When we encounter a patient who mentions anaemia, we often picture symptoms like fatigue and a pale face. Nutritional anaemia or iron deficiency is common; however, not all anaemias are the same. Aplastic anaemia is fundamentally different and life-threatening; treating it as iron-deficiency anaemia is not the right approach.
Aplastic anaemia is a bone marrow failure disorder in which the marrow does not produce sufficient blood cells. Common features include low haemoglobin, leading to fatigue; a low white blood cell count, increasing the risk of infections; and a low platelet count, increasing the risk of bruising or bleeding. Physicians call this combination “pancytopenia,” meaning reduced levels of all blood cell types.
Aplastic anaemia is a bone marrow failure disorder in which the marrow does not produce sufficient blood cells. Common symptoms of this condition include low haemoglobin (leading to tiredness), low white blood cell count (increasing the risk of infections), and low platelet count (increasing the risk of bruising or bleeding). Treating physicians call this combination “pancytopenia”, which means low counts of all blood cells.
Certain medications (including some chemotherapeutic agents), toxins, viral infections, and autoimmune mechanisms can lead to bone marrow failure. Also, studies suggest that, in rare cases, aplastic anaemia can be inherited.
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Studies report that a noticeable proportion of patients presenting with pancytopenia are ultimately diagnosed with aplastic anaemia. A study published in the Indian Journal of Haematology and Blood Transfusion reported that aplastic anaemia accounts for a substantial number of bone marrow failure cases in India. Another Indian review notes that patients in India often present at a younger age than in Western populations. These findings indicate that aplastic anaemia is highly prevalent in India, requiring urgent attention to build awareness.
Aplastic anaemia can be treated, and it may include the following, depending on the patient’s condition:
*Blood stem cell transplants, which have the potential to give a second chance at life
*Regular blood transfusions
*Medicines that are prescribed to stop the immune system from attacking stem cells in the bone marrow
*Medicines(Growth Factors) to help the patient’s body produce new blood cells
Regular blood transfusions carry risks; first, the patient needs specially matched blood to manage the condition for a longer period. Additionally, repeated transfusions must be monitored to avoid complications such as iron overload and alloimmunization (immune reactions). Therefore, access to donor management and to blood stem cell registries becomes critical.
A blood stem cell transplant can provide a chance at life for patients with aplastic anaemia. However, the success of a transplant depends on a key criterion—ideally, a 10 out of 10 HLA match (Human Leukocyte Antigen).
Transplant physicians look for a near-perfect ‘10 out of 10’ match to ensure the patient’s body accepts the transplanted cells. However, only about 30% of patients find such a match within their family, leaving nearly 70% dependent on unrelated donors registered in donor databases. Unfortunately, there is a huge gap in India’s stem cell donor registry. Ideally, a 10 out of 10 HLA match, leaving patients and their families with limited options to access the means for transplant.
One of the concerning reasons for such low donor registration is misinformation, which underscores the urgent need to raise awareness of the importance of being a potential lifesaver and the outcomes of blood stem cell donation for the recipient. Apart from this, people shy away from registering because of the persistent myths around stem cell donation, and different emotions fog the decision-making process, such as fear of pain, long-term health effects, or impact on fertility. In reality, blood stem cell donation is safe. It is voluntary and is similar to donating blood platelets.
India needs a strategic and large-scale effort to bridge this gap. A collaborative, multi-stakeholder approach that leverages policy advocacy, technology, and strategic partnerships can help address these challenges. Increasing the available blood stem cell donor registry pool is essential, and this requires a multifaceted approach. Organisations like ours have made efforts to spread awareness among the masses through donor registration drives, online and offline, through donor registration drives, partnerships with corporates and educational institutions, and participation in community outreach initiatives.
Dr Nitin Agarwal, MD, Transfusion Medicine, HOD - Donor Request Management at DKMS Foundation India
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
