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Aplastic Anemia

What is aplastic anemia? 

Aplastic anemia happens when the bone marrow does not make enough blood cells. When your child has too few blood cells, it raises the risk of anemia (low red blood cells), infections, and bleeding too much. 

Bone marrow

Bone marrow is the soft, spongy tissue at the center of your bones. Blood-forming stem cells in the bone marrow make new blood cells.

A doctor takes a bone marrow sample to learn if your child has aplastic anemia. Finding out if your child has this disease can take several weeks. 

Causes of aplastic anemia 

People with aplastic anemia have few or no stem cells. Experts believe this is because the body's immune system attacks and kills blood-forming stem cells. When this happens, the body makes fewer blood cells. 

Most cases of aplastic anemia do not have a known cause. But it can be passed down from a parent or other relative. Other causes include being around toxic chemicals, taking certain medicines, and having chemotherapy or radiation. 

Symptoms of aplastic anemia 

The bone marrow makes different types of blood cells. Your child's symptoms depend on which type of blood cell is affected: 

Type of Blood Cell   Symptoms of Aplastic Anemia  
Red blood cells  Fatigue, trouble focusing, loss of appetite, weight loss, pale skin, trouble breathing, rapid heartbeat, dizziness, headache 
White blood cells and neutrophils  More infections than normal 
Platelets  Bleeding or bruising easily, or flat red spots under the skin called petechiae  

Aplastic anemia diagnosis 

Aplastic anemia is rare. This means that diagnosing it involves ruling out other illnesses such as leukemia.  

Your child’s care team might ask for: 

  • A medical history 
  • Exams to look for other illnesses 
  • Blood tests 
  • Bone marrow test 

The blood tests will look at things like your child’s liver and kidney function. Bone marrow tests will check to see how many cells are present in a bone marrow sample.  

Generally, it takes several weeks to diagnose aplastic anemia.  

After a diagnosis 

Your child's aplastic anemia can be moderate, severe, or very severe. 

  • Moderate aplastic anemia – Your child has a low number of cells in the bone marrow and in their blood. They might not feel sick or only mildly sick. Your child might not need treatment. But your doctor may recommend regular blood tests. 
  • Severe aplastic anemia – Your child has a very low number of cells in the bone marrow. Their level of new red blood cells is under 20,000. Severe aplastic anemia is defined by an absolute neutrophil count (ANC) of 500 and a platelet count of 20,000. 
  • Very severe aplastic anemia – Your child has a very low number of cells in the bone marrow. Their ANC is less than 200. 

Your child’s care team will use the diagnosis to create a treatment plan for your child. 

Treatments for aplastic anemia 

The right treatment for your child depends on cause, severity, and other factors.  

Treatments include: 

  • Medicines to keep the immune system from attacking stem cells 
  • A stem cell transplant, which puts new stem cells into your child's body so they can create new blood cells 
  • Care to help your child feel better, such as getting red blood cells, platelets, or medicine to help replace lost blood cells 
  • Medicines to prevent infection 

Today, most people who get treatment recover from aplastic anemia.  

Recovery depends on: 

  • How severe the case is 
  • Type of treatment 
  • Your child's age.  

Without treatment, aplastic anemia can be life-threatening. 

Life with aplastic anemia 

Children with aplastic anemia may need frequent visits to the hospital — up to two or three times per week. 

Call the doctor if your child: 

  • Looks pale, has trouble breathing, or is more tired than usual 
  • Has skin or eyes that look yellow 
  • Has a fever at or above 100.4°F 
  • Has symptoms of infection 
  • Bleeds easily or for too long after an injury 

Also call your child's doctor before your child: 

  • Flies in a plane 
  • Travels to a mountain area 
  • Has surgery or a dental procedure 

These things can be risky for someone with aplastic anemia. 

Your child might not be able to attend a traditional school. They should avoid: 

  • Contact sports 
  • Tiring activities 
  • New pets or other animals 
  • Dust and digging in dirt 
  • Mold 

Your child’s care team can help you if you have questions about which activities your child might need to avoid.  

Key Points

  • Aplastic anemia happens when bone marrow does not make enough blood cells. A doctor takes a bone marrow sample to learn if your child has aplastic anemia. 
  • Your child's aplastic anemia can be moderate, severe, or very severe. Treatment depends on the cause, severity, and other factors. 
  • Symptoms might include tiredness, pale skin, trouble breathing, rapid heartbeat, fever, infection, or bleeding or bruising easily. 

Reviewed: September 2022