Are you always tired? Do you turn blue easily? Could that be aplastic anemia?

Do you also feel tired all the time these days, unable to do anything? Do you feel weak even after doing small tasks? Maybe you just turn blue and see bruises on your body? Or do you suffer from an illness like a cold or fever that keeps coming back? Although we think these are normal things, sometimes these can be a sign of a serious condition inside our body. Today we are talking about such rare diseases, but we all need to be aware of them.

What exactly is aplastic anemia?

Simply put, aplastic anemia is a serious, but somewhat rare, blood disorder that occurs when our bone marrow is unable to produce enough new blood cells.

Think of our bone marrow as a blood factory. This factory makes three things that our body needs:

1. Red blood cells: Cells that carry oxygen throughout the body.

2. White blood cells: Cells that fight germs and protect us from disease.

3. Platelets: Cells that stop bleeding when there is a wound.

In a person with aplastic anemia, this blood-making factory, the bone marrow, suddenly stops working. Production almost completely stops. So all three types of blood cells that the body needs are lost. This increases the risk of many complications, such as serious infections, bleeding problems, and heart disease. Although there are treatments for this disease, the only way to completely cure this disease is through a stem cell transplant.

How common is this condition?

This is not a very common disease. Even in developed countries, the disease affects only about two people in a million. That means it is very rare. Although this condition can occur at any age, it is most common in young people between the ages of 15 and 25 and in people over the age of 60 .

What are the symptoms of this condition?

Most of the time, these symptoms develop gradually, over weeks or months. So you may not notice a big difference right away. But for some people, symptoms can suddenly appear in a serious way. Let's take a look at what these symptoms are and why they occur.

Why does something like this happen?

It's not always possible to pinpoint the exact cause. But often, something very strange happens. Simply put, our body's defense system (immune system) goes haywire and attacks its own bone marrow. It's like our own army attacking our own vital organs. This attack destroys the stem cells in the bone marrow, the cells that make new blood cells.

There are several reasons why the immune system can become compromised in this way.

Due to some medical conditions

• Autoimmune diseases: In diseases like lupus, our immune system attacks our own body.
• Viral infections: Some types of viruses, for example Epstein-Barr virus, cytomegalovirus (CMV), Parvovirus B19, and HIV virus, can cause this condition.
• Paroxysmal nocturnal hemoglobinuria: This is when red blood cells break down rapidly.
• Pregnancy: Very rarely, this condition can also occur during pregnancy.

Hereditary causes

These are very rare. Some inherited genetic diseases can cause the bone marrow to not function properly. For example:

• Fanconi anemia
• Dyskeratosis congenita
• Shwachman-Diamond syndrome

Some medical treatments and chemicals

• Cancer treatments: Radiation and chemotherapy can damage the bone marrow.
• Some medications: Some medications given for autoimmune diseases.
• Exposure to chemicals: Long-term exposure to carcinogenic chemicals like arsenic and benzene is also a risk.

What are the possible side effects (complications) of this?

When blood cells are lost, many processes in the body are disrupted, which can lead to serious complications.

• Severe Anemia: Can lead to extreme fatigue, rapid heartbeat, and heart failure.
• Serious infections: Without white blood cells, even a common germ can be life-threatening.
• Uncontrollable bleeding: Due to the lack of platelets, even a small wound can cause excessive bleeding. Bleeding inside the brain is very dangerous.
• Heart disease: Anemia can cause the heart to work harder, leading to heart rhythm changes (arrhythmia) or heart failure.
• Myelodysplastic syndrome: This is also a bone marrow disease, and there is a risk of developing into a blood cancer such as leukemia.

How does a doctor find this?

When you go to see a doctor, he will first listen carefully to your symptoms and examine you. Then, if he suspects this disease, he will order some specific tests.

What are the treatments for this?

The treatment method depends on factors such as your age, the severity of the disease, and its cause.

Sometimes, if the condition is caused by cancer treatment, changing the treatment may improve the condition. If you have mildly low blood cell counts and no major symptoms (moderate aplastic anemia), your doctor may decide not to treat you and just monitor your condition.

But in serious cases, treatment is necessary.

• Immunosuppressants: As mentioned earlier, these medications are given to stop our immune system from attacking our bone marrow. Antithymocyte globulin (Atgam®) and Cyclosporine (Sandimmune®) are such drugs.
• Blood transfusions: This does not cure the disease, but it can temporarily control symptoms such as fatigue and bleeding caused by a lack of red blood cells and platelets.
• Antibiotics: Low white blood cell counts increase the risk of developing infections. Therefore, these medications are given to treat infections that do occur.
• Allogeneic stem cell transplantation: This is the only way to completely cure this disease. Here, the damaged bone marrow is completely destroyed and stem cells taken from a healthy person (a matched donor) are injected into the body. These new cells go and settle in the bone marrow and start making new healthy blood cells. This treatment is more likely to be successful in younger people.

Are there any side effects of the treatment?

Yes, side effects may vary depending on the treatment method.

• Graft-versus-host disease: A complication that can occur during stem cell transplantation. In this case, the newly transplanted cells attack the patient's body.
• Increased risk of infection: Medications that suppress the immune system further reduce the ability to fight germs.
• Iron overload: Frequent blood transfusions can cause the body's iron levels to rise unnecessarily.

Is it possible to live with this disease?

The survival rate depends on many things, including your age and the treatment you receive. Some studies show that after stem cell transplant treatment, the five-year survival rate is almost 100% in children and people under 40.

Is this cancer?

No. Aplastic anemia is not cancer. However, people with this condition may have a slightly increased risk of developing blood cancers such as leukemia in the future.

If you have this condition, how do you take care of yourself?

The most important thing is to follow your treatment plan exactly and pay attention to your symptoms. In addition, think about these things.

• Avoid activities that can cause you to fall hard and get injured. It's best to avoid sports like football, hockey, and wrestling, as you can bleed easily.
• Protect yourself from germs. You are more likely to get infections. Wash your hands often with soap and water. Stay away from people who have colds or stomachaches. Ask your doctor what vaccinations are right for you.
• Get plenty of rest. Anemia can make you feel very tired. It can also make it difficult to do your daily tasks. So get enough sleep. Rest as soon as you feel tired, don't put it off.
• Eat a nutritious diet. A balanced diet can increase your energy. It is best to consult a nutritionist about this.
• Do some light exercise. Light exercise like walking can help reduce stress. But be sure to talk to your doctor before starting a new exercise routine.

What are the best times to see the doctor?

It is important to stay in touch with your doctor regularly. Especially,

• If you have a fever over 38°C (102°F).
• If your symptoms are getting worse.
• If you experience uncontrollable bleeding, go to the nearest hospital's Emergency Department (ETU) immediately.

This condition, although rare, is serious. It is understandable to be worried and saddened. But remember, even if the cause cannot be found, it can be treated and sometimes completely cured. Your doctor will explain the best treatment for you and its side effects.

Aplastic Anemia, bone marrow, anemia, frequent illness, fatigue, bleeding, stem cell transplant