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 the three blood components are in lower than the normal is known as pancytopenia. Patients with aplastic anemia are at high risk for bleeding, infections and weight lose due to compromised nutrition.

 What are the Signs and Symptoms of Aplastic Anemia?

• Bleeding and easily Bruising
• Gum bleed
• Heavy menstrual (periods) 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 low amount of hemoglobin in the blood.

 What are the Diagnostic tests?

1. Complete blood count (CBC) : (In complete blood count there will be severely dropped white blood cells, dropped hemoglobin, and 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:

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 defected marrow of the patient is replaced with the healthy bone marrow from a fully HLA-matched sibling.

 What are the Causes of Aplastic Anemia?

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

• Chemical exposure.
• Moreover, 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 very necessary to prevent complications.such as infections,bleeding,weight lose and skin breakdown and prevent from falls.

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.The mouth care must be given to the patient after meals.e.g after breakfast,aftrer lunch and after dinner.This routine will help in maiantaining the oral cavity clean by rinsing the food particles after eating food.
• 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 is with compromised immunity so, there are higher chances to catch infections in such places .avoiding visiting such crowded places can prevent the patient from life threatening infections.
• Avoid the use of 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?

• Uncontrolled Bleeding:

Uncontrolled bleeding may lead to life-threatening conditions even deaths’ very low levels of platelets in the blood does not help in stopping the bleeding if occurs.bleeding may occur in brain,gastro intestinal bleeding or bleeding form gums and from urinary tract.

• Frequent Infections:

In aplastic anemia patients are highly prone for 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 respiratory system such as pnemonia,COVID -19 or influenza or tuberclosis ,other infections include gasterointestinal and urinary tract infection. Furthermore, frequent infections lead to frequent hospitalizations which increases the financial burden too.

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 on regular basis and keep and eye on platelet count.

Growth and development problems: Aplastic anemia can cause growth and developmental problems in children.

Skin problem:

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

Mouth ulcers:

Aplastic patients are at high risk of developing mouth ulcers ,if oral care is compromised. Therefore,It is very much important to take proper mouth care and oral hygiene care. For good oral hygiene antiseptic mouth washes especially that contains antifungal are highly recommended.

Furthermore, mouth ulcers further lead to low oral intake. Which further leads to get chances of other complications such as weight loss and low immunity.

Conclusion:

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 bone marrow transplant is very necessary for the best outcomes of treatment.