Blood cells are produced by the bone marrow, a spongy tissue inside bones. The bone marrow is responsible for the production of red blood cells that help to carry oxygen to various tissues in the body. It also aids production of white blood cells that are vital for the body's immune system to fight against infection. Besides this, platelets, which are essential for clotting of blood to stop bleeding from cuts and wounds are also formed because of the bone marrow. When the bone marrow does not produce sufficient blood cells, the condition is called aplastic anemia. The production of blood cells is an ongoing process because all blood cells have a limited lifespan. While white blood cells last just for a day or even less, platelets die after 8 or 10 days. Red blood cells have a longer life cycle, lasting about 120 days, after which they have to be replaced by fresh cells. Under normal conditions, in response to an infection, the bone marrow increases white blood cell production. Platelet production is hiked to meet with increased demand because of a cut or a wound that results in bleeding. Shortfall in the production of blood cells is a fairly rare occurrence, but it can happen in adults as well as in children. A rare inherited form of anemia called Fanconi's anemia may lead to aplastic anemia.
Diagnosis of aplastic anemia can be confirmed only after blood tests. Once the doctor detects signs of anemia during a physical examination like pale skin, heart murmur, and such other symptoms, he/she records the medical and family history of the patient, particularly if there is a blood disorder or autoimmune disease in the family. Details about exposure to toxins or chemicals, medication ingested recently, problems like bleeding gums or nosebleeds give the doctor an indication of the condition and point to the need for further tests. Aplastic anemia tests include a complete blood count test, a reticulocyte count test, and a bone marrow test. A complete blood count measures the levels of hemoglobin in the blood as well as the hematocrit levels. The number of red blood cells, white blood cells, platelets is also checked along with the mean corpuscular value, which measures the average size of blood cells. A reticulocyte count records the number of immature red blood cells in the blood sample, to check if the bone marrow is producing enough red blood cells. A bone marrow aspiration tests draws the fluid in the bone marrow to check for irregular shaped cells. A sample of the bone marrow tissue is removed during a biopsy, and this sample of checked for the number and types of blood cells in it.
The good news is that in some cases of acquired aplastic anemia, it is only a temporary condition that responds to treatment. Pregnancy is one such cause. The use of certain medication like chloramphenicol can also lead to this type of anemia and discontinuing the medication is advised in such cases. There are cases of aplastic anemia being the result of an autoimmune disease, meaning the body's own immune system mistakenly attacks the body's cells, destroying them. Among known aplastic anemia causes, exposure to toxins such as benzene, arsenic, and toxic chemicals in pesticides are more common. Avoiding repeated exposure to these chemicals can improve the condition of patients. Patients with cancer may suffer from this type of anemia as a result of exposure to radiation and chemotherapy, though the condition may be a temporary side effect of radiation therapy. Those who do not opt for such treatment also run the risk of the spread of the cancer to the bone, eventually leading to aplastic anemia as well. Infectious diseases such as HIV, hepatitis may also place a strain on the immune system, resulting in insufficient production of white blood cells to meet the demand. Idiopathic aplastic anemia is a condition where physicians are unable to identify any cause for the disease.
When the bone marrow is unable to produce enough blood cells, symptoms of aplastic anemia such frequent and inexplicable bruises, nosebleeds, fatigue, dizziness, and breathlessness may be observed. Aplastic anemia symptoms in adults, children and women are similar and may include pale skin, skin rashes, and bleeding, which is more prolonged than normal in case of cuts and wounds. When flu like symptoms persists or when a person suffers from severe infections frequently, doctors usually order a complete blood count test to make sure that the white blood cell count in the blood is normal and that the person is not anemic. Women may experience heavy menstrual bleeding, one of aplastic anemia symptoms that may be confused with other gynecological problems. Bleeding gums and nosebleeds in children call for blood tests so that treatment may be started as soon as possible in case the test results point to aplastic anemia. Most people experience shortness of breath because their body is unable to get adequate oxygen in all the tissues because of the reduced number of red blood cells, which are the carriers of oxygen. Heart murmurs and arrhythmia are the result of the heart having to work harder to supply oxygen-rich blood to all corners of the body.
Patients with mild or moderate aplastic anemia may be required to monitor their blood count regularly to make sure that their condition remains stable. Aplastic anemia treatment needs to be started as soon as possible for those with severe anemia. Blood transfusions may be required as an immediate measure to maintain blood cell count at near normal levels. Though this may relieve some of the symptoms, it is by no means a long term solution. Stem cell transplantation with donated stem cells from a matched donor like a sibling or a blood relative can be successful in treating the anemia, particularly in children and young adults. In the case of older patients, there is a possibility of post transplant complications like rejection of the donors stem cells.
Bone marrow transplantation replaces the diseased stem cells in the bone marrow with healthy donor cells so that they can generate the required amount of blood cells. Drug therapies in the treatment of aplastic anemia use immune suppressants, particularly for those with auto immune disorders. A major disadvantage of immunosuppressive drug therapy is that the body's immune system is considerably compromised, increasing the risk of contracting other diseases. Another form of drug therapy uses growth factors to boost the production of red blood cells in the bone marrow, though it has a limited success rate. The use of this type of therapy is more helpful after a bone marrow transplant or immunosuppressive therapy.