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Causes
By Mayo Clinic staffAplastic anemia develops when damage occurs to your bone marrow, slowing or shutting down the production of new blood cells. Bone marrow is a red, spongy material found within the cavities of many of your bones.
Bone marrow produces stem cells, which give rise to other cells. Stem cells in the bone marrow produce blood cells — red cells, white cells and platelets. Stem cells also make more stem cells.
Normally, your body continually replaces blood cells. Red blood cells live about 120 days, platelets about seven days and most white blood cells a day or less before they're used and absorbed by your body.
Factors that can temporarily or permanently injure bone marrow and affect blood cell production include:
- High-dose 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. Exposure to toxic chemicals, such as some used in pesticides and insecticides, may cause aplastic anemia. Exposure to benzene — an ingredient in gasoline — also has been linked to aplastic anemia. This type of anemia sometimes gets better on its own if you avoid repeated exposure to the chemicals that caused your initial 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, such as lupus, in which your immune system begins attacking healthy cells, may involve stem cells in your bone marrow.
- A viral infection. Viral infections that affect bone marrow may play a role in the development of aplastic anemia in some people. Viruses that have been linked to the development of aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B-19 and HIV.
- Pregnancy. Aplastic anemia that occurs in pregnancy may be related to an autoimmune problem — your immune system may attack your bone marrow during pregnancy.
- Unknown factors. In about half the cases, doctors aren't able to identify the cause of aplastic anemia. This is called idiopathic aplastic anemia.
In aplastic anemia, the bone marrow is described in medical terms as aplastic or hypoplastic — meaning that it's empty, or contains very few blood cells.
Confusion with myelodysplastic syndrome
Aplastic anemia can be mistaken for a condition called myelodysplastic syndrome. In this group of disorders, the bone marrow produces new blood cells, but they're deformed and underdeveloped. The bone marrow in myelodysplastic syndrome is sometimes called hyperplastic — meaning that it's packed with blood cells. But some people with myelodysplastic syndrome have empty marrow that's difficult to distinguish from aplastic anemia.
Connections with other rare disorders
Additionally, about 30 percent of people with aplastic anemia also have a rare disorder known as paroxysmal nocturnal hemoglobinuria. Marrow cells become overly sensitive to the immune system in this disorder, destroying red blood cells and causing defective platelets to form.
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.
- Aplastic anemia. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/aplastic/aplastic_all.html. Accessed Feb. 5, 2009.
- Aplastic anemia. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec11/ch130/ch130f.html#sec11-ch130-ch130e-91. Accessed Feb. 5, 2009.
- Young NS. Aplastic anemia. Current Opinion in Hematology. 2008;15:162.
- Schrier SL. Aplastic anemia: Pathogenesis; clinical manifestations; and diagnosis. http://www.uptodate.com/home/index.html. Accessed Feb. 5, 2009.
- Schrier SL. Aplastic anemia: Prognosis and treatment. http://www.uptodate.com/home/index.html. Accessed Feb. 5, 2009.
- Shih RD. Plants, mushrooms, and herbal medications. In: Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2006. http://www.mdconsult.com/das/book/body/119296292-3/801134565/1365/515.html#4-u1.0-B0-323-02845-4..50167-0--cesec32_8318. Accessed Feb. 6, 2009.
