VOL: 102, ISSUE: 24, PAGE NO: 25WHAT IS IT?
WHAT IS IT?
- Aplastic anaemia is a serious acquired condition in which blood production by stem cells fails resulting in a lack of red cells, white cells and platelets.
- It is not a form of cancer - the blood cells produced are normal. However, the marrow produces fat cells rather than blood cells.
- Patients with the condition are divided into three categories:
- Non-severe: the blood count is low but not low enough to be classified as severe. Patients may require transfusions of red blood cells but their marrow will produce adequate platelets;
- Severe: two of the following conditions need to be filled: a low platelet count (less than 20); a reticulocyte count of less than 25; an absolute neutrophil count of less than 0.5;
- Very severe: the absolute neutrophil count is less than 0.2.
- Approximately 50% of cases are idiopathic. However, identified causes include:
- Exposure to toxic chemicals;
- High doses of radiation and chemotherapy;
- Some medications, for example those used in the treatment of rheumatoid arthritis and some antibiotics;
- Autoimmune disorders;
- Viral infections;
- Rarely, aplastic anaemia can occur in pregnancy. As in autoimmune disorders the immune system begins attacking the bone marrow;
- Bone marrow diseases.
- As the loss of stem cell function is gradual, symptoms appear over a period of time.
- The symptoms of aplastic anaemia are caused by the deficiency of blood cells and can be divided according to the type of cells that are lacking.
- A deficiency in red blood cells results in anaemia. Symptoms include:
- Shortness of breath;
- Pale complexion.
- A deficiency of white blood cells leaves the patient vulnerable to infection. Symptoms include:
- Recurrent sore throat;
- Pulmonary infections;
- Dermatological infections.
- A deficiency of platelets will result in bleeding in various sites including:
- Nose bleeds;
- Heavy menstruation;
- Oral blood blisters;
- Bruising of the skin even on light contact.
- A blood test can identify aplastic anaemia by showing low levels of all blood cells. Other conditions usually have a deficiency in only one cell type.
- A biopsy can confirm that the bone marrow contains fewer blood cells than normal.
- Severe aplastic anaemia is life-threatening and requires immediate hospital admission.
- Treatment includes:
- Blood transfusions: including transfusions of red blood cells, helping to prevent anaemia and fatigue, or platelets helping to reduce bleeding. White blood cells are harder to transfuse as they are so short-lived. Blood transfusions do not cure the condition but relieve symptoms;
- Immune-suppressing drugs can be used if an autoimmune disorder is attacking the bone marrow;
- Bone marrow transplantation is the only way of ensuring that aplastic anaemia does not reoccur. However, there is a chance of rejection, with life-threatening complications;
- Antibiotics fight infection;
- Growth factors can help stimulate the bone marrow to produce new blood cells. Their long-term safety is unknown.