ANEMIA, APLASTIC

General Information

DEFINITION--A serious disease characterized by decreased bone-marrow production of white and red blood cells and platelets.

BODY PARTS INVOLVED--Bone marrow; lymphatic system; blood.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

> Spontaneous bleeding from the nose, mouth, rectum, vagina, gums and other sites--

including the central nervous system.

• Red dots of bleeding under the skin.
• Unexplained bruising.
• Ulcers in the mouth, throat and rectum.

CAUSES--Poor bone-marrow function. Bone marrow is often infiltrated with fat cells, which supplant areas that manufacture blood cells. Infections occur because of reduced white cells, which normally protect against infection. Half of all cases are caused by drugs, especially immunosuppressive drugs, anticancer drugs, chloramphenicol or chemicals such as benzene. Other cases probably result from immunodeficiency, severe illness or unidentifiable causes.

RISK INCREASES WITH

• Family history of aplastic anemia.
• Genetic factors, such as those associated with congenital hypoplastic anemia (See Glossary).
• Use of drugs listed as causes.
• Recent severe illness.

HOW TO PREVENT

• Avoid prolonged exposure to toxic compounds, such as benzene, that are used in many industrial chemicals.
• Don't use drugs that cause aplastic anemia if substitute drugs are available.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory studies of blood and bone marrow.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Surgery to transplant bone marrow.
• Blood transfusions if necessary.
• Hospitalization for isolation until the body can resist infection.

POSSIBLE COMPLICATIONS--Poor response to treatment, resulting in uncontrollable infections and bleeding. Complications are fatal in 50% to 70% of those with severe aplastic anemia.

PROBABLE OUTCOME--If the cause can be identified and treated successfully, the disorder is curable. Anemia caused by immuno-suppressive drugs usually improves spontaneously when drugs are withdrawn. Full recovery often requires 6 to 8 months.

How To Treat

GENERAL MEASURES--

• A bone-marrow transplant requires a donor with compatible antigens. A twin, brother or sister usually makes the best donor. Donated marrow is injected gradually into the patient's veins to try to replace poorly functioning bone marrow with normal cells.
• Keep the mouth scrupulously clean to decrease the chance of infection. Brush often with a soft toothbrush. Rinse the mouth with a solution of equal parts hydrogen peroxide and water or use a medicated mouthwash, if prescribed.

MEDICATION--Your doctor may prescribe:

• Immunosuppressive drugs to prevent rejection, if a bone-marrow transplant is necessary.
• Antibiotics to prevent or treat infection.
• Medicated mouthwash to suppress fungus infections.

ACTIVITY--Resume your normal activities after treatment.

DIET--No special diet. You may need iron and vitamin supplements. Ask your doctor.

Call Your Doctor If

• You or a family member have symptoms of aplastic anemia.
• The following occurs after a bone-marrow transplant: Fever. Any sign of infection, such as swelling anywhere in the body. Redness, tenderness or pain may not be present. Skin rash. Jaundice (yellow skin and eyes). Joint pain. Puffy feet and ankles. Urinary discomfort. Decreased urine in 1 day.