aplastic anaemia

Aplastic anaemia is a very rare and serious disorder of the bone marrow, and it leaves the blood counts low. In Scotland, it affects around 2 people in every 1 million each year.

Bone marrow sits inside your bones, and its job is to make blood cells. In aplastic anaemia, the bone marrow doesn't make blood cells the way it should. Production can slow down or stop altogether, so the body no longer has enough of them.

You have 3 types of blood cells, and each does a different job. These are:

• red blood cells, which carry oxygen around the body
• white blood cells, which help fight infections, bugs and germs
• platelets, which stop bleeding and bruising

Aplastic anaemia can be:

• very severe
• severe
• not severe

Doctors measure the level of blood cells in your body to work out how severe your aplastic anaemia is. The fewer blood cells you have, the more severe it is likely to be.

Aplastic anaemia can cause symptoms that vary in how severe they are. They come from low blood counts, which affect the red blood cells, white blood cells and platelets.

The symptoms of aplastic anaemia can include:

• fatigue
• shortness of breath
• headaches
• chest pains
• bleeding
• bruising
• reoccurring severe infections

Some patients also report more general symptoms, such as:

• brain fog
• poor concentration

These symptoms may be caused by the aplastic anaemia itself, by the different treatments, or by other factors.

Aplastic anaemia is a rare cause of a low blood count. If you have symptoms of a low blood count, you'll need several tests. These help your doctor rule out other, more likely reasons and find the exact cause.

Most people with a low blood count will need:

• blood tests
• bone marrow investigations

Some people may need:

• X-rays and other scans
• genetic testing

If you do have aplastic anaemia, you'll also need tests to find out how severe it is.

Doctors will also check whether you have enough vitamin B12 and folate to make blood cells. This helps to rule out other reasons for your symptoms.

If you have aplastic anaemia, your treatment will usually be managed by haematologists, who are specialist blood doctors.

Your treatment will be planned around your own needs, and it can vary depending on:

• how severe your aplastic anaemia is
• your age
• your general health
• if you have any underlying health conditions

Research on treatments for aplastic anaemia is ongoing.

In most people, doctors never find out what causes aplastic anaemia. It's seen as an unusual immune disorder, because the immune system attacks the bone marrow.

Doctors will still look for an underlying cause in your case. For example, they'll check whether it could be caused by:

• medicine
• an infection, including viral infections or hepatitis
• an autoimmune condition
• an inherited condition

In some people, aplastic anaemia is linked to an inherited condition, which means it runs in families.

The inherited conditions that can cause aplastic anaemia include:

• Fanconi Anaemia
• Dyskeratosis Congenita
• Shwachman Diamond Syndrome

You may need a genetic test to rule out some of these causes.

Aplastic anaemia can affect anyone at any age. It is most common in people aged 10 to 20 years old, and in those aged over 60.

The Aplastic Anaemia Trust has further information on aplastic anaemia in children and young people.

Sometimes aplastic anaemia is also linked with another rare condition called Paroxysmal Nocturnal Haemoglobinuria (PNH).

If you have aplastic anaemia and your white blood count is low, you're at higher risk of severe infections. So if you become unwell, get medical help quickly.

People with aplastic anaemia who have a low platelet count are also more likely to bruise and bleed.

When people talk about anaemia, they usually mean iron deficiency anaemia. Aplastic anaemia is a different thing. It's a serious condition of the bone marrow.

Aplastic anaemia is not a blood cancer, but some of the treatments can be similar. You may need to be treated in hospital, for example, and some patients need blood transfusions, medicine given through a drip, or a bone marrow transplant.

Patients with aplastic anaemia may also need to take steps to protect themselves from infections, in much the same way as patients who are having chemotherapy for cancer.