Pediatric Anemia (aplastic)

Aplastic anemia is a serious condition in which the bone marrow doesn’t make enough new blood cells. With fewer blood cells, a child with aplastic anemia has:

• Less oxygen sent to organs, tissues and cells (from too few red blood cells)
• Increased risk of infection (from too few white blood cells)
• Increased risk of bleeding problems (from too few platelets)

Aplastic anemia in children has many causes. Sometimes the cause is unknown. There are many known causes. Aplastic anemia may develop it at some point during childhood. Or, it may be passed down from parent to child.

Acquired causes include:

• Infection.These include hepatitis or liver infection and many different viral illnesses, such as Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus B19, or human immunodeficiency virus (HIV).
• Cancer. Some cancers affect the bone marrow.
• Autoimmune disease. These include lupus and rheumatoid arthritis.
• Medicines. This includes some antibiotics and other medicines.
• Toxins. These include heavy metals, pesticides and benzene.
• Radiation therapy and chemotherapy. These are done to treat cancer.

Each child is different based on how severe his or her symptoms are and what treatment he or she may be getting. Talk with your child's healthcare provider about when you should call. For example, you may be instructed to call if your child has:

• Signs of infection, like a fever or flu-like symptoms
• Bleeding that you cannot control
• Increased tiredness

The most common symptoms of aplastic anemia are below.

Low levels of red blood cells can cause:

• Pale skin
• Chest pain
• Irregular heart beat
• Enlarged heart

Low levels of white blood cells can cause:

• Fevers
• Mouth sores
• Infections

Low levels of platelets can cause:

• Easy bruising
• Nosebleeds
• Bleeding gums
• Blood in the stool
• Heavy bleeding with menstrual periods

Other symptoms can include:

• Nausea
• Skin rashes

The symptoms of aplastic anemia may look like other blood disorders or medical problems. Always check with your child's doctor for a diagnosis.

Your child's healthcare provider will likely refer you to a hematologist, an expert in blood disorders. Along with a complete medical history and physical exam of your child, tests for aplastic anemia may include:

• Hemoglobin and hematocrit. This blood test measures the amount of hemoglobin, the part of red blood cells that carry oxygen and red blood cells in the blood.
• Complete blood count (CBC). A complete blood count checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.
• Peripheral smear. A small sample of blood is examined under a microscope. Blood cells are checked to see if they look normal or not.
• Bone marrow aspiration or biopsy. This procedure is done by taking a small amount of bone marrow fluid (aspiration) or solid bone marrow tissue, called a core biopsy. The hip bone is often used. The fluid and tissue are examined for the number, size and maturity of blood cells or abnormal cells.

Treatment will depend on your child’s symptoms, age, general health and how severe the condition is. Treatment for aplastic anemia also depends on the cause. For mild aplastic anemia, treatment may not be needed. Treatment may include:

• Blood transfusions
• Platelet transfusions
• Antibiotics
• Hormones or other medicines (to stimulate the bone marrow to produce cells)
• Immunosuppressive medicine
• Stem cell transplant

With proper treatment, most children with aplastic anemia have no complications.

Without treatment, complications of aplastic anemia include:

• Medicine used to treat anemia may cause side effects
• Problems with growth and development
• Cancers
• Heart failure
• Uncontrolled bleeding
• Severe infections

Work with your child's healthcare provider to develop a treatment plan.

• Try to make your child's life as normal as possible.
• Remember to also pay attention to other children in the family. 
• Work closely with your child’s school to make sure he or she gets what is needed.
• Your child may also qualify for special programs under Section 504 of the Rehabilitation Act of 1973. 
• If your child feels different or alone, find a support group for children with anemia.

Your child should not do activities that increase the chance of infection or bleeding. These activities include things like:

• Staying away from people who are sick
• Eating uncooked foods 
• Contact sports (for example, football, hockey, skiing or rollerblading)
• Traveling to high altitudes (children with a low red blood cell count will have increased fatigue and need for oxygen in high altitudes)