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Aplastic anaemia

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VOL: 102, ISSUE: 24, PAGE NO: 25


- 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;

- Headache;

- Fatigue;

- 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.

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