Aplastic Anemia

Aka: Aplastic Anemia

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II. Epidemiology

  1. Median age of onset: 25 years

III. Presentation: Symptoms

  1. Fatigue
  2. Fever

IV. Causes: Acquired

  1. Idiopathic (most common cause)
  2. Viral Infection
    1. Infectious Mononucleosis (Epstein-Barr Virus)
    2. Viral Hepatitis (non-A, non-B, non-C)
    3. Human Immunodeficiency Virus
    4. Parvovirus B19
      1. Pure red cell aplasia
      2. Transient aplasia
  3. Medications
    1. Cancer Chemotherapy (common cause)
      1. Antileukemic medications
      2. Nitrogen mustard
    2. Chloramphenicol (1 per 60,000 courses)
    3. Phenylbutazone
    4. Phenytoin (Dilantin)
    5. Carbamazepine
    6. Sulfonamide
    7. Sulfonylurea
    8. Heavy Metals (Gold, Arsenic, Mercury, bismuth)
    9. Quinacrine
    10. Chloroquine
    11. Antithyroid Drugs (e.g. Propylthiouracil)
    12. Carbonic anhydrase inhibitors (e.g. Acetazolamide)
    13. NSAIDs
    14. Antihistamines (Cimetidine, Chlorpheniramine)
    15. High dose Estrogen (e.g. Pregnancy)
  4. Immune Causes
    1. Eosinophilic fasciitis
    2. Hypoimmunoglobulinemia
    3. Thymoma
    4. Graft Versus Host Disease (related to Immunodeficiency)
    5. Large Granular Lymphocytosis
  5. Toxins
    1. Radiation
    2. Insecticides (DDT, Lindane, Chlordane)
    3. Benzene (Kerosene, Carbon Tetrachloride, Chlorphenol)
  6. Miscellaneous
    1. Paroxysmal Nocturnal Hemoglobinuria
    2. Pregnancy

V. Causes: Inherited

  1. Dyskeratosis congenita
  2. Fanconi's Anemia
  3. Reticular dysgenesis
  4. Schwachman-Diamond Syndrome
  5. Familial Aplastic Anemia (Preleukemia)

VI. Differential Diagnosis

  1. See Pancytopenia

VII. Labs

  1. Complete Blood Count
    1. See Pancytopenia
  2. Peripheral Smear
    1. See Pancytopenia
  3. Bone Marrow Biopsy
    1. Hypoplastic marrow (fat infiltration)

VIII. Evaluation

  1. See Pancytopenia

IX. References

  1. Bacigalupo in Rakel (2001) Conn's Therapy, p. 366-8
  2. Ravel (1995) Clinical Laboratory Medicine, p. 35-6
  3. Young in Goldman (2000) Cecil Medicine, p. 848-53

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