Aplastic Anemia

Updated: Mar 15, 2023
  • Author: Sameer Bakhshi, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Overview

Practice Essentials

Aplastic anemia is a syndrome of bone marrow failure characterized by peripheral pancytopenia and marrow hypoplasia (see the image below). Although the anemia is often normocytic, mild macrocytosis can also be observed in association with stress erythropoiesis and elevated fetal hemoglobin levels.

Aplastic anemia. Low-power view of hematoxylin-eosAplastic anemia. Low-power view of hematoxylin-eosin–stained bone marrow showing hypocellularity, with increased adipose tissue and decreased hematopoietic cells in the marrow space.

Signs and symptoms

The clinical presentation of patients with aplastic anemia includes signs and symptoms related to the decrease in bone marrow production of hematopoietic cells. The onset is insidious, and the initial clinical manifestation is frequently related to anemia or bleeding, although fever or infections may be noted at presentation.

Signs and symptoms of aplastic anemia may include the following:

  • Pallor
  • Headache
  • Palpitations, dyspnea
  • Fatigue
  • Foot swelling
  • Gingival bleeding, petechial rashes
  • Overt and/or recurrent infections
  • Oropharyngeal ulcerations

A subset of patients with aplastic anemia present with jaundice or other evidence of hepatitis. [1, 2]

See Presentation for more detail.

Diagnosis

Testing

Laboratory testing for suspected aplastic anemia includes the following:

  • Complete blood count
  • Peripheral blood smears
  • Hemoglobin electrophoresis and blood-group testing
  • Biochemical profile
  • Serology for hepatitis and other viral entities
  • Autoimmune-disease evaluation for evidence of collagen-vascular disease
  • Fluorescence-activated cell sorter profiling
  • Fluorescent-labeled inactive toxin aerolysin testing
  • Diepoxybutane incubation
  • Histocompatibility testing
  • Kidney function studies
  • Liver function studies
  • Transaminase, bilirubin, and
 
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