Overview

Aplastic anemia is a serious condition in which the bone marrow doesn’t make enough new blood cells. With fewer blood cells, a child with aplastic anemia has:

  • Less oxygen sent to organs, tissues and cells (from too few red blood cells)
  • Increased risk of infection (from too few white blood cells)
  • Increased risk of bleeding problems (from too few platelets)

Causes

Aplastic anemia in children has many causes. Sometimes the cause is unknown. There are many known causes. Aplastic anemia may develop it at some point during childhood. Or, it may be passed down from parent to child.

Acquired causes include:

  • Infection. These include hepatitis or liver infection, and many different viral illnesses, such as Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus B19, or human immunodeficiency virus (HIV).
  • Cancer. Some cancers affect the bone marrow.
  • Autoimmune disease. For example, lupus and rheumatoid arthritis
  • Medicines.
  • Toxins. For example, heavy metals, pesticides, benzene
  • Radiation therapy and chemotherapy. For the treatment of cancer.

Symptoms

These are the most common symptoms of aplastic anemia.  Symptoms may include:

  • From decreased red blood cells:
    • Headache
    • Dizziness
    • Shortness of breath
  • Lack of energy or tiring easily (fatigue)
    • Pale skin
    • Chest pain
    • Irregular heart beat
    • Enlarged heart
  • From too few white blood cells:
    • Fevers
    • Mouth sores
    • Infections
  • From too few platelets:
    • Easy bruising
    • Nosebleeds
    • Bleeding gums
    • Blood in the stool
    • Heavy bleeding with menstrual periods
  • Other symptoms:
    • Nausea
    • Skin rashes

The symptoms of aplastic anemia may look like other blood disorders or medical problems. Always check with your child's doctor for a diagnosis.

Diagnosis

Your child's healthcare provider will likely refer you to a hematologist, an expert in blood disorders. Along with a complete medical history and physical exam of your child, tests for aplastic anemia may include:

  • Blood tests
    • Hemoglobin and hematocrit. This test measures the amount of hemoglobin, the part of red blood cells that carry oxygen, and red blood cells in the blood.
    • Complete blood count, or CBC. A complete blood count checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.
    • Peripheral smear. A small sample of blood is examined under a microscope. Blood cells are checked to see if they look normal or not.
  • Bone marrow aspiration and/or biopsy. This procedure involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue, called a core biopsy. The hip bone is often used. The fluid and tissue are examined for the number, size, and maturity of blood cells or abnormal cells.

Treatment

Treatment will depend on your child’s symptoms, age, general health, and how severe the condition is. Treatment for aplastic anemia also depends on the cause. For mild aplastic anemia, treatment may not be needed. Treatment may include:

  • Blood transfusions
  • Platelet transfusions
  • Antibiotics
  • Hormones or other medicines (to stimulate the bone marrow to produce cells)
  • Immunosuppressive medicine
  • Stem cell transplant

Complications

With proper treatment, most children with aplastic anemia have no complications.

Without treatment, complications of aplastic anemia include the following:

  • Medicine used to treat anemia may cause side effects
  • Problems with growth and development
  • Cancers
  • Heart failure
  • Uncontrolled bleeding
  • Severe infections

Living with

Work with your child's healthcare provider to develop a treatment plan.

  • Try to make your child's life as normal as possible.
  • Remember to also pay attention to other children in the family. 
  • Work closely with your child’s school to make sure he or she gets what is needed.
  • Your child may also qualify for special programs under Section 504 of the Rehabilitation Act of 1973. 
  • If your child feels different or alone, find a support group for children with anemia.

Your child should avoid activities that increase the chance of infection or bleeding. These activities include things like the following:

  • Staying away from people who are sick
  • Eating uncooked foods 
  • Contact sports (for example, football, hockey, skiing, or rollerblading)
  • Traveling to high altitudes (children with a low red blood cell count will have increased fatigue and need for oxygen in high altitudes)

When to Call a Healthcare Provider

Each child is different based on how severe his or her symptoms are and what treatment he or she may be getting. Talk with your child's healthcare provider about when you should call. For example, you may be instructed to call if your child has:

  • Signs of infection, like a fever, or flu-like symptoms
  • Bleeding that you cannot control
  • Increased tiredness

Key Points

  • Aplastic anemia is a serious condition in which the bone marrow does not produce enough new blood cells.
  • It may be passed down from the parents or develop sometime during childhood.
  • Some symptoms include tiredness, paleness, frequent infections, and easy bruising and bleeding.
  • Aplastic anemia is diagnosed with blood and bone marrow tests.
  • Treatment depends on the cause. It may include blood transfusions, medicines, and stem cell transplantation.

Next Steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.