Aplastic Anemia
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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 Anemia Aplastic Anemiaa G6PD Deficiency Immune Hemolytic Anemia Chloramphenicol
Cycloserine
Ethanol
Isoniazid
PyrazinamideAcetazolamide
Antineoplastic drugs
Carbamazepine
Chloramphenicol
Gold salts
Hydantoins
Penicillamine
Sulfonamides
Phenylbutazone
QuinacrineDapsone
Doxorubicin
Methylene blue
Nalidixic acid
Nitrofurantoin
Pegloticase
Phenazopyridine
Primaquine
Rasburicase
Sulfacetamide
Sulfamethoxazole
Sulfanilamide
SulfapyridineCephalosporins (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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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 Anemia Aplastic Anemiaa G6PD Deficiency Immune Hemolytic Anemia Chloramphenicol
Cycloserine
Ethanol
Isoniazid
PyrazinamideAcetazolamide
Antineoplastic drugs
Carbamazepine
Chloramphenicol
Gold salts
Hydantoins
Penicillamine
Sulfonamides
Phenylbutazone
QuinacrineDapsone
Doxorubicin
Methylene blue
Nalidixic acid
Nitrofurantoin
Pegloticase
Phenazopyridine
Primaquine
Rasburicase
Sulfacetamide
Sulfamethoxazole
Sulfanilamide
SulfapyridineCephalosporins (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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