Aplastic anemia is an anemia in which the bone marrow fails to produce adequate numbers of peripheral blood elements. The usual course is insidious. Pure red cell aplasia is a related syndrome that is caused by a selective failure of the production of erythroid elements. It can be associated with thymomas. Constitutional (Fanconi's) anemia is associated with congenital anomalies.; Genetic pattern undetermined in acquired; Autosomal recessive in constitutional.
Anemia may manifest as pallor, headache, palpitations, dyspnea, fatigue, or foot swelling.
Thrombocytopenia may result in mucosal and gingival bleeding or petechial rashes.
Neutropenia may manifest as overt infections, recurrent infections, or mouth and pharyngeal ulcerations.
The cause of aplastic anemis is unkownn (idiopathic) in about 50% of the cases. Known causes include: Injury to pleuripotential stem cells; Destruction of pleuripotential stem cells; Immunologic injury; Toxic exposure, e.g., benzene, inorganic arsenic; Infectious hepatitis; Radiation exposure; Drugs - especially antibiotics, anticonvulsants, gold; Pregnancy (rare); and Inherited (constitutional anemia).
Risk factors include: Viral illness; Toxin exposure; and Tumors of thymus (red cell aplasia).
A decrease is seen in the number of platelets, RBCs, granulocytes, monocytes, and reticulocytes. The degree of cytopenia is useful in assessing the severity of aplastic anemia. The corrected reticulocyte count is uniformly low in aplastic anemia.
The peripheral blood smear is often helpful in distinguishing aplasia from infiltrative and dysplastic causes. Teardrop poikilocytes and leucoerythroblastic changes suggest an infiltrative process. A leukemic process may result in evidence of blasts on the peripheral smear.
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