Aplastic Anemia is a disease in which the body fails to produce blood cells in sufficient numbers. Blood cells are produced in the bone marrow by stem cells that reside there. Aplastic anemia causes a deficiency of all blood cell types; red blood cells, (white blood cells, and platelets).¹

The basic problem is failure of the stem cells to a varying degree producing hypoplasia of the marrow elements. An autoimmune mechanism may be responsible in a proportion of cases. This is due to the reduction or virtual absence of production of erythrocytes: Granulocytes and platelets. As a presentation of disease what is seen is bleeding occurs in the skin and mucous membranes. Complications include Infections and hemorrhage.¹

CLINICAL FEATURES

The disorder may occur at any stage, the peak incidence usually being around the age of 30 years.The onset is insidious and the clinical problems are due to the reduction or virtual absence of production of erythrocytes granulocytes and platelets. Haematuria (blood in urine) and epistaxis (blood from nose) are common. Intracranial bleeding is always a risk. Necrotic mouth and throat ulcers and monilial infections reflect the neutropenia (low neutrophil count).¹

Usually patients do not have any specific symptoms. When present, signs and symptoms can include:

• Fatigue
• Shortness of breath
• Rapid or irregular heart rate
• Pale skin
• Frequent or prolonged infections
• Unexplained or easy bruising
• Nosebleeds and bleeding gums
• Prolonged bleeding from cuts
• Skin rash
• Dizziness
• Headache
• Fever

CAUSES

In aplastic anemia, stem cells of bone marrow which produce blood cells are damaged. As a result, the bone marrow is either empty (aplastic) or contains few blood cells (hypoplastic).

The most common cause of aplastic anemia is immune system attacking the stem cells in bone marrow.

Other factors that can injure bone marrow and affect blood cell production include:

• Radiation and chemotherapy treatments. While these cancer-fighting therapies kill cancer cells, they can also damage healthy cells, including stem cells in bone marrow. Aplastic anemia can be a temporary side effect of these treatments.
• Exposure to toxic chemicals. Toxic chemicals, such as some used in pesticides and insecticides, and benzene, an ingredient in gasoline, have been linked to aplastic anemia. This type of anemia might improve if you avoid repeated exposure to the chemicals that caused your illness.
• Use of certain drugs. Some medications, such as those used to treat rheumatoid arthritis and some antibiotics, can cause aplastic anemia.
• Autoimmune disorders. An autoimmune disorder, in which your immune system attacks healthy cells, might involve stem cells in your bone marrow.
• A viral infection. Viral infections that affect bone marrow can play a role in the development of aplastic anemia. Viruses that have been linked to aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV.
• Unknown factors. In many cases, cause cannot be identified (idiopathic aplastic anemia).

Connections with other rare disorders

Some people with aplastic anemia also have a rare disorder known as paroxysmal nocturnal hemoglobinuria, which causes red blood cells to break down too soon. This condition can lead to aplastic anemia, or aplastic anemia can evolve into paroxysmal nocturnal hemoglobinuria.

Fanconi’s anemia is a rare, inherited disease that leads to aplastic anemia. Children born with it tend to be smaller than average and have birth defects, such as underdeveloped limbs. The disease is diagnosed with the help of blood tests.

RISK FACTORS

Aplastic anemia is a rare condition. Factors that can increase risk include:

Treatment with high-dose radiation or chemotherapy for cancer

Exposure to toxic chemicals

The use of some prescription drugs — such as chloramphenicol, which is used to treat bacterial infections, and gold compounds used to treat rheumatoid arthritis

Certain blood diseases, autoimmune disorders and serious infections

Pregnancy, rarely

GENERAL APPROACH

The acuteness and severity of the anemia determine whether transfusion therapy with packed RBCs is indicated. Rapid occurrence ofsevere anemia or development of angina or other symptoms is an indication for transfusion. Chronic anemia (e.g., vitamin B12deficiency), even when severe, may not require transfusion therapy if the pt iscompensated and specifictherapy is instituted.²

MANAGEMENT¹

Treatments for aplastic anemia, depends on the severity of condition and age of patient. It might include observation, blood transfusions, medications, or bone marrow transplantation. Severe aplastic anemia, in which blood cell counts are extremely low, is life-threatening and requires immediate hospitalization. Treatment will include following aspects.

Require blood product support and aggressive management of infection

Bone marrow transplantation.

Immunosuppressive therapy

Antilymphocyte globulin

Androgens and steroids

Blood transfusions

Stem cell transplant

SCOPE OF HOMEOPATHY

Homeopathy work as a supportive therapy in management of Aplastic anemia, where homeopathy plays a role by overall for immunity of patient & reduces tendency to infections. Homeopathy has been found useful in case of Aplastic anemia in improving the overall condition of the patient. Here, role of homeopathy is more of a supportive therapy and an integrative approach to case where conventional medicine and homeopathy can be given together.

Seek advice of a registered homeopathic practitioner for role of homeopathy in your case. No specific medicine can be advised in such cases, an individual based treatment shall be the approach to be taken.

REFERENCES

1. Ralston S.H., Penman I.D., Strachan M.W.J., Hobson R.P. Davidson’s, Principles and Practice of Medicine. 17^threv.ed. Edinburgh; New York: Churchill Livingstone; 1995. 1203p.
2. Kasper D.L., Fauci A.S., Hauser S.L., Longo D.L., Jameson J.L., Loscalzo J. Harrison’s Manual of Medicine. 19^th rev. ed.United States: McGraw Hill; 2016, 1222p.
3. Boericke W. Pocket Manual of Homoeopathic Materia Medica. New Delhi: B. Jain Publishers (P) Ltd.; 2011.