Morning Report Pearls: Aplastic Anemia

This morning Dr. Carlos Cardenas presented a fascinating case of aplastic anemia manifesting as syncope. Please see below for high yield concepts for aplastic anemia.

  • Overview
    • Aplastic anemia is characterized by diminished or absent hematopoietic precursors in the bone marrow, most often due to injury to the pluripotent stem cell.
    • “Aplastic anemia” is a misnomer because the disorder is defined as pancytopenia rather than anemia
  • Causes of Acquired Aplastic Anemia
    • Direct stem cell destruction
      • Drugs: Chemotherapy, Anticonvusants, NSAIDS, PTU/MTZ
      • Toxins: Benzene, Glue
      • Viral: EBV, HIV, HCV
      • Immune: Eosinophilic fasciitis, GVHD, SLE
      • Miscellaneous: PNH, Pregnancy, Anorexia
  • Evaluation
    • History, CBC, Bone Marrow Bx, Viral Serologies, Cytommetry/Cytogenetics (eval for MDS/PNH)
  • Treatment
    • Mild-Moderate Disease: Supportive Care/Transfusion
    • Severe: For the majority of patients under age 50 years with severe disease stem cell transplant is first line.
    • Immunotherapy: Typically indicated when stem cell transplant is contraindicated or unavailable
      • Horse antimymocyte globulin + Cyclosporin A
      • Cyclosporin
      • Steroids