Aplastic Anaemia

Apalstic Anaemia refers to a bone marrow failure,

condition in which the formed elements of the blood are
simultaneously depressed.
 Also known as Bone Marrow Failure Syndrome
 Characterized by Pancytopenia or the triad of
Profound Anaemia
Leucopenia
Thrombocytopenia
 Hypoplastic Anaemia is the condition where only RBC
production is profoundly decreased but normal or slightly
decreased WBC and Platelets.

Etiology and Classification:

Aplastic Anaemia can be
1. Primary or Congenital (Inherited)
Fanconi’s Anaemia
Dyskeratosis Congenita
Reticular Digenesis
Diamond Blackfan (Pure Red Cell) Anaemia
 Miscellaneous: Familial Aplastic Anaemia, Monosomy,
Down’s Syndrome etc.
2. Secondary or Acquired
A.Idiopathic
B.Secondary
Drugs: Cytotoxic Drugs, Antiepileptic Drugs,
Chloramphenicol, Gold
Radiation
Chemicals: Benzene, Dyes
 Viruses: Hepatitis, HIV, Human para viruses
Pregnancy
Paroxysmal Nocturnal Hemoglobinurea
(PNH)
Clinical Manifestation
1. Thronbocytopenia: Bleeding Manifestation- Mucosa,
Skin, Brain
2. Neutropenia: Infection, PUO
3. Fatigue, Breathlessness, Puffiness of Face, CCF
Pathophysiology
Seed and Soil Theory
a. Seed theory: Aplastic Anaemia is caused by lack of
Pluripotent Stem Cell (Evidence-Success of BMT)
b. Soil theory: Aplastic Anaemia is caused by lack of
Surroundings microenvironment / Stroma of the bone
(Evidence-Success of Immuno-suppression)
Laboratory Investigations:
I. Peripheral Blood Smear
II. Bone Marrow Cytology
III. Chromosomal Study- Rule out Fanconi’s Anaemia
IV. Liver Function Test
Treatment:
A.Measures to increase Blood Components
1. Blood / Packed Cell Transfusion- Maintain Se. Hb >8
– 10 gm/dl
2. Platelets Transfusion: Maintain > 20000 to prevent
spontaneous bleeding
3. Bleeding Control- Local Pressure, Dental Care,
Restricted use of NSAID
4. Steroid- Stabilizes capillary wall Prevent bleeding,
Promote Erythropoiesis
Tab. Prednisolone- 0.5 -1 mg / kg / day
B.Promote Erythropoiesis
1. Growth Factor
2. Androgenic Steroid: Inj. Nandronolone enanthate-
2 – 5mg / kg / day / 10 days apart
Inj. Methylprednisolone- 15 – 20 mg / kg / day
Tab. Prednisolone- 0.5 -1 mg / kg / day
C.Immunosuppression
1. Antilymphocyte Globulin (AMG)
2. Antinomocyte Globulin (AMG): 10-15 mg / kg / day
for 4 days
3. Cyclosporin: 8 -10 mg /kg / day for 6 months
D.Antibiotics: Broad Spectrum as per culture report
E.Nursing Care:
1. Prevention from infection
2. Prevention from Trauma
3. Dental Care
4. Hydration
5. Care of Central Line