Aplastic aneamia: the rare and deadly disorder

A patient suffering from aplastic anaemia will only be sustained by blood transfusions until they get a bone marrow transplant. NET Photo

What you need to know:

  • Aplastic anemia is one of the seven types of anemia.
  • Because it is rare, it is usually misdiagnosed which makes it deadlier than the other forms of anemia.
  • The only form of treatment is a bone marrow transplant.

Mercy Nazziwa, a secondary school teacher, succumbed to aplastic anemia eight months ago. She was diagnosed with the condition in December 2015. Nazziwa majorly depended on blood transfusions where she received four of blood units of per week in addition to other expensive drugs that she received on a daily basis. Her relatives were soliciting for money to take her abroad for a bone marrow transplant. Nazziwa needed Shs175m to save her life but unfortunately, she died before it could come to pass.
Another patient who succumbed to the illness recently is Herbert Busingye. Busingye breathed his last on August 13, at Mulago Hospital after doctors in India failed to help. His sister, Molly Musana says, although they managed to fly Busingye to India for treatment doctors could not do much as they diagnosed the patient with cancer of the bone marrow. Busingye was flown back and survived on blood transfusions until his last day.
Cohen Maliro, a medical clinical officer at Doctor’s Palace Medical Centre in Wakiso, defines aplastic anaemia as a condition that occurs when the body’s bone marrow is unable to produce any new blood cells.
In this case, the bone marrow, (a sponge-like tissue) inside the bones which makes stem cells that develop into red blood cells, white blood cells, and platelets is damaged.
“With aplastic anaemia, there is a deficiency in the blood cells; the red blood cells that carry oxygen and the nutrients plus the waste products, the white blood cells which fight infections and the platelets that control excessive bleeding. This leaves the person feeling fatigued and with a higher risk of infections and uncontrollable bleeding,” Maliro explains.

He further notes that this type of anaemia is rare but serious condition that can develop at any age though most common in people of 15 years and above.
“The condition may occur suddenly, or it can occur slowly and get worse over a long period of time depending on the predisposed factors,”Maliro notes.

The medical practitioner explains that in most cases this illness develops when damage occurs to the bone marrow thus slowing or shutting down the production of new blood cells. The factors that may injure the bone marrow and affect blood cell production may include among others;

Exposure to heavy chemicals
This is most common with people working in big factories that deal in dangerous chemicals. These can be hazardous in case they get in contact with the human body.

Drugs
Some medications, such as Anti-Retrial Viral drugs (ARVs) can suppress the bone marrow thus resulting to anaemia which later graduates to aplastic.

Radiation and chemotherapy treatments
Several exposures to radiations or chemotherapy can in the long run affect healthy cells. As the cancer-fighting therapies kill the cancer cells, they tend to also damage healthy cells including stem cells in the bone marrow thus gradually causing aplastic anaemia.

Deficiency in vitamins
Like Vitamin D and folic acid, this is mostly common in alcohol addicts who go without food because of loss of appetite. Vitamins also contribute much to cell production, so having a deficiency subjects one to megaloblastic anaemia, a condition in which the bone marrow produces immature red blood cells (megaloblasts). This in the long run may suppress the bone marrow thus causing aplastic anaemia.
Auto immune diseases
In the situation where the anti- bodies are fighting one’s immunity (the immune system begins attacking the healthy cells) the bone marrow gets suppressed thus leading to aplastic anaemia.

Hereditary diseases
There are illnesses such as cancers whose treatments can predispose the health cells to being damaged thus resulting into the condition.

Viral infections
Viral infections such as hepatitis can affect the bone marrow thus causing the condition.

Signs and symptoms
Uncontrolled bleeding
In cases where the platelets that are responsible for controlling excessive bleeding are suppressed, they person is likely to have aplastic anaemia and since the immunity is low, they will be predisposed to any kind of infection.
“In this condition, even a simple wound may fail to heal since the blood cannot colt,” Maliro reveals. Other symptoms may include; headache, palpitations, fatigue, foot swelling, gingival bleeding, petechial rashes and oral ulcers.
Some people may experience fatigue, a shortness of breath, dizziness, and bleeding from the nose, mouth or rectum, bruising easily and pinpoint red spots on the skin, and frequent infections. Visit your doctor if you are concerned.

Diagnosis
Dr George Bwesigye, a general practitioner at Najeera Hospital reveals that aplastic anaemia can only be diagnosed by taking a complete and clear medical history of the patient.
Tests include an X-ray, liver function test or ultra sound scans and a bone marrow biopsy (test). They will also have to do antibody check-up, blood cell count, hemoglobin electrophoresis and blood-group testing, serology for hepatitis and other viral entities among others.

Management /Treatment
Although there are blood transfusions given, Dr Bwesigye says that a bone marrow transplant would be the best treatment since the transfused blood cannot last for long.
With the transplant however, he indicates the need for compatibility for a new bone marrow and the patient’s body. This eases the blood transfusion as well as avoiding other likely risks such as death.
“In cases of incompatibility, the graphed bone marrow tends to fight against the recipient of the bone marrow thus supressing the tissues the more,” Dr Bwesigye says.
Other treatments may include drugs like antithymocyte globulin or cyclophosphamide among others that can increase the patient’s life span.
The clinical management of the condition such as supportive care, medical follow-ups such regular full blood counts to ascertain the prognosis or how the patient is reacting to the medication or even the transplant, can also go a long way in preventing fatalities.
If you have an illness that is prolonged and it makes you feel exhausted all day, even if you are sleeping at night, then schedule an appointment with your doctor.