagnosis, treatment options, potential side effects, prognosis, and any lifestyle modifications that may be necessary.

What to Expect from the Doctor?

The doctor may ask the patient several questions to gather information about their medical history, symptoms, and potential risk factors. Some common questions to expect include:

1. What symptoms are you experiencing?

2. When did you first notice these symptoms?

3. Are these symptoms continuous or occasional?

4. Does anything seem to improve or worsen your symptoms?

5. Have you had recent infections?

6. Do you experience more fatigue than usual?

7. Have you been diagnosed with other medical conditions?

8. Have you undergone treatment for cancer?

9. Have you been exposed to chemicals, toxins, or radiation?

10. Do you have a family history of blood disorders or aplastic anaemia?

Questions to Ask the Doctor

Asking questions during a consultation appointment can help individuals better understand their condition and treatment options. The following are some questions they may consider asking:

1. What is the cause of my symptoms?

2. What tests do I need for diagnosis?

3. What are the available treatment options for my aplastic anaemia? Which treatment do you recommend for my specific case?

4. What are the potential risks and benefits of the recommended treatment?

5. Are there any alternative or complementary therapies that may be considered?

6. How long will the treatment take, and what will the process involve?

7. How can I manage aplastic anaemia with other health conditions?

8. What follow-up tests or appointments will be necessary?

9. How will aplastic anaemia affect my daily life, including work, school, and other activities? 

10. What is my prognosis? Are there any factors that may affect the prognosis?

Aplastic anaemia treatment stimulates the bone marrow to produce new cells and improve symptoms. The specific treatment approach depends on various factors. 

These factors include the underlying cause of the condition, its severity, and the patient’s age and overall health. Here are some common treatment options for aplastic anaemia:

1. Blood Transfusions: Transfusions raise the number of red blood cells and platelets in the body.
   While it does not cure aplastic anaemia, it can temporarily reduce symptoms like anaemia, fatigue, and excessive bleeding. 

   Although multiple blood transfusions are common, some risks are involved, such as iron buildup.
   Over time, the body may develop antibodies that destroy transfused blood cells. 

2. Bone Marrow Transplant: Also known as a stem cell transplant, this is the only cure for aplastic anaemia.
   A stem cell transplant from a matched sibling is generally a treatment option for younger patients.

   It involves replacing the damaged bone marrow with healthy stem cells from a compatible donor.
   This can restore normal blood cell production. However, not everyone is a candidate for this procedure. 

3. Immunosuppressants: These are a treatment option for people who cannot undergo a bone marrow transplant or have aplastic anaemia due to an autoimmune disorder.

   Immunosuppressants are drugs that suppress immune cell activity that damage the bone marrow.
   These drugs include cyclosporine and anti-thymocyte globulin.
   Symptoms improve in about two out of three people who take these medicines. 

4. Bone Marrow Stimulants: Certain drugs help stimulate the bone marrow to produce new blood cells.
   These drugs include sargramostim, filgrastim, epoetin alfa, etc.  

5. Antibiotics or Antivirals: Aplastic anaemia can increase the risk of infections. An infection that gets worse may be life-threatening.
   This is why doctors prescribe antibiotics or antivirals for people with severe aplastic anaemia to prevent infections. 

Please Note: The treatment selection is based on the patient’s condition and the treating doctor’s opinion. 

Cost of Aplastic Anaemia Treatment

The cost of aplastic anaemia treatment in India varies based on several factors, including the patient’s age, patient comorbidities, treatment modality, doctor’s reputation, hospital type and location, insurance coverage and much more.

To know the exact cost of aplastic anaemia treatment in India, one must consult their healthcare provider.
However, the table below also provides the approximate cost of various treatment modalities for aplastic anaemia.

Guidelines for Aplastic Anaemia Treatment

There are certain aplastic anaemia guidelines for treating the condition. These guidelines are reviewed by the British Committee for Standards in Haematology (BCSH).
Key recommendations for different treatment approaches are:

1. Supportive Care:

1. Blood transfusions should be given to improve the patient’s quality of life. 

2. A threshold haemoglobin concentration should not be recommended for all patients. It should be individualised according to co-morbidities. 

3. All patients undergoing immunosuppressive therapy or stem cell transplant should receive irradiated blood products.
   Irradiated blood is blood treated with radiation to prevent transfusion-associated graft-versus-host disease.  

2. Immunosuppressive Therapy: 

1. The standard immunosuppressive therapy is horse ATG (anti-thymocyte globulin) combined with cyclosporin. Cyclosporin prevents T-lymphocytes, a type of white blood cell, from becoming active. 

2. Immunosuppressive therapy is recommended as a first-line treatment for:

1. Non-severe AA patients who require treatment

2. Severe or very severe AA patients who have no matched sibling donors

3. Severe and very severe AA patients above 35-50 years

3. Patients may require a second course of ATG after failure to respond to the first course or after a recurrence of the condition.  

3. Stem Cell Transplant:

1. All patients considered for a stem cell transplant should be evaluated in a multi-disciplinary team setting. 

2. All potential candidates must undergo human leucocyte antigen (HLA) typing at diagnosis. 

3. Alternatives such as immunosuppressive therapy should be actively considered in the treatment plan. 

4. Unrelated donor transplants in adults should be considered after a failure to respond to one course of immunosuppressive therapy. 

Prognosis of Aplastic Anaemia

The prognosis for individuals with aplastic anaemia is generally good. In most cases, people who receive treatment live a high-quality life. However, the outlook depends on several factors, such as:

1. Age of onset

2. The overall health of the patient

3. The severity of anaemia

4. Availability of a stem cell donor matches

Aplastic anaemia can lead to several complications due to the decreased production of platelets, red blood cells, and white blood cells.
Some common complications associated with aplastic anaemia include:

1. Frequent Infections: Aplastic anaemia can weaken the immune system, making individuals more susceptible to infections.
   Infections can be severe and life-threatening, requiring prompt medical attention. 

2. Bleeding: A decrease in platelet count can cause prolonged bleeding from minor cuts, nosebleeds, or bleeding gums.
   Platelet transfusions may be necessary to manage bleeding episodes.

3. Serious Blood Disorder: Aplastic anaemia can increase the risk of developing leukaemia or other serious blood disorders. 

When to See a Doctor?

It is important to see a doctor if a person experiences any signs or symptoms that could be related to aplastic anaemia. The following symptoms may need medical attention:

1. Persistent fatigue and weakness

2. Frequent infections

3. Unexplained bruising or bleeding

4. Recurrent or persistent fever

5. Shortness of breath

6. Pale skin

Risks of Delaying Treatment

If the condition is left untreated or the treatment is delayed, it can result in complications and worsen the disease.
Untreated aplastic anaemia can lead to heart problems such as:

1. An enlarged heart

2. Arrhythmia (irregular heartbeat)

3. Heart failure  

4. Death

No specific diet can cure aplastic anaemia or directly increase blood cell production. However, a healthy and balanced diet is important for recovery for stem cell transplant patients.
Avoiding certain foods can also help lower the chances of infection while the immune system is weak after a transplant. 

1. Fruits and Vegetables:

1. Eat:

1. Thoroughly washed fresh fruits and vegetables

2. Freshly prepared washed salad

3. Tinned fruit

4. Vegetables such as broccoli, spinach and kale

5. Fruits such as bananas, oranges, and strawberries

2. Avoid:

1. Unwashed fruits and vegetables

2. Overripe fruits and vegetables

3. Salad

4. Unpasteurised or freshly squeezed fruit or orange juice

2. Pasteurised Milk and Yoghurt: Greek and fruit yoghurts.

3. Meat and Poultry: 

1. Eat: 

1. Well-cooked meat and poultry

2. Tinned meat or paste

2. Avoid: 

1. Raw or undercooked meat and poultry 

2. Smoked or cured meat like salami

4. Eggs: Eat products made with pasteurised eggs, like mayonnaise, dressing, and pasta.
   However, avoid undercooked or raw eggs and raw egg products, like homemade mayonnaise.

Aplastic anaemia is a rare and serious condition characterised by the failure of the bone marrow to produce enough blood cells. It can cause significant complications such as anaemia, infections, and bleeding.
Timely diagnosis, appropriate treatment, and regular medical monitoring are crucial to manage the condition and improve outcomes.

The HexaHealth team is dedicated to supporting individuals with aplastic anaemia and other complex health conditions.
Our experienced healthcare professionals can provide expert guidance and personalised care plans for each individual. Contact us TODAY to know more!

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