ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

All You Need To Know About Aplastic Anemia Or Bone Marrow Failure (Hypoplastic Anemia)

Updated on January 20, 2014

Aplastic Anemia Patient



This is anemia resulting from failure to produce the formed elements of blood by the bone marrow. Morphologically, in the vast majority of cases, the bone marrow is hypocellular or even totally acellular. Generally, all the elements are affected though at times the affection may be selective.

Aplastic anemia is a rare disorder contributing to 1-2% of the total number of anemia cases. Males suffer twice as many as females. The disease is primary (idiopathic) in over 75% of cases, in the rest, it is secondary to known casuses.

What Causes Aplastic Anemia?

Agents that occasionally produce bone marrow hypoplasia: Chloramphenicol, sulphonamides, phenylbutazone, gold, thiouracil, antoconvulsants, antidiabetic agents, insecticides, industrial solvents, hair dyes etc.
Agents that occasionally produce bone marrow hypoplasia: Chloramphenicol, sulphonamides, phenylbutazone, gold, thiouracil, antoconvulsants, antidiabetic agents, insecticides, industrial solvents, hair dyes etc. | Source

Causes of Aplastic Anemia

Primary: Acquired idiopathic congenital (Fanconi’s)

Secondary: Chemicals and toxins including drugs

  1. Agents which regularly produce bone marrow hypoplasia
  • Anti-cancer drugs (busulphan, cyclophosphamide, etc)
  • Ionizing radiations
  • Benzene and its derivatives

These damage the stem cells and arrest mitosis. If the damage is not severe, withdrawal of the drug is curative.

  1. Agents that occasionally produce bone marrow hypoplasia: Chloramphenicol, sulphonamides, phenylbutazone, gold, thiouracil, antoconvulsants, antidiabetic agents, insecticides, industrial solvents, hair dyes etc.

These are not dose related. Many have an immunological basis. Withdrawal of the drug may not improve the marrow aplasia.

  1. Infections -infective hepatitis (HAV), military tuberculosis
  2. Pregnancy
  3. Thymoma (autoimmune)
  4. Paroxysmal nocturnal hemoglobinuria (PNH)
  5. Systemic disorders such as chronic renal failure, hypothyroidism, and Addison’s disease may be accompanied by varying grades of marrow aplasia.

How Aplastic Anemia Came About



In this disorder, the proliferation and differentiation of hemopoietic stem cells are deranged. Most cases of aplastic anemia are due to a deficiency of marrow stem cells. Immune mechanisms may be responsible for bone marrow aplasia in some cases. A third suggested mechanisms is abnormality of the microenvironment in which the stem cells are proliferating.

The marrow is reduced in volume, often it is yellow due to increase in fat. It is difficult to obtaine a specimen and ‘dry taps’ are common. In an ordinary case, all the formed elements are reduced. Megakaryocytes, myeloid elements and erythroblasts are progressively wiped out resulting in thrombocytopenia, neutropenia and anemia as the disease evolves. In the final stage, all cells are uniformly reduced. Due to reduction in granulocytes, the lymphocytes, plasma cells and other reticuloendothelial cells may appear to be relatively increased.

How To Detect Aplastic Anemia


Clinical features

Symptoms are slow in onset, taking 1-2 months for manifestation. Sometimes bleeding and infection may set in early. Symptoms are due to the consequences of pancytopenia. Varying grades of anemia develop and often it is severe. Hemorrhagic manifestations occur due to thrombocytopenia. Common presentations are purpura, ecchymosis, epistaxis, bleeding from the gums, gastrointestinal bleeding and vaginal bleeding. Bacterial infections occur due to neutropenia. These present with fever or other localized infections.

Hematological features

The erythrocytes, granulocytes and platelets are all reduced. Reticulocytes may be absent. In some cases, granulocytes may be present in small numbers, but the young forms are considerably reduced. Erythrocytes are normocytic and normochromic with uniform size and shape. The bone marrow shows aplasia or hypoplasia. Stainable Iron in the marrow may be increased.

Managing An Aplastic Anemia Patient


Diagnosis And Management


The picture of peripheral pancytopenia with aplastic bone marrow confirms the diagnosis of aplastic anemia. Bone marrow biopsy is essential in all cases, since it helps to rule out conditions like acute leukemia, lymphomas, multiple myeloma, myelofibrosis, which may superficially resemble aplastic anemia. Peripheral pancytopenia with normocellular or hypercellular marrow should suggest the possibility of aleukemic leukemia, sideroblastic anemia, dyserythropoietic states, and paroxysmal nocturnal hemoglobinuria. Acute myeloid leukemia may be mistaken for alastic anemia in the initial stages, but presence of splenomegaly is suggestive.

Thrombocytopenic purpura, agranulocytosis and hemolytic anemia with aplastic crises cause difficulty in diagnosis at times. In immune thrombocytopenia, the marrow shows increase in the number of megakaryocytes. In agranulocytosis, only the granulocyte precursors are diminished. Other elements are normal. In hemolytic anemia with aplastic crises, erythroid precursors are selectively depressed.

Course and prognosis

The course is variable in aplastic anemia and the course may extend for periods ranging from a few months to even years. Severe cases have particularly grave prognosis and the median survival is less than 4 months and 80% die within 1-2 years if untreated. Early response to therapy is a favourable sign. About 80% of nonresponding patients die within 3-4 months. Life can be prolonged for several years by proper substitution therapy.


This consists of

  1. Withdrawal of the offending agents;
  2. Supportive measures to compensate for the pancytopenia and prevent complications; and
  3. Positive attempts to restore bone marrow activity.

Supportive measures include transfusion of blood or packed red cells, platelets and granulocytes. The patient should be isolated and care should be taken to prevent cross infection from attendants and endogenous infections by the commensal flora. Infection should be diagnosed early and treated with bactericidal antibiotics.

© 2014 Funom Theophilus Makama


    0 of 8192 characters used
    Post Comment

    No comments yet.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)