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3.5: Aplastic Anaemia (Bone Marrow Failure)

Table of Contents

Aplastic anaemia is defined as pancytopenia resulting from aplasia of the bone marrow
Pancytopenia – a reduction in the blood count of all the major cell lines

Table 3.2: Causes of aplastic anaemia

Primary Secondary

(Fanconi and non-fanconi

Ionozing radiation: Accidental exposure

(radiotherapy, radioactive isotopes, nuclear power stations

Idiopathic acquired Chemicals:Benzene, DDT, insecticides

T lymphocyte mediated autoimmune suppression of haemopoietic stem cell

Drugs esp. chloramphenical

Infections esp viral hepatitis (A or non-A

Connective tissue diseases, pregnancy


Clinical Features

Vary with severity but include; Anaemia, easy bruising/bleeding, recurrent infection; splenomegaly is not a feature.

Diagnostic Criteria

Pancytopenia, Bone marrow hypocellularity of < 30% hematopoietic cells for children and young adults; confirmed by trephine biopsy.

Classification by severity of Aplastic Anaemia (AA)

Severe AA (SAA)

For SAA at least two of the following three criteria have to be fulfilled:

Reticulocytes <60×109/L (using an automated analyzer) or < 20 x 109/l (manual count) Platelets < 20×109/L

Absolute neutrophils <0.5 x109/L

Very severe AA (vSAA)

For vSAA, the same criteria of SAA have to be fulfilled; however the absolute neutrophil count has to be < 0.2 x109/l

Moderate Aplastic Anaemia (AA)

Moderate AA is considered when the severity criteria of SAA are not fulfilled.

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