Written by Dr. Stalin Ramprakash
Aplastic anaemia in children is a serious condition that can interfere with their growing years and an inability to live a normal life. This condition can happen due to innate or acquired reasons. The symptoms associated with this type of anaemia can be debilitating for the child and the treatment options can be tiring too.
Fortunately, there is hope for parents of children suffering from this disease. A heamatologist is the specialist to approach when your child has this condition. We explain in-depth aplastic anaemia in children, its manifestations, treatment options and when you should approach a doctor.
In This Article
A human body regularly needs fresh new cells to carry on with all its normal functions. These fresh and new blood cells are continuously made by a special set of cells. These stem cells reside in a tissue called bone marrow. When the bone marrow fails to generate new blood cells often due to deficiency of stem cell number or function in the bone marrow, and the decreased number of blood cells is severe enough to affect the health of the patient. This condition is known as aplastic anaemia.
Aplastic refers to the failure of a tissue or an organ to work normally. There are various causes behind the failure of the bone marrow in producing new blood cells.
There are three types of blood cells in the human body, Red Blood Cells (RBCs) or erythrocytes, White Blood Cells (WBCs) or leukocytes, Platelets, or thrombocytes.
All these three types of blood cells have three different functions.
When the bone marrow fails to produce these blood cells-
Aplastic anaemia in children remains connected to many causes, or sometimes it arises spontaneously without any known reason.
There are two types of aplastic anaemia.
The possible causes for aplastic anaemia in children include
Autoimmune disorders are the kind of diseases where the immune system attacks our own body leading to conditions like rheumatoid arthritis and lupus. These autoimmune disorders can eventually result in aplastic anaemia. Most of the unexplained acquired aplastic anaemia is now thought to be due to autoimmunity that targets the bone marrow stem cells making this the most common cause of aplastic anaemia.
Children who are undergoing extensive chemotherapy and radiation for existing cancers are at the risk of getting aplastic anaemia. Radiation and chemotherapy can sometimes affect the functioning of the bone marrow.
Exposure to some toxins leads to the destruction of red blood cells resulting in aplastic anaemia. Toxins like pesticides, insecticides, and metals like arsenic. Exposure to benzene also causes aplastic anemia.
Some viral diseases like hepatitis, Epstein-Barr virus (EBV), Cytomegalovirus (CMV), Human Immuno Virus (HIV) can also affect the bone marrow and lead to aplastic anaemia.
Certain drugs like antibiotics can cause aplastic anaemia. (drug-induced aplastic anaemia)
Some types of cancers can lead to bone marrow damage thus causing aplastic anaemia.
Aplastic anaemia is a condition where the production of new blood cells either reduces or fails completely. The symptoms of this condition in children include
Other symptoms include
Symptoms in children suffering from aplastic are notable and visble. If your child complains of fatigue all the time, falls ill often with infections and looks pale, you may need to consult a doctor, preferably haematologist. A haematologist prescribes the following tests to diagnose the disease.
Doctors will prescribe a Complete Blood Count or Complete Blood Picture (CBP) to check the number of blood cells that are present in the body. Blood tests are useful to determine if there is an autoimmune disorder.
Complete Blood Picture is also useful to determine the percentage of haemoglobin and hematocrit. Haemoglobin is a protein that transports oxygen in the blood. Technicians or will microscopically observe the cells to see if there is any abnormality in their size and shape.
In the advanced stages of aplastic anaemia, a bone marrow biopsy will be done. In this process, doctors will insert a needle into the hip bone to collect the fluid sample from the bone marrow and a small piece of bone marrow. Pathologists will examine the fluid sample through the procedure to check for any abnormal cells. The sample also provides information about the matured and number of healthy cells the bone marrow can produce.
For painless biopsy procedures, children might need anaesthesia so that they do not endure any pain during the process. Doctors can also ask for the family history and the symptoms that the child is experiencing.
Treatments for aplastic anaemia always depend on the severity of the disease. If the child has mild aplastic anaemia, they might not need any treatment, but need to follow up closely to ensure aplastic anaemia recovers and does not progress to severe aplastic anaemia. Any suspected offending agent must be removed if possible. But, in severe cases treatment needs to be initiated urgently.
Urgency and type of treatment is based on some of the following factors
The treatment can be divided into supportive care and definitive treatment.
The supportive care for aplastic anaemia will include the following methods of treatment.
Aplastic anaemia, in severe cases, needs blood transfusions and may need a platelet transfusion. Ideally, the definitive treatment needs to start as soon as the severe aplastic anaemia diagnosis is established.
Antibiotics are given to reduce infections. Infections recur due to the decreased number of white blood cells.
The definitive treatment for aplastic anaemia will include the following treatment methods.
This therapy is given if aplastic anaemia is diagnosed, and inherited bone marrow failure syndromes were ruled out by appropriate investigations. Immunosuppressive therapy stops the human immune system from reacting abnormally on its own bone marrow stem cells and thereby allowing recovery of the blood cells. This treatment may be very prolonged and there is a possibility of losing the response to treatment after some time in which case stem cell transplant may become necessary.
Some hormonal medications and some newer small molecule medications are given to stimulate the stem cells of the bone marrow. Stimulating the bone marrow helps increase the production of healthy blood cells. This is often used along with immunosuppressive medication.
This is the main treatment option for those with inherited bone marrow failure syndromes and those with severe acquired aplastic anaemia as a permanent curative option. If a healthy fully matched donor is available, stem cell transplant is a preferred treatment option. The results of half-matched related donors ( eg. parents) and unrelated transplant results have improved significantly recently. This is the most preferred treatment option for severe cases and works successfully in younger people and children. A bone marrow transplant or a stem cell transplant can be a permanent solution for aplastic anaemia.
[Read : Bone Marrow Transplant For Children]
After the treatments, the child might require regular physical examinations and blood tests to make sure they are doing fine.
Aplastic anaemia reduces the overall immunity in children. As a result, there are some complications the the disease causes.
Here is a list of complications that aplastic anaemia causes in children.
Severe aplastic anaemia is a condition in which the bone marrow is unable to generate any more new blood cells and the blood cell numbers are critically low and are life-threatening. Since these blood cells are very important to carry on with the regular and vital functions of the body, their absence can lead to serious health complications.
If treatment is not initiated on an urgent basis, severe aplastic anaemia is likely to result in death over a short period of time due to complications such as infection or bleeding.
Severe aplastic anemia might need blood and platelet transfusions and a bone marrow transplant (BMT). The fresh and new bone marrow will be able to produce new blood cells thus increasing blood cell production and helping in eradicating the disease. In most cases of severe aplastic anaemia in young adults, bone marrow transplant works as a successful treatment.
Children should be followed up regularly preferably by a pediatric hematologist and treatment should be started as soon as possible after appropriate investigations. Children suffering from aplastic anaemia and their parents must be provided with proper psychological support from their health care provider.
When you have a child with aplastic anaemia, here are a few pointers on how you can deal with it and help your child deal with it as well.
Aplastic anaemia is a condition in which the stem cells of the bone marrow fail to generate new blood cells. This condition can be life-threatening and can be very serious if ignored. Children with aplastic anaemia need proper monitoring at home and in the hospital. This condition is treatable, and the child will be able to outgrow the disease with the right treatment options. Frequent health checkups and follow-ups with the paediatrician can help the child with aplastic anaemia avoid unnecessary complications. Following all the necessary precautions and helping the child physically and psychologically plays a key role in their recovery.
Aplastic anaemia is a condition in which the bone marrow fails to generate new blood cells eventually leading to the loss of immunity, increased tendency for bleeding and may need frequent blood transfusions. Aplastic anaemia can also cause serious health complications if ignored. Proper monitoring and the doctor’s assistance can help the child recover from the disease.
Yes, aplastic anaemia has many treatment options based on the severity of the disease. Doctors analyze and administer treatments based on the child’s health condition and their medical history.
The early symptoms of aplastic anaemia in children include
Any child can get affected by aplastic anaemia. People of any age group can get aplastic anaemia. It is most common in the age group of 10-20 years and children with hereditary conditions. Children undergoing extensive chemotherapy and radiation are at the risk of getting aplastic anaemia.
Dr. Stalin Ramprakash is an experienced and dynamic consultant who provides high-quality comprehensive care for children with cancer and blood-related problems. He completed his paediatric training in Madras Medical College and pursued further training in the United KingdomRead more.
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