Aplastic anemia can’t be cured with iron
DEAR DOCTOR: I have aplastic anemia. It is hard to explain this to people. Most of them hear the anemia part and get stuck there. I hear often: “Just take some iron” or “My aunt was cured with B12 shots.” How do I explain it better?
DEAR READER: Aplastic anemia is a bone marrow disease that leads to bone marrow failure. This is a rare disorder, diagnosed in one in every 500,000 people per year. The function of the bone marrow is to produce red blood cells, white blood cells and clotting cells called platelets. The bone marrow contains specific cells, called hematopoietic stem cells, that are necessary to produce all of these. With aplastic anemia, these stem cells are damaged, so all of the cell lines are diminished.
Most cases of aplastic anemia are due to an attack by the body’s immune system on the bone marrow, which destroys the hematopoietic stem cells. The cause of this attack is unknown, but a virus, chemical, drug or mutation may be the instigator, altering the immunity so that the white blood cells
see the stem cells as foreign and thus attack them.
As the name implies, the disease causes anemia, which is a lowering of the red blood cell count. This can lead to significant fatigue and stress on the heart, which has to pump this deficient blood to the rest of the body. In addition, depletion of the white blood cells leads to an increased risk of pneumonia, urinary tract infections and severe bloodstream infections. When the white blood cell counts are chronically low, patients face a risk of invasive fungal infections, which can lead to death. Further, the lowering of the platelet counts increases the risk of bleeding due to the blood’s decreased clotting ability. Ultimately, mutations in the bone marrow can lead to leukemia.
Aplastic anemia treatment depends upon the severity of the disease, the patient’s age and whether the patient has other illnesses. Because of the disease’s potential complications, treatment is much more aggressive than taking iron or B12 supplements.