'Aplasia' means the lack of development of a tissue, cell or other body part. Aplastic anaemia is the condition in which the bone marrow fails to produce blood cells. Normally, the bone marrow produces:

red blood cells (which carry oxygen in the blood)
various types of white blood cell (which are part of the immune system)
platelets (which are involved in blood clotting).

Each of these different types of blood cell originates from simpler cells, known as precursors or stem cells, which develop into the more specialised forms.

There are numerous reasons for the bone marrow to fail to produce blood cells in adequate numbers, but in aplastic anaemia there is a marked deficiency of all the precursor cells that should mature into adult blood cells.

The person complains of increasing tiredness, weakness and shortness of breath. Bleeding, bruising and blood spots may be noticed. Sore throats and other infections are noticeable. A high temperature with shivering attacks is an important symptom that demands immediate medical attention.

Patients will need to steel themselves, at least initially, to a life dependent on the local haematology service. While it is possible to continue working or schooling, there are certain restrictions. Bodily contact sports must be avoided and a close watch must be kept for infection. Transfusions will be a regular interruption. Some infections proceed very rapidly and need instant remedies, hence the need for close contact with the haematology service.

All of the therapies carry side effects. ATG may cause a fever and often leads to 'serum sickness'. During this phase there may be rashes and joint pains. Ciclosporin can also cause problems with unusual hair growth and gum swelling. In higher doses it can cause high blood pressure and kidney failure. For these reason blood levels have to be regularly monitored. The major complication of bone marrow transplantation is graft-versus-host disease. This shows itself as a rash, diarrhoea or liver abnormalities.


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