Aplastic Anemia: Causes, Symptoms and Treatment.

What is Aplastic Anemia?

Definition:

Aplastic Anemia is a disorder in which a person’s bone marrow fails to produce healthy blood cells, which include red blood cells(RBCs), white blood cells(WBCs), and platelets.

This results in a decrease in the level of hemoglobin, platelets, and white blood cells. In medical terms, the condition in which all three blood components are lower than the normal is known as pancytopenia.

Patients with aplastic anemia are at high risk for bleeding, infections, and weight loss due to compromised nutrition.

 What are the Signs and Symptoms of Aplastic Anemia?

• Bleeding and easily bruising
• Gum bleed
• Heavy menstrual (period) bleeding in females
• Hematuria (blood in urine )
• Fever ( sign of infection)
• Weakness
• Also, pale skin due to low levels of hemoglobin
•  Frequent infections due to low levels of infection-fighting cells (white blood cells)
• Lethargy (unable to perform daily routine activities). This occurs due to a low amount of hemoglobin in the blood.
• A wound that is not healing

 What are the Diagnostic tests?

1. Complete blood count (CBC) : (In a complete blood count, there will be a severe drop of white blood cells, a drop in hemoglobin, and a very low platelet count.
2. Bone Marrow Biopsy: (Bone marrow biopsy is a gold standard test that confirms aplastic anemia and reveals markedly hypocellular marrow.)

Treatment/ Management of aplastic anemia?

Moreover, the treatment of Aplastic Anemia includes supportive and curative treatment, and the patient will be treated by a hematology-oncology team/consultant.

• Supportive Treatment: The supportive treatment after diagnosing aplastic anemia includes some immunosuppressive medications and blood and blood product transfusions (blood and blood products, usually platelets and packs of Red blood cells, will be transfused to avoid complications like bleeding.

• Curative Treatment: Curative treatment includes bone marrow or stem cell transplantation.

• Stem cell transplant: A stem cell transplant is the only curative treatment for severe aplastic anemia, in which the defective marrow of the patient is replaced with the healthy bone marrow from a fully HLA-matched sibling.

 What are the Causes of Aplastic Anemia?

The exact cause of aplastic anemia is not known. However, the following could be some risk factors.

• Chemical exposure. Some researchers say exposure to Pesticides and fertilizers may cause it.
• Exposure to unnecessary radiation or chemotherapeutic drugs.

What is the Care of a patient at home?

 Proper care of patients at home is essential to prevent complications. Such as infections, bleeding, weight loss, and skin breakdown, and prevent falls.

The following are some tips to manage patients at home.

• Avoid brushing teeth to prevent gum bleeding; instead, use a good mouthwash to maintain good oral hygiene. Mouth care must be given to the patient after meals. e.g, after breakfast, after lunch, and after dinner. This routine will help in maintaining the oral cavity clean by rinsing the food particles after eating.
• Avoid the use of sharp objects such as blades, razors, and knives.
• Avoid going to overcrowded places to prevent airborne infections like COVID-19, influenza, and tuberculosis. As the patient has compromised immunity, there are higher chances of catching infections in such places. Avoiding visiting such crowded places can prevent the patient from contracting life-threatening infections.
• Try not to use public toilets to avoid the risk of urinary tract infections.
• Avoid the use of over-the-counter medicines like NSAIDs, which may worsen your bleeding, as bleeding is the main side effect of NSAIDs.

 What are the Complications of Aplastic Anemia? Aplastic Anemia: Causes, Symptoms, and Treatment.

• Uncontrolled Bleeding: Aplastic Anemia: Causes, Symptoms and Treatment.

Uncontrolled bleeding may lead to life-threatening conditions, even death. Very low levels of platelets in the blood do not help in stopping the bleeding if it occurs. Bleeding may occur in the brain, gastrointestinal bleeding, or bleeding from the gums and from urinary tract.

• Frequent Infections:

In aplastic anemia, patients are highly prone to infections due very low number of infection-fighting cells, which leads to compromised immunity. Infections, especially severe fungal and bacterial infections, may worsen the patient’s condition.

Infections usually include blood infections known as sepsis, infections related to the respiratory system, such as pneumonia, COVID-19, influenza, or tuberculosis, and other infections include gastrointestinal and urinary tract infections. Furthermore, frequent infections lead to frequent hospitalizations, which increases the financial burden too.

How can aplastic anemia cause Stroke?

Patients with severely low quantities of platelets are at a higher risk for intracranial bleeding, known as stroke. To prevent such complications, it is necessary to check blood pressure regularly and keep an eye on platelet count.

Growth and development problems:

Aplastic anemia can cause growth and developmental problems in children.

Skin problem: Aplastic Anemia: Causes, Symptoms, and Treatment.

Patients with aplastic anemia are at high risk of skin bruising cuts and bleeding. Skin bruising occurs due to low platelets. Skin becomes dehydrated due to low intake due to disease process, and low energy.

Mouth ulcers: Aplastic Anemia: Causes, Symptoms and Treatment.

Aplastic patients are at high risk of developing mouth ulcers if oral care is compromised and not properly cleaned. Therefore, it is very important to take proper mouth care and oral hygiene. For good oral hygiene, antiseptic mouth washes, especially those that contain antifungal, are highly recommended.

It is recommended that you clean your mouth after meals, such as after breakfast, lunch, and dinner. So, cleaning the mouth in these timings will keep the oral mucosa free from food particles and lower the risk of mouth infections and dental caries.

Furthermore, mouth ulcers further lead to low oral intake. This further leads to an increased chance of other complications, such as weight loss and low immunity.

Conclusion: Aplastic Anemia: Causes, Symptoms, and Treatment.

Aplastic Anemia is a disease of bone marrow with markedly severe symptoms. Diagnosed through bone marrow biopsy and managed by blood and blood product transfusion.

Moreover, the patient will be under the services of a heam–oncology consultant. Curative treatment will be a bone marrow /stem cell transplant with a fully HLA-matched sibling. Home care before and after a bone marrow transplant is very necessary for the best outcomes of treatment.