Aplastic Anaemia: What it is, Types, Causes, Symptoms, and Treatment

What Is Aplastic Anaemia?

Aplastic anaemia is a rare but dangerous haematologic condition (blood disorder) that diminishes the capacity of bone marrow (spongy tissue inside the bones) to produce enough red and white blood cells and platelets. As a result, this condition can also cause the body to not get enough oxygen, fight infection effectively, or control bleeding properly.

Aplastic anaemia can result from several conditions, including autoimmune illnesses, exposure to specific chemicals or drugs, and viral infections. Extreme exhaustion, heightened vulnerability to infections, and an elevated risk of bleeding are often a result of untreated.

Types of Aplastic Anaemia

Types of aplastic anaemia based on cause are:

How Common Is Aplastic Anaemia in India?

In India, doctors report 20,000 cases of aplastic anaemia every year, with higher prevalence in younger people between the ages of 15 and 25 and those over the age of 60. Lack of awareness and inadequate access to dedicated haematology centres contribute to the increase and under-reporting of aplastic anaemia in the country.

Further, treatments related to aplastic anaemia are relatively expensive, which also creates affordability issues for a section of the population in getting the required medical assistance.

What Are the Symptoms of Aplastic Anaemia?

Symptoms of aplastic anaemia include:

• Bruising (blood trapped under skin) or bleeding more readily

• Shortness of breath (dyspnoea)

• Prolonged and recurring viral infections

• Exhaustion

• Paler skin tone

• Lightheadedness

• Dizziness

• Headache

• Fever

What Causes Aplastic Anaemia?

The following causes can damage bone marrow and impact the formation of blood cells, leading to aplastic anaemia:

• Chemotherapy and Radiation Therapy: These cancer-fighting treatments destroy cancer cells, but they can also harm healthy cells, such as bone marrow stem cells.

• Exposure to Harmful Substances: Aplastic anaemia is often a result of exposure to toxic substances, including benzene, a component of gasoline, and several herbicides and insecticides.

• Specific Medications: Aplastic anaemia can be caused by some medications, including those for rheumatoid arthritis and certain antibiotics.

• Autoimmune Conditions: In autoimmune conditions, your immune system may target healthy cells, which can affect your bone marrow's stem cells.

• Viral Infections: Aplastic anaemia may occur as a result of viral infections that impact bone marrow. Hepatitis, Epstein-Barr, CMV, parvovirus B19, and HIV are among the viruses that are known to cause aplastic anaemia.

• Pregnancy: During pregnancy, your immune system may target your bone marrow, causing aplastic anaemia.

• Inherited Conditions: Inherited conditions like Fanconi anaemia, dyskeratosis congenita, Pearson syndrome, Shwachman-Diamond syndrome, and Diamond-Blackfan anaemia are also linked to aplastic anaemia.

• Unknown Factors: Physicians are frequently unable to determine the cause of aplastic anaemia. This variation is called idiopathic aplastic anaemia.

What Are the Complications of Aplastic Anaemia?

Some of the complications associated with aplastic anaemia include:

• Severe Infections: When the body is unable to produce enough white blood cells, immunity is compromised, making an individual susceptible to severe infections.

• Excessive Bleeding: Low platelet count compromises blood clotting and causes problems like uncontrolled bleeding and easy bruising.

• Arrhythmia or Heart Failure: Severe anaemia can make the heart work harder than normal, which can lead to heart problems like arrhythmia (irregular heart rhythm) or heart failure.

• Myelodysplastic Syndrome (MDS): Aplastic anaemia can sometimes turn into a condition called myelodysplastic syndrome (MDS), which can make the bone marrow incapable of producing healthy blood cells.

When Should I See A Healthcare Provider?

Seek immediate professional medical help if you experience:

• Chest pain or extreme breathing difficulties

• Uncontrollable and severe bleeding (eg., severe nosebleeds or vomiting blood)

• A persistent fever or signs of severe infection

• Faiting or sudden dizziness

How Is Aplastic Anaemia Diagnosed?

Medical professionals use blood tests, genetic testing, and physical examinations to identify aplastic anaemia. The tests include:

• Complete Blood Count (CBC) with Differential

• Peripheral Blood Smear

• Reticulocytes Count

• Bone Marrow Biopsy and Aspiration

Diagnostic Overview Table

How Is Aplastic Anaemia Managed/Treated?

Traditional treatment and management of severe or very severe aplastic anaemia include:

• Immunosuppressive Drugs: Immunosuppressive drugs that suppress your immune system, preventing it from attacking your stem cells.

• Blood Transfusions: Blood transfusions help replace affected red blood cells and platelets with fresh and healthy blood cells.

• Antibiotics: Aplastic anaemia increases the risk of bacterial infections. Doctors can prescribe certain antibiotics to treat the infections.

• Stem Cell Transplant: Doctors use healthy stem cells from donated blood or bone marrow to replace damaged stem cells.

What Is the Prognosis?

With standard treatment, most people who have mild or non-severe aplastic anaemia have an excellent prognosis. Children and adults under the age of 40 are generally more likely than older individuals to receive successful treatment.

For patients with severe and very severe aplastic anaemia, a successful allogeneic stem cell transplant may be considered. Through this procedure, damaged stem cells are replaced with healthy stem cells from a donor, which usually has a favourable prognosis and a minimal risk of recurrence.

How Can I Prevent Aplastic Anaemia?

There are no known preventions for aplastic anaemia. However, the following measures can help minimise the risk of developing aplastic anaemia or prevent it from worsening:

• Avoid exposure to hazardous substances like benzene and some pesticides.

• If there is a family history of bone marrow disorders, some people may benefit from genetic counselling.

• Early detection and prevention may be possible by maintaining optimal overall health and routine medical examinations.

Does Health Insurance Cover Aplastic Anaemia?

Yes, health insurance covers treatment for aplastic anaemia in India. Generally, comprehensive health insurance policies with critical illness riders cover hospitalisation expenses, blood transfusion expenses, medications, and stem cell transplant procedures.

However, coverage usually depends on whether aplastic anaemia was a pre-existing disease, as in that case, a waiting period of 1 to 3 years may apply, depending on the insurer and policy. Review policy details carefully to understand the applicable coverage inclusions and exclusions.

How Much Health Insurance Coverage is Needed for Aplastic Anaemia Treatment?

Aplastic anaemia is expensive in India, as it requires a bone marrow transplant (BMT). The cost of this procedure might range from ₹10 lakh to ₹30 lakh or more, depending on the type of transplant, the hospital, and the patient's condition.

Autologous (self-donor) stem cell transplant is the most affordable; however, the costs can exceed ₹40 lakh in case of haploidentical (half-match) BMT, as it requires intensive monitoring.

Most health insurance companies provide coverage that includes hospitalisation, donor matching, pre-transplant testing, post-transplant care, and prescription drugs. Considering the above-mentioned expenses, a coverage of ₹15 to ₹50 lakh should be ideal.

However, the extent of coverage, waiting periods, and other restrictions might vary greatly between insurers and policies. Always review policy details to ensure the plan matches your requirements.