Aplastic anaemia is a rare but serious blood disorder in which the bone marrow fails to produce enough blood cells—red blood cells, white blood cells, and platelets. This condition can lead to fatigue, increased risk of infections, and uncontrolled bleeding.
It can be either acquired or inherited.
ACQUIRED APLASTIC ANAEMIA (MOST COMMON):
AUTOIMMUNE DISORDERS: The immune system mistakenly attacks bone marrow. Exposure to toxins: Benzene (found in gasoline, industrial chemicals). Radiation & chemotherapy: Used in cancer treatment, damaging bone marrow.
CERTAIN INFECTIONS: Hepatitis, Epstein-Barr virus (EBV), HIV, and parvovirus B19.
DRUGS & MEDICATIONS: Some antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and anti-seizure drugs.
PREGNANCY: Rarely, the immune system may attack the bone marrow during pregnancy.
INHERITED APLASTIC ANAEMIA:
FANCONI ANAEMIA: A genetic disorder leading to bone marrow failure.
DYSKERATOSIS CONGENITA: A rare inherited condition affecting bone marrow function.
SHWACHMAN-DIAMOND SYNDROME: A disorder affecting the pancreas and bone marrow.
SYMPTOMS: IN THIS CASE THE SYMPTOMS ARISE DUE TO LOW LEVELS OF DIFFERENT BLOOD CELLS:
LOW RED BLOOD CELLS (ANAEMIA SYMPTOMS): Fatigue, shortness of breath, pale skin, dizziness and rapid heart rate.
LOW WHITE BLOOD CELLS (INFECTION RISK): Frequent infections, fever.
LOW PLATELETS (BLEEDING ISSUES): Easy bruising, prolonged bleeding from minor cuts, nosebleeds or gum bleeding and small red spots on the skin (petechiae).
TREATMENT OPTIONS:
BLOOD TRANSFUSIONS: Temporary relief for anaemia and low platelet counts.
BONE MARROW (STEM CELL) TRANSPLANT: Potential cure, especially for younger patients.
IMMUNOSUPPRESSIVE THERAPY: Drugs like ATG (antithymocyte globulin) and cyclosporine suppress immune attacks on the marrow.
GROWTH FACTORS: Medications like erythropoietin (EPO) to stimulate blood production.
ANTIBIOTICS & ANTIVIRALS: To prevent infections due to low white blood cells.
Aplastic anaemia weakens the immune system and affects blood cell production, making a proper diet and lifestyle precautions essential for managing the condition. In the situation, a healthy and well-balanced diet can help support blood cell production and boost immunity.
- IRON-RICH FOODS (FOR HEMOGLOBIN PRODUCTION): Lean red meat, poultry, fish spinach, kale, broccoli beans, lentils, tofu and nuts and seeds.
- VITAMIN B12 & FOLATE-RICH FOODS (FOR RED BLOOD CELL PRODUCTION): Eggs, dairy, fish (B12), leafy greens, citrus fruits, beans (Folate).
- VITAMIN C-RICH FOODS (FOR IRON ABSORPTION AND IMMUNITY): Oranges, lemons, strawberries, bell peppers.
- PROTEIN-RICH FOODS (TO SUPPORT BONE MARROW FUNCTION): Eggs, lean meat, fish, soy, legumes.
- ZINC & COPPER-RICH FOODS (FOR IMMUNE SUPPORT): Nuts, seeds, whole grains, shellfish.
- AVOID PROCESSED & JUNK FOODS: Reduce processed sugars, fried foods, and sodas, as they can weaken immunity.
- STAY HYDRATED: Drink plenty of water, herbal teas, and fresh juices to maintain good circulation.
PRECAUTIONS FOR APLASTIC ANAEMIA: Since this condition weakens the immune system and increases bleeding risks, patients should take extra precautions.
- PREVENT INFECTIONS: Wash hands frequently. Avoid large crowds and sick individuals. Get vaccinations as advised by your doctor. Cook food thoroughly to prevent foodborne illnesses.
- AVOID BLEEDING & INJURIES: Use a soft toothbrush to prevent gum bleeding. Be cautious with sharp objects (razors, knives). Avoid contact sports or activities that can cause bruising.
- MEDICATION & TREATMENT COMPLIANCE: Take prescribed medications (immunosuppressants, antibiotics, etc.) as directed. Attend regular check-ups and blood tests.
- REDUCE EXPOSURE TO TOXINS: Avoid smoking and second-hand smoke. Stay away from pesticides, benzene, and other harmful chemicals. Minimize exposure to radiation.
- MANAGE STRESS & FATIGUE: Get enough rest and sleep. Engage in light activities like yoga or meditation.Avoid overexertion.
Aplastic anaemia is a serious condition where the bone marrow fails to produce sufficient blood cells. In India, treatment options have advanced significantly, offering patients various effective therapies.
BONE MARROW TRANSPLANT (BMT):
PREFERRED TREATMENT: For patients up to 40-44 years old, especially those with a matched sibling donor, BMT is often recommended.
SUCCESS RATES: Approximately 80% success rate in suitable candidates.
COST: Generally ranges from Rs 800,000 to Rs1million.
IMMUNOSUPPRESSIVE THERAPY:
ANTITHYMOCYTE GLOBULIN (ATG) THERAPY: For patients beyond 40-45 years or those without a suitable donor. Administration: Requires hospitalization for about four days.
RESPONSE TIME: Approximately three months, with immunosuppressive medications continued for up to two years.
SUCCESS RATES: Around 60%. Eltrombopag (EPAG):
USAGE: A thrombopoietin receptor agonist showing significant effectiveness, especially when combined with immunosuppressive therapy.
- ALTERNATIVE MEDICATIONS: For those unable to afford ATG or BMT, oral medications like Danazol and Cyclosporin can be considered, potentially benefiting about 30% of patients.
- LEADING TREATMENT CENTERS IN INDIA: Medanta – The Medicity, Gurugram: Known for its world-class hematology department.
FORTIS MEMORIAL RESEARCH INSTITUTE (FMRI), GURGAON: Offers a multidisciplinary approach to aplastic anaemia treatment.
APOLLO HOSPITALS, CHENNAI: Renowned for advanced treatment modalities and experienced specialists. India’s advancements in medical infrastructure and expertise have made it a viable destination for aplastic anaemia treatment, offering hope to many patients
Research on aplastic anaemia has led to promising advancements in treatment. Scientists are exploring new therapies to improve survival rates, reduce dependency on transplants, and enhance the quality of life for patients.
IMPROVED BONE MARROW TRANSPLANTATION:
HAPLOIDENTICAL TRANSPLANTS: Advances in donor matching allow bone marrow transplants from partially matched family members, increasing availability.
REDUCED-INTENSITY CONDITIONING (RIC): New methods to prepare the body for transplants with less toxicity and fewer side effects.
GENE EDITING IN STEM CELLS: CRISPR-based technologies are being explored to correct genetic mutations in inherited aplastic anaemia cases.
ADVANCED IMMUNOTHERAPY:
T-CELL THERAPIES: Research is ongoing to modify the immune system and prevent attacks on bone marrow.
MONOCLONAL ANTIBODIES: New antibodies, such as Eculizumab, target specific immune pathways to prevent marrow destruction.
TARGETED DRUG THERAPIES:
ELTROMBOPAG (REVOLADE/PROMACTA): Stimulates platelet production and is now used alongside immunosuppressive therapy for better outcomes.
ROMIPLOSTIM & OTHER TPO RECEPTOR AGONISTS: Boost platelet and red blood cell production.
JAK INHIBITORS (RUXOLITINIB): Being studied for their ability to regulate immune dysfunction in bone marrow failure.
GENE THERAPY FOR INHERITED APLASTIC ANAEMIA:
FANCONI ANAEMIA GENE THERAPY: Scientists are testing ways to replace faulty genes using viral vectors to restore healthy bone marrow function.
ARTIFICIAL & LAB-GROWN BLOOD CELLS:
INDUCED PLURIPOTENT STEM CELLS (IPSCS): Researchers are working on generating blood cells in the lab, potentially offering a future alternative to transplants.
MICROBIOME & GUT HEALTH RESEARCH: New findings suggest gut bacteria influence immune responses. Probiotics and microbiome-targeted therapies are being explored to improve immune function in patients with aplastic anaemia.
PERSONALIZED & PRECISION MEDICINE:
GENETIC PROFILING: Helps determine which treatment works best for each patient, reducing trial-and-error approaches.
AI AND MACHINE LEARNING: Being used to analyze patient data and predict treatment success with these advancements, the future of aplastic anaemia treatment is shifting toward less invasive, more targeted, and more effective therapies. Over time, patients may rely less on transplants and long-term immunosuppressive drugs, reducing side effects and improving outcomes.
