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Aplastic anemia
Other Resources UpToDate PubMed

Aplastic anemia

Contributors: Nina Haghi MD, Mary Anne Morgan MD, Paritosh Prasad MD
Other Resources UpToDate PubMed


Aplastic anemia (AA) is a rare disorder caused by the failure of bone marrow to produce hematopoietic stem cells (HSCs), causing severe anemia, thrombocytopenia, and leukocytopenia. If untreated, AA has a very high mortality.

AA presents with pancytopenia, and bone marrow biopsy will reveal hypocellularity. It can be caused most commonly by autoimmune processes, direct injury to the bone marrow (toxic effect, drugs, radiation, etc), viral infection, clonal disorders (eg, paroxysmal nocturnal hemoglobinuria, myelodysplastic syndrome, acute myeloid leukemia), or genetic disorders (eg, Fanconi anemia, Shwachman-Diamond syndrome, thrombopoietin abnormalities, telomere abnormalities). Despite the various pathophysiologic mechanisms that can lead to AA, the disorder remains rare, with an incidence in the Western world of 2 per million per year, with half of all cases occurring before the age of 30 years.

Patients with AA usually present with recurrent infections due to neutropenia, mucosal hemorrhage or menorrhagia due to thrombocytopenia, and fatigue, dyspnea, and cardiopulmonary compromise due to anemia.


D61.9 – Aplastic anemia, unspecified

306058006 – Aplastic Anemia

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Megaloblastic anemia (deficiencies of Vitamin B12 deficiency and/or Folate deficiency)
  • Bone marrow involvement by other clonal or infiltrative disorder (malignancies, large granular Chronic lymphocytic leukemia, primary Myelofibrosis, among others)
  • Predictable, cytotoxic effect of radiation or chemotherapy (see Drug-induced anemia)
  • Bone marrow infiltrative disorders (Myelofibrosis, Tuberculosis, fungal infection, certain neoplasms)
  • Myeloid malignancies (Acute myeloid leukemia, Myelodysplastic syndromes)
  • Sequestration (Hypersplenism, Liver cirrhosis)
  • Severe Bacterial sepsis

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:04/22/2021
Last Updated:01/11/2022
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Aplastic anemia
A medical illustration showing key findings of Aplastic anemia : Fatigue, Easy bruising, Dyspnea, Menorrhagia, Pallor, Gingival bleeding, WBC decreased, PLT decreased, RBC decreased
Clinical image of Aplastic anemia - imageId=1559435. Click to open in gallery.
Copyright © 2024 VisualDx®. All rights reserved.