Aplastic Anemia

Introduction
The bone marrow stops producing a sufficient amount of RBC, WBC, and platelets,
thereby increasing the risk of infection and hemorrhage. The red cells remaining in
circulation are normal in size and color. This may be due to chemical exposure, high-
dose radiation exposure, or exposure to toxins. Cancer treatments such as radiation
therapy and chemotherapeutic agents may suppress bone marrow function, which
will result in anemia (low RBC), thrombocytopenia (low platelets), and leukopenia
(low WBC). The cause may also be unknown or idiopathic.

SIGNS AND SYMPTOMS

• Fatigue due to hypoxemia
• Weakness due to tissue hypoxia
• Pallor due to lack of oxygen reaching superficial tissues due to anemia
• Infections due to low white blood cell production, causing decreased ability
to fight infection
• Bruising (ecchymosis), and tiny subcutaneous (SC) hemorrhages (petechiae)
due to decrease in platelets, altering clotting ability
• Bleeding from mucous membranes (GI tract, mouth, nose, vagina)



TEST RESULTS
• Low hemoglobin.
• Low hematocrit.
• Low RBC count.
• Thrombocytopenia—low platelet count.
• Leukopenia—low WBC.
• Reticulocyte count low.
• Positive fecal occult blood test.
• Decreased cell counts in bone marrow biopsy as body stops producing.

TREATMENT

• Administer hematopoietic growth factor to correct anemia in patients with
low erythropoietin levels:
• erythropoietin, epoetin alfa (recombinant human erythropoietin) by SC
injection or IV
• Administer human granulocyte colony-stimulating factor (G-CSF) to correct
low WBC levels:
• filgrastim by SC injection or IV
• granulocyte-macrophage colony-stimulating factor (GM-CSF) sargram-
ostim by IV infusion
• Packed RBC transfusions when anemia is symptomatic.
• Platelet transfusion for severe bleeding.
• Bone marrow transplant replaces functioning stem cells.
• Administer immunosuppressive drugs, antithymocyte globulin, and cortico-
steroids.
• Splenectomy when spleen is enlarged and destroying RBCs.

NURSING DIAGNOSES

• Risk for infection
• Activity intolerance
• Risk for deficient fluid volume

NURSING INTERVENTION

• Monitor vital signs for changes.
• Record intake and output of fluids.
• Protect patient from falls.
• Avoid IM injections due to altered clotting ability.
• Explain to the patient:
• No aspirin due to effect on platelet aggregation (clotting ability).
• Plan to take rest periods during activities due to fatigue.
• Only use an electric razor to decrease risk of bleeding due to decreased
platelet count.
• Call your physician, nurse practitioner, or physician assistant for signs of
bleeding or bruising.