Aplastic Anemia

WHAT YOU SHOULD KNOW:

Bone marrow is the spongy red tissue inside bones. The bone marrow makes red blood cells (RBCs), white blood cells (WBCs) and platelets. RBCs carry oxygen to all areas of the body. White blood cells (WBCs) fight infection (in-FEK-shun) by attacking and killing germs. Platelets stop bleeding by making blood clots when you are cut or injured. When your bone marrow cannot make enough RBCs, WBCs, and platelets, you have aplastic anemia (ah-NEE-mee-uh). Treatment for aplastic anemia may include blood transfusions. It may include medicine to help your bone marrow start working, or a bone marrow or blood stem cell transplant.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Aplastic anemia is a serious health problem. You may need to have many different types of treatment for your aplastic anemia. There are many risks with the treatments for aplastic anemia. You could have a bad reaction to a bone marrow or blood stem cell transplant. You could have a bad reaction to a blood transfusion, such as a seizure or death. Treatments may be slow to work, or may not work at all. If you do not have treatment, or the treatment does not work, you could die.

WHILE YOU ARE HERE:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Activity: You may need to rest. Your caregiver will tell you when it is OK to increase your activities. Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Diet: It is important that you get good nutrition when you have aplastic anemia. Eat a variety of healthy foods. Eat different foods from the following groups every day:
  
  
  • Bread, cereal, rice and pasta.
    
    
  • Vegetables.
    
    
  • Fruits.
    
    
  • Milk, yogurt, and cheese.
    
    
  • Meat, poultry (chicken), fish, dry beans, eggs and nuts.
    
    
  • Ask your caregiver how many servings of fats, oils and sweets should be included in your diet.
  Eating healthy foods may help you feel better and have more energy. If you have trouble swallowing, eat foods that are soft or in liquid form. Ask your caregiver about any extra nutrition you may need, such as nutrition shakes or vitamins. Tell your caregiver if you have problems eating, or if you are getting sick to your stomach.
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antifungal medicine: This medicine helps kill fungus that can cause illness.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
    
    
  • Antiviral medicine: This is given to prevent or treat an infection caused by a germ called a virus. Antiviral medicine may also be given to control symptoms of a viral infection that cannot be cured.
    
    
  • Antipyretics: This medicine is given to decrease a fever.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Reverse isolation: You may be put on reverse isolation safety measures if your body is having a hard time fighting infections. You are given a private room to protect you from other people's germs. Caregivers and visitors may wear gloves, a face mask, or a gown to keep their germs away from you. Everyone should wash their hands when entering and leaving your room.

What tests may I need?

You may need one or more of the following tests to help caregivers plan your treatment.

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Bone marrow biopsy: This is when a sample of bone marrow is removed and sent to a lab for tests. Bone marrow is the soft, spongy tissue inside the bone. The skin over your upper hipbone is first cleaned. Caregivers put numbing medicine into your skin so you will have little pain. A bandage is put on the biopsy area after the tissue sample is taken.

What treatments may I get?

Your plan of treatment will depend on test results, your age and your health. It may depend on other things, such as how long you have had aplastic anemia.Your caregiver may first try a medicine to get your bone marrow to work well again. Your caregiver may choose to try giving you a bone marrow or blood stem cell transplant first. You may have some of the following treatments alone or together:

• Blood Transfusions:
  
  
  • You may need many blood (RBCs and platelet) transfusions. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. With aplastic anemia, the risk of not getting the blood is much greater than getting AIDS, hepatitis, or West Nile Virus. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.
    
    
  • You may be asked to help find donors. Do not ask close family members to donate blood for you until you know they cannot be a bone marrow donor. A close family member may be able to donate blood or bone marrow, but not both. Ask your caregiver for more information about finding donors.
    
    
  • Platelets are donated by hemapheresis (hem-ah-FER-ee-sis). Blood is taken from the donors vein through an IV tube and put into a blood-separating machine. The platelets are removed and the rest of the blood is given back to the donor. The donor's body makes new platelets within one to two days. You are given the platelets through an IV.
  
  
• Drug Therapy:
  
  
  • Hematopoietic Growth Factor Medicine: Growth factors are substances that are naturally made in the body. Hematopoietic (hee-mah-toh-poi-ET-ik) growth factors cause bone marrow to make blood cells. You may not have enough growth factors in your body. Caregivers can give you more growth factors in high doses (amounts). Having higher amounts of growth factor may help your bone marrow work better, and make more blood cells.
    
    
  • Immunosuppressive Medicines: These medicines work with a person's immune system. The immune system is the body's way of protecting itself against disease and infection. It is believed that with aplastic anemia, the person's immune system may be fighting against itself. This slows down or stops the making of blood cells. Immunosuppressive (im-u-noh-su-PRES-iv) medicines help prevent the body from attacking its own bone marrow. This may help the bone marrow make more blood cells.

What type of transplant may I get?

You may one of the following types of transplants:

• Bone Marrow Transplant (BMT): Your diseased bone marrow is replaced with healthy bone marrow. You are usually given bone marrow from someone else (a donor). The bone marrow transplant is given to you in an IV while you are in the hospital. A BMT may cure your aplastic anemia, but it can cause other very serious health problems. You may be in the hospital for a month or longer for a BMT.
  
  
• Peripheral (pe-RIF-er-al) Blood Stem Cell Transplant (PBSCT): Bone marrow has many "stem cells" in it. The stem cells are the part of the bone marrow that make or change into blood cells. During a PBSCT, stem cells are put into your body. To do this, blood is first given by someone who has blood close to or exactly like yours. The blood is then put through a process called apheresis (af-eh-REE-sis). During apheresis, the stem cells are taken out of the blood. The stem cells are then put into your body through an IV. The stem cells should go into your bone marrow. Once in the bone marrow, stem cells can grow and become blood cells.
  
  
• Umbilical Cord Blood Transplant: The placenta (plah-SEN-tah) and umbilical (um-BIL-i-kal) cord connect an unborn baby to his mother. They help the unborn baby grow by giving him food and oxygen. Once the baby is born, he does not need the placenta or umbilical cord anymore. Right after the baby is born, caregivers take blood from the umbilical cord. The collected blood is frozen and put into a special freezer until it is needed for a transplant. Umbilical cord blood has many stem cells in it.
  
  
• Contact the following organization for more information about transplants:
  • National Marrow Donor Program
    3001 Broadway Street NE, Suite 100
    Minneapolis , MN 55413-1753
    Phone: 1- 888 - 999-6743
    Web Address: http://www.marrow.org
    

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Aplastic Anemia (Inpatient Care)