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Secondary Causes of Aplastic Anemia (Pediatric Nursing)

by Paula Ruedebusch

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    00:00 Now that we've discussed Fanconi anemia as a genetic cause of aplastic anemia, let's look at some of the other causes of aplastic anemia.

    00:08 The first is medications.

    00:09 These can be toxic to the bone marrow and can damage the pluripotent hematopoeitic stem cells before they differentiate to committed stem cells.

    00:18 The onset of drug-induced aplastic anemia is variable and can be insidious.

    00:23 This can occur days after the initiation of the medication up to months after the start of a new drug.

    00:28 The average time is about 6 1/2 weeks after starting a medication.

    00:33 It typically starts with neutropenia which is the low white blood cells followed by thrombocytopenia which is low platelets.

    00:40 Finally anemia develops and this happens slowly due to that longer lifespan of the red blood cell.

    00:46 Clinical features of drug-induced aplastic anemia depend on the degree to which each cell line is suppressed.

    00:52 Medication-induced aplastic anemia is one of the few life threatening reactions to medications.

    00:59 Common drug classes include cytotoxic chemotherapy We know this is a medication but this is also a toxin.

    01:06 Chemotherapy is effective in killing off cancerous cells but the chemical sometimes ends up harming the healthy stem cells found in the bone marrow.

    01:13 In fact, chemotherapy can cause blood cell counts to fall in the first week after starting treatment.

    01:19 This reduces the number of red cells, white cells and platelets in the body.

    01:23 Thankfully this reduction is usually temporary and it should improve after the chemotherapy has been successfully completed.

    01:30 The next is certain medications that we used to treat rheumatoid arthritis, and certain antibiotics.

    01:36 To stop the aplastic anemia caused by a medication, the patient will need to stop the medication, if able.

    01:42 Remember this isn't always possible especially if the medication is being used to manage a serious condition.

    01:48 The patient can also receive a blood transfusion to replace the components of the blood that are not being made by the marrow.

    01:54 The prognosis is similar when caused by medications as when aplastic anemia is idiopathic.

    01:59 These patients usually respond well to immunosuppressive therapy and stem cell transplantation.

    02:05 Aplastic anemia can also be caused by viral infections.

    02:08 It is thought of as a response to the persistent inflammatory feedback to the hematopoietis system which makes it difficult for the bone marrow to function normally.

    02:17 Viruses that have been linked to the development of aplastic anemia include hepatitis, the Epstein-Barr virus and cytomegalovirus.

    02:25 In addition, Parvovirus B19 and HIV have also been linked.

    02:30 Both the virus in itself can ensue this immune response and this can have a tremendous impact on the hematopoeitic process resulting in aplastic anemia.

    02:40 How about aplastic anemia in pregnancy? Well a woman who has aplastic anemia prior to becoming pregnant will typically have a worsening of her symptoms during her pregnancy and some women will develop aplastic anemia while pregnant which is thought of as a sort of autoimmune reaction.

    02:55 There is significant maternal and neonatal morbidity and mortality in patients with aplastic anemia These women have complicated obstetric and anaesthetic management and will likely be managed by a high risk maternal fetal medicine specialist These women are at high risk for hemorrhage due their thrombocytopenia and up to 75% of these patients require a blood transfusion during or after delivery.

    03:21 The platelet count can also be too low to perform a safe cesarean delivery.

    03:26 Due to their neutropenic state, these women are at an increased risk for infections and sepsis.

    03:32 Aplastic anemia is managed in the same way as a non-pregnant patient although there are some additional potential risks.

    03:39 And immunosuppressants, this can interfere with breastfeeding and these women may need to formula feed their babies.

    03:45 They can also receive blood transfusions and stem cell transplant.

    03:50 Chemotherapy is unique as it fits into the medication category and it also fits into the toxin category because it's a cellularly toxic medication.

    03:58 Some patients with cancer will also receive radiation therapy and this can also damage the healthy cells in the bone marrow.

    04:04 This usually improves once the therapy is completed.

    04:08 Certain chemicals including pesticides, insecticides and benzene which is an ingredient in gasoline have been implicated and causing aplastic anemia.

    04:17 With elimination of the exposure to these chemicals, aplastic anemia usually resolves.


    About the Lecture

    The lecture Secondary Causes of Aplastic Anemia (Pediatric Nursing) by Paula Ruedebusch is from the course Blood Disorders – Pediatric Nursing. It contains the following chapters:

    • Aplastic Anemia for Medications
    • Aplastic Anemia in Pregnancy
    • Aplastic Anemia from Toxins

    Included Quiz Questions

    1. Stop the medication if able.
    2. Give a blood transfusion.
    3. Give chemotherapy.
    4. Give iron supplements.
    5. Increase fluid intake.
    1. Hepatitis
    2. Epstein-Barr virus
    3. Cytomegalovirus
    4. Influenza
    5. Herpes zoster

    Author of lecture Secondary Causes of Aplastic Anemia (Pediatric Nursing)

     Paula Ruedebusch

    Paula Ruedebusch


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