How do we manage this?
Well, blood transfusions.
The treatment of aplastic anemia
usually involves blood transfusions
to control bleeding and relieve
the anemia signs and symptoms.
Blood transfusions aren't a cure,
they can relieve the signs and symptoms
by providing these cells that
your bone marrow isn't producing.
A blood transfusion can
include packed red blood cells
and this is transfusion of red blood
cells to raise the red blood cell count.
This is gonna help relieve the
symptoms of anemia and fatigue.
Platelets. Transfusions of platelets
help prevent the excessive bleeding.
Wwhile there's generally no limit to the
amount of transfusions that can be given,
there is a risk to receiving
Transfused red blood cells contain
iron that can accumulate in your body
and can damage your vital
organs with iron overload.
Medications called chelating agents can
help your body get rid of this excess iron.
Over time, your body can also develop
antibodies to these transfused blood cells
making them less effective at relieving symptoms.
The use of immunosuppressive medications
can make this complication less likely.
A stem cell transplant in patients
with severe aplastic anemia.
A stem cell transplant can offer the
only successful treatment option.
A stem cell transplant is also
called a bone marrow transplant
and this is generally the treatment
of choice for patients who are younger
and have a matching donor, most often a sibling
If a donor is found, the diseased bone marrow
is first depleted with radiation or chemotherapy.
Healthy stem cells from the
donor are filtered from the blood
and these healthy stem cells are
injected intravenously into the bloodstream
where they can migrate to the bone marrow
cavities and start making new blood cells.
This procedure requires a lengthy hospital stay.
After a transplant, the patient will continue to receive
drugs to prevent rejection from these donated stem cells.
If a patient's aplastic anemia is
due to an autoimmune disorder,
or for patients who are not candidates for a
bone marrow transplant, immunosuppression is used.
These drugs suppress the activity of the immune cells that
are damaging your bone marrow.
This helps your bone marrow
recover and generate new blood cells.
These medications can be very
effective at treating aplastic anemia
but they can further
weaken the immune system.
It's possible for aplastic anemia to return once
the patient stops this immunosuppressive therapy.
Bone marrow stimulants.
Certain drugs including colony-stimulating factors
can help stimulate the bone marrow to make new cells.
Growth factors are often used in combination
with these immunosuppressive medications.
Antibiotics and antivirals.
Remember aplastic anemia weakens your immune
system because of the decreased white blood cells.
This leaves the patient susceptible to infections.
Patients with severe aplastic anemia can take
preventative antibiotic and antiviral medications.
Patients with aplastic anemia need
to make some lifestyle modifications.
This includes resting when they need to.
Remember anemia can cause fatigue and
shortness of breath with even mild exertion.
Encourage your patients
to take a break and rest.
Avoiding contact sports.
Because of the risk of bleeding
associated with the low platelet count,
patients with aplastic anemia should avoid
activities that can result in a cut and injury
or a fall that might cause internal bleeding.
Protecting themselves from germs.
Patients can reduce the risk of infection through
frequent handwashing and avoiding sick contacts.
Complications of aplastic anemia are vast and include
infections, bleeding due to the decreased platelet count,
haemochromatosis because these
patients are receiving frequent blood transfusions.
This is when the extra iron builds up in the
body and remember it can deposit in the liver,
the heart and the endocrine system.
This is a common complication of the
bone marrow and stem cell transplant.
Now, graft-versus-host disease occurs
when the donor's immune cells - so the graft
actually attacks the recipient which is the host.
The graft contains donor white blood cells called
lymphocytes which distinguish between the cells in the body.
During graft-versus-host disease, the new transplanted
stem cells will believe that the host tissues are foreign.
The new stem cells will go on the offense within the
host body and will try to destroy the host tissues.
Remember the recipient's immune
system has been suppressed
so that they can receive these
transplanted cells, so the defenses are gone.
The new stem cells can damage
organs such as the liver skin or bowel.
This is managed with corticosteroids such as prednisone
and this will further suppress the immune system.
such as cyclosporin can be given
This can help prevent and
treat graft-versus-host disease.
After the transplant, a child will take cyclosporin for
about 6 months and these levels need to be monitored.
Methotrexate. This is gonna stop the
cells from dividing and making new cells.
Methotrexate is used to prevent graft-versus-host
disease following a bone marrow or stem cell transplant.
Children who receive stem cells or bone marrow cells
from a donor can receive 3 or 4 doses of methotrexate.
Since this medication can cause mouth sores
called stomatitis, good mouth care is important.
Now here's an image of what actually
happens in graft-versus-host disease.
We see the donor has given their
stem cells and these are the graft.
These are gonna be transplanted into the recipient and
they're going to start attacking the recipient's tissues,
this includes the liver, the bowel and the skin.
Patients with aplastic anemia can also
have serious complications resulting in death.
So what is the nursing
management of aplastic anemia?
Well, certain nursing diagnoses can be
watching for the risk of injury or infection
and helping your patient
with their activity tolerance.
The nursing care. You're
going to administer medications.
This may be blood transfusions
You're gonna help your patient prevent infection,
you're going to use aseptic technique when necessary
and watch for bleeding.
And you're gonna also educate your
patient about potential complications.