Management of Aplastic Anemia in Older People

Introduction:

Aplastic anemia is a blood disorder that occurs due to less production of blood cells by bone marrow. It is a serious condition that is rare. The onset of aplastic anemia can be sudden or gradual, and it can be acute (short-term) or chronic (long-term). Aplastic anemia can affect individuals of any age, gender, and race. The cause of aplastic anemia is multifactorial, including certain infections and medications. Although aplastic anemia is found equally in all age groups, a comparatively higher incidence is found in childhood and young adulthood between 20 to 25 years of age. However, it can also occur frequently in elderly patients.

Asians or Asian-American are also at higher risk for developing aplastic anemia. Aplastic anemia is of inherited and acquired types. Inherited aplastic anemia occurs due to gene mutation and occurs more in children and young adults, while acquired occurs due to dysfunction of the immune system and is common in elderly people.

What Are the Causes of Aplastic Anemia in Older People?

1. Autoimmune Disorders: The most common cause of aplastic anemia is an autoimmune disorder when the immune system starts attacking the healthy cells of the body. When the immune system attacks bone marrow, a tissue inside bones that is responsible for the production of blood cells, aplastic anemia occurs.

2. Exposure to Chemicals: Studies revealed that exposure to toxic chemicals in insecticides and pesticides can induce aplastic anemia

3. Radiation therapy or Chemotherapy: Radiation therapy and chemotherapy can kill the growth of tumors or cancer cells. But sometimes, it can also affect bone marrow stem cells which leads to a decrease in the production of blood cells. Aplastic anemia is a common side effect of these therapies.

4. Use of Medications: Medications used to treat thyroid disorders, rheumatoid arthritis, and certain antibiotics can cause aplastic anemia.

5. Infections: Some viral infections like hepatitis, cytomegalovirus, Ebstein-Barr virus, HIV, etc., are found to be associated with aplastic anemia.

6. Family History: Aplastic anemia can be inherited and can occur in many members of the same family. It occurs as a part of a syndrome called inherited bone marrow failure syndrome (IBMFS), which is a rare genetic disorder.

7. Unknown Causes: The exact cause of aplastic anemia is unknown in certain cases and is known as idiopathic aplastic anemia.

What Are the Symptoms of Aplastic Anemia in Older People?

Blood cells comprise red blood cells (RBCs), white blood cells (WBCs), platelets, and so on. All these have many functions. RBCs carry oxygen, WBCs can fight infections, and platelets induce clotting or stoppage of bleeding. When the stem cells get affected, the number of all these cells in the blood gets reduced which results in the following symptoms:

• Frequent nosebleeds and bleeding gums.

• An irregular and fast heartbeat.

• Tiredness.

• Shortness of breath.

• Bruising or bleeding easily.

• Petechiae or red-colored round spots.

• Pale skin.

• Chest pain.

• Headaches.

• Fever.

• Contracting infections frequently.

• Skin rashes.

What Are the Complications of Aplastic Anemia?

If left untreated aplastic anemia can end up in severe complications such as:

• Leukemia.

• Irregular heartbeat.

• Heart failure.

• Paroxysmal nocturnal hemoglobinuria.

• Uncontrolled bleeding.

How Is Aplastic Anemia Diagnosed?

The physician will ask for a detailed medical history of symptoms and history of diseases, medications, exposure to any toxins, etc. Family history of aplastic anemia will also be inquired.

• Blood Test: The physician will advise a blood test to get a count of red blood cells, white blood cells, and platelets. The levels of all these cells will be low in a person with aplastic anemia.

• Bone Marrow Biopsy: A tiny sample of bone marrow will be isolated from the person’s larger bone, like hip bone, and is analyzed under the microscope. Bone marrow biopsy is the confirmatory test for aplastic anemia.

How Is Aplastic Anemia Treated in Older People?

• Immunosuppressants: These are often indicated in patients with autoimmune disorders to suppress the immune system. The immunosuppressant cyclosporin, in combination with anti-thymocyte globulin, a horse or rabbit-derived antibody, suppresses the immune system and generates new cells in the bone marrow.

• Bone Marrow Stimulants: Sargramostim, filgrastim, and eltrombopag are some of the bone marrow stimulants that are used in the treatment of aplastic anemia. These drugs can stimulate bone marrow for the production of new blood cells.

• Bone Marrow Transplantation: In this procedure, the bone marrow of the person with aplastic anemia is removed by radiotherapy or chemotherapy, followed by the infusion of healthy stem cells from a donor through an intravenous route into the blood. The infused stem cells will migrate to the bone marrow cavities, where they start forming new blood cells. A healthy sibling is usually preferred as a donor. Also known as stem cell transplantation, this procedure is indicated in severe aplastic anemia and young adults. However, if the older patients are overall healthy, they can also be eligible for this procedure.

• Blood Transfusion: Although blood transfusion is not a cure for aplastic anemia, it can manage symptoms like bleeding or bruising.

• Antibiotics and Antivirals: Infections are common in patients with aplastic anemia. So antibiotics and antiviral drugs are prescribed as supportive therapy based on the infection.

What Are the Precautions to Be Taken by People With Aplastic Anemia?

Elderly patients with aplastic anemia have to take extra precautions because, in addition to this condition, they may also suffer from other diseases.

• Stay Away From Sick People: The risk of contracting infections is very high in aplastic anemia. Hence, patients need to prevent infection by staying away from infected people.

• Wash Hands Properly: Hands have to be washed or sanitized frequently to kill bacteria, viruses, or other germs that may have the potential to cause disease.

• Get flu shots annually, as flu is a very common illness.

• Stay away from crowds as crowds may contain asymptomatic infected people.

• Before taking a flight or going to high altitudes, oxygen levels have to be checked by consulting a doctor.

Conclusion

Aplastic anemia is a serious but rare disorder that can affect individuals of any age. It is caused by the impairment of bone marrow to produce sufficient amounts of red blood cells, white blood cells, and platelets which leads to many symptoms like frequent infections, uncontrolled bleeding, shortness of breath, etc. Inherited aplastic anemia is common in children, while acquired is the one that is commonly seen in older people. Certain medications, exposure to toxins, radiotherapy, chemotherapy, autoimmune disorders, etc., are the causes of acquired aplastic anemia. Various treatment options have been developed to treat and manage the symptoms of aplastic anemia, and as a part of prevention, some countries have banned the medications which induce aplastic anemia.