Aplastic Anemia

Aplastic Anemia is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Aplastic anemia (AA) is a disorder of hematopoietic stem cells that usually presents with pancytopenia.
  • Most cases are acquired and idiopathic, but AA can also arise from an inherited BM failure syndrome such as Fanconi anemia, dyskeratosis congenita, and Shwachman–Diamond syndrome.
  • Approximately 20% of cases may be associated with drug or chemical exposure (Table 21-5).
    Table 21-5: Commonly Used Drugs That Can Induce Red Blood Cell Disorders
    Sideroblastic AnemiaAplastic AnemiaaG6PD DeficiencyImmune Hemolytic Anemia
    Chloramphenicol
    Cycloserine
    Ethanol
    Isoniazid
    Pyrazinamide
    Acetazolamide
    Antineoplastic drugs
    Carbamazepine
    Chloramphenicol
    Gold salts
    Hydantoins
    Penicillamine
    Sulfonamides
    Phenylbutazone
    Quinacrine
    Dapsone
    Doxorubicin
    Methylene blue
    Nalidixic acid
    Nitrofurantoin
    Pegloticase
    Phenazopyridine
    Primaquine
    Rasburicase
    Sulfacetamide
    Sulfamethoxazole
    Sulfanilamide
    Sulfapyridine
    Cephalosporins (cefotetan, ceftriaxone)
    Penicillins (piperacillin)
    Purine nucleoside analogues (fludarabine, cladribine)
    NSAIDs (diclofenac, ibuprofen)
    Quinidine
    Quinine
    Rifampin
    Sulfonamides (trimethoprim/sulfamethoxazole)

    Data compiled from multiple sources. Agents listed are available in the United States.

    a Drugs with ≥30 cases reported; many other drugs rarely are associated with aplastic anemia and are considered low risk.

    G6PD, glucose-6-phosphate dehydrogenase.

  • Approximately 10% of cases are associated with viral illnesses (e.g., viral hepatitis, Epstein–Barr virus, cytomegalovirus [CMV]).
  • Clonal hematopoiesis is a feature of AA, with MDS and acute myeloid leukemia (AML) developing in ∼15% of patients.

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