ANEMIA, APLASTIC |
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DESCRIPTIONAplastic anemia is a serious disease characterized by decreased bone-marrow production of blood cells. The bone marrow, lymphatic system, and blood are involved.
Appropriate health care includes:
Physician's monitoring of general condition and medications.
Surgery to transplant bone marrow. A bone-marrow transplant requires a donor with compatible antigens. A twin, brother or sister usually makes the best donor. Donated marrow is injected gradually into the patient's veins to try to replace poorly functioning bone marrow with normal cells.
Hospitalization for isolation until the body can resist infection.
SIGNS & SYMPTOMS
Paleness.
Weakness, tiredness, faintness, and breathlessness.
Frequent infections.
Spontaneous bleeding from the nose, mouth, rectum, vagina, gums, and other sites--including the central nervous system.
Red dots of bleeding under the skin.
Unexplained bruising.
Ulcers in the mouth, throat, and rectum.
CAUSES
Poor bone-marrow function. Bone marrow is often infiltrated with fat cells, which supplant areas that manufacture blood cells. Infections occur because of reduced white cells, which normally protect against infection.
Half of all cases are caused by drugs, especially immunosuppressive drugs, anti-cancer drugs, chloramphenicol, or chemicals such as benzene. Other cases probably result from immunodeficiency, severe illness, or unidentifiable causes.
RISK FACTORS
Family history of aplastic anemia.
Genetic factors, such as those associated with congenital hypoplastic anemia (See Glossary).
Use of drugs listed as causes.
Recent severe illness.
PREVENTING COMPLICATIONS OR RECURRENCE
The child should avoid prolonged exposure to toxic compounds, such as benzene, that are used in many industrial chemicals.
Don't use drugs that cause aplastic anemia, if substitute drugs are available.
BASIC INFORMATION
MEDICAL TESTS
Your own observation of symptoms.
Medical history and physical exam by a doctor.
Laboratory studies of blood and bone marrow.
POSSIBLE COMPLICATIONSPoor response to treatment, resulting in uncontrollable infections and bleeding. Complications are fatal in 50% to 70% of those with severe aplastic anemia.
PROBABLE OUTCOME
If the cause can be identified and treated successfully, the disorder is curable. Anemia caused by immunosuppressive drugs usually improves spontaneously when drugs are withdrawn. Full recovery often requires 6 to 8 months.
TREATMENT
HOME CARE
Hair loss often accompanies treatment, and may require wearing a wig temporarily.
Keep the child's mouth scrupulously clean to decrease the chance of infection. Brush often with a soft toothbrush. Rinse the mouth with a solution of equal parts hydrogen peroxide and water, or use a medicated mouthwash, if prescribed.
MEDICATION
Your doctor may prescribe:
Immunosuppressive drugs to prevent rejection, if a bone-marrow transplant is necessary.
Antibiotics to prevent or treat infection.
Medicated mouthwash to suppress fungus infections.
See Medications section for information regarding medicines your doctor may prescribe.
ACTIVITY
The child may resume normal activities after treatment.
DIET & FLUIDS
No special diet. Your child may need iron and vitamin supplements. Ask your doctor.
OK TO GO TO SCHOOL?When signs of infection have decreased, appetite returns, and alertness, strength, and feeling of well-being will allow.
CALL YOUR DOCTOR IF
Your child has symptoms of aplastic anemia.
The following occurs after a bone-marrow transplant:
-- Fever.
-- Any sign of infection, such as swelling anywhere on the body. Redness, tenderness or pain may not be present.
-- Skin rash.
-- Jaundice (yellow skin and eyes).
-- Joint pain.
-- Puffy feet and ankles.
-- Urinary discomfort.
-- Decreased urine during any 24-hour period.
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