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Aplastic anemia is an insidious disease that produces very few early symptoms, but the sooner it is diagnosed, the better the chances for recovery.

George Jefferson, as he prefers we call him, had a dry cleaning business. He loved his work and he loved his customers. But in early 2016 he started "springing leaks." He would bleed profusely even from a paper cut, and he would sometimes bleed without any obvious break in his skin at all. 

George never got a lot of sun, but he started looking even more pale than usual. His feet were swollen, even when he took time out to prop them up in the afternoon. He started having dizzy spells and fell asleep behind the wheel of his car.

Fortunately, George's injuries from the car crash were minor. But when a gash from some broken glass just would not stop bleeding, George's doctors ran some tests that he revealed he suffered a condition called aplastic anemia.

The Shocking Cause of Low Red Blood Cell Count and Dizzy Spells

What is aplastic anemia?

Aplastic anemia is a condition of blood deficiency due to the failure of the bone marrow to produce mature blood cells. The red blood cells and white blood cells that the bone marrow produces usually are normal, although sometimes they are enlarged [1]. There just aren't enough of them. It's not a condition in which the raw materials are lacking. High hemoglobin levels won't correct failures of red blood cell production. It's as if the "software" for making blood cells has been damaged by chemical exposure.

This blood deficiency produces a variety of symptoms, including:

  • Fatigue.
  • Swollen feet.
  • Bleeding gums.
  • Rashes around the eyes.
  • Headache.
  • Ulcers of the mouth and throat.
  • Infections that keep coming back.
  • Pale skin.
  • Palpitations.
  • Shortness of breath (dyspnea).

A minority of people who have aplastic anemia also develop hepatitis with or without jaundice (yellowing of the skin) [2,3].

What Causes Aplastic Anemia?

A small number (no more than about 20 percent) of people who are diagnosed with aplastic anemia display genetic factors that help explain it [4]. These cases tend to show up in children and teens. The majority of people who are diagnosed with aplastic anemia develop the condition after years of exposure to toxic chemicals, especially dry cleaning solvents. These cases tend to appear in people approaching retirement age. [5] It usually doesn't do any practical good to try to track which chemicals caused a particular case of aplastic anemia. In general, chemicals slowly destroy the ability of the marrow to produce new stem cells that become new blood cells [6]. As this happens, stem cells turn into fat cells instead of blood cells, greatly reducing blood cell production, and also making the bones weaker [7].

What Is the Treatment for Aplastic Anemia?

The usual advice on how to cure anemia doesn't apply to aplastic anemia.

Sometimes the bone marrow can make more red blood cells if it doesn't have to make as many white blood cells. In about 70 percent of people who have aplastic anemia, drugs that counteract the immune system redirect the bone marrow to making red blood cells that transport oxygen throughout the body [8].

Suppressing the immune system takes advantage of higher hemoglobin levels provided by good diet and iron supplements so the body can make red blood cells, but it also leaves the individual who receives the treatment more vulnerable to infection. People who have this disease are particularly vulnerable to fungal infections, especially fungal infections of the lungs [9]. When this happens, sometimes doctors give expensive drugs to increase white blood cell production, but if these drugs don't work in a week or less, their expense and toxicity require them to be discontinued [10].

About 30 percent of people who develop aplastic anemia don't respond to immunosuppressive therapy. They may be given a new drug called eltrombopag (Promacta), but it's only effective about 40 percent of the time. Beyond that, sometimes patients are offered bone marrow transplants, but that requires destroying the old bone marrow and hoping that the transplant is a good enough match to "take" before the patient succumbs to infection.

What Can People Who Have Aplastic Anemia Do to Improve Quality of Life?

Long after their disease has developed complex symptoms, patients may still be concerned about low red blood cell counts and dizzy spells. It's easy for doctors to forget what brought their patients to the office in the first place. Doctors who treat aplastic anemia sometimes become so intent on treating this rare and difficult disease that they overlook what really bothers their patients:

  • People who have aplastic anemia constantly have to be on guard against new infections. It can help to reorganize your life so you can do at least some of the things you like to do without worrying about infections.That may mean establishing a firm understanding with family and friends about your need to be infection-free, but it may also involve assuring children and elderly loved ones that you still care about them even when you can't see them.
  • People who have aplastic anemia take treatments that require a great deal of time. Stem cell transplants involve months in the hospital. Immunotherapy involves hours-long trips to the hematologist's office every week. Anything that takes other burdens out of your life (shopping for routine items, housekeeping to reduce infection, yard work that exposes you to potentially dangerous fungal infections) improves your quality of life.
  • The simple fact that aplastic anemia never just goes away is also a source of constant emotional strain. Just as some people need to turn off the news for a day or two at a time, you may need to establish information-free days. You will do all the things you need to do to stay healthy today, but you won't obsess about your disease. Choose good doctors, take your meds, and trust you are doing all you can.

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