Aplastic Anemia Treatment in India

Aplastic Anemia is considered an auto-immune disease and is described as a rare blood disorder in which the bone marrow while producing normal and properly functioning cells, does not produce sufficient blood cells to support the needs of the body.  Aplastic Anemia can manifest in moderate to extremely severe forms and can appear at any age irrespective of gender.  People suffering from Aplastic Anemia can develop a variety of symptoms including an increased risk of uncontrolled bleeding and infections.  Currently, the only cure for Aplastic Anemia is a bone marrow transplant; however, in most cases, it can be managed with proper and regular medical attention.  

What are the treatment options for Aplastic Anemia?

Cost of TreatmentIndia
Bone Marrow TransplantStarting from $22,000
ATG + Cyclosporine TherapyStarting from $9,500

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Blood Cell Formation And Types

Your blood is made of various types of cells suspended in a fluid called plasma which is made up primarily of water and contains proteins, nutrients, hormones and other chemicals that are vital to your bodies proper function and health.

Blood cells come in three distinct forms each with its own unique function:

  • Red Cells (RBCs) – Also known as erythrocytes, the red blood cells are filled with hemoglobin, a type of protein that transports oxygen from the lungs throughout the rest of the body. RBCs make up approximately half of the blood cells in the body.
  • White Cells (WBCs) – White blood cells, or leukocytes, serve as an important part of the immune system by fighting the germs that cause infection and other illnesses. WBCs come in a variety of forms each specialized to defend the body against specific types of germs.
  • Platelets – Platelets, or thrombocytes, aid in blood clotting to allow the wounds to stop bleeding. Without platelets, and the ability to clot, even a minor cut would bleed indefinitely.

All blood cells are created inside spongy bone marrow that is inside certain bones. The stem cells in the bone marrow can develop into any of the three types of blood cell. Once the cell is mature it leaves the bone marrow and enters the bloodstream. In healthy individuals, the stem cells inside the bone marrow produce sufficient healthy cells. On rare occasions, however, there can be a failure in the bone marrow which leads to certain blood disorders such as Aplastic Anemia.

Causes of Aplastic Anemia

In rare instances Aplastic Anemia may be inherited however, it is generally considered an acquired illness. It is an autoimmune related disease in that the condition can trigger autoimmune responses in which the body’s immune system stops recognizing its own tissues and organs as part of the body and begins to attack it as if it the tissues and organs were a germ or virus.
Aplastic means empty and refers to the fact that the bone marrow is “empty” of mature red cells that can be released into the bloodstream. As the bone marrow slows in its production of new cells or stops producing them completely then Aplastic Anemia develops. This type of bone marrow failure can be caused by damage to the bone marrow.

Damage to the bone marrow can be caused by:

  • Exposure to Chemicals – Exposure to toxins that are found in substances like insecticides or pesticides can trigger Aplastic Anemia. When there is a chemical cause the disease may be reversed in its early stages by eliminating exposure to the toxic substance.
  • Autoimmune Disease – Some autoimmune diseases can cause the body to attack its own stem cells in the bone marrow and lead to Aplastic Anemia.
  • Radiation and Chemotherapy – While radiation and chemotherapy are useful treatments in the fight against cancer they sometimes have the side effect of damaging healthy stem cells such as those found in bone marrow. Aplastic Anemia caused by radiation and chemotherapy is typically a temporary, not a chronic, condition.
  • Viruses – A link has been discovered between some viruses such as HIV, Parvovirus and Hepatitis and Aplastic Anemia.
  • Pregnancy – In very rare instances pregnant women may develop Aplastic Anemia due to an acute autoimmune condition triggered by the pregnancy.
  • Drugs – Some drugs, such as antibiotics and those used to treat rheumatoid arthritis have been linked to instances of Aplastic Anemia.

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Symptoms of Aplastic Anemia

While all Aplastic Anemia is caused by insufficient red blood cells the symptoms vary greatly depending on the severity of the disease and how low the RBC count is. Symptoms can be further complicated by age and preexisting health conditions. 

Some of the most common symptoms of Aplastic Anemia include:

  • Rapid and/or irregular heartbeat or heart rate
  • Paleness or rashes
  • Fatigue and/or breathlessness with very little exertion
  • Headaches
  • Dizziness
  • Cuts that take a long time to stop bleeding or don’t stop
  • Bruising easily
  • Frequent infections and fevers

If these symptoms develop without a known cause it is recommended to see your physician for a checkup.

Diagnosis of Aplastic Anemia

Aplastic Anemia is diagnosed by microscopic examination of the cells of the bone marrow, collected from the hip bone, and blood.  Once the samples are collected a lab will examine the number of all blood cells that are present as well as the ratio between the blood cells.  Kidney function may also be tested as poor kidney function and be indicative of Aplastic Anemia.  The final diagnosis is typically made by a senior bone marrow specialist and can be moderate, severe or very severe.

Treatment of Aplastic Anemia

The available treatment options for Aplastic Anemia depends on the stage of the disease (moderate, severe or very severe), the age of the patient and the availability of a donor. In cases of moderate aplastic anemia, the treatment generally consists of drug therapies that control the condition and treat the symptoms. When Aplastic Anemia has reached the severe or very severe stage the treatment is typically dictated by age. In patients under the age of 40, who have a suitable donor available, a bone marrow transplant is the preferred treatment. If a patient is over 40 years old or does not have a suitable donor then drug therapies are recommended. Some of the most common treatment options include:

  • Cyclophosphamide – Cyclophosphamide is a drug that is commonly used when a bone marrow transplant is not needed or is not possible. This drug therapy kills the cells that are causing the Aplastic Anemia but preserves the stem cells.
  • Transfusion – If the blood cell count is drastically low doctors may use a transfusion of blood platelets to raise the cell count. Transfusions can reduce symptoms such as fatigue, shortness of breath and hemorrhage. Although transfusion offers quick relief of symptoms it is rare for it to lead to a long-term recovery.
  • Drug Therapy – When a bone marrow transplant is not an option due to age, health risks or lack of donor, the immunosuppressive drugs anti-thymocyte globulin (ATG) and cyclosporine are used. While this combined drug therapy can induce a partial restoration of blood cell production it is not a cure. In rare cases, marrow from an unrelated donor may be used if drug therapies are not effective and the Aplastic Anemia is very severe.
  • Allogenic Bone Marrow Transplant – Sometimes referred to as a stem cell transplant a bone marrow transplant is one of the most successful treatments and the only possible cure for Aplastic Anemia. The damaged bone marrow is destroyed using radiation or chemotherapy. Bone marrow from a suitable donor, typically a close family member, is then used to replace the bone marrow of the patient.
  • Supportive Care – If a patient requires regular transfusions to keep the disease in check a central venous catheter may be implanted to make the transfusions and administration of any required drugs easier. Packed RBCs (red blood cells) are kept on hand to treat any blood deficiencies that may arise and to avoid cardiopulmonary complications. An additional aspect of supportive care is the administration of antivirals, antibiotics, and antifungals to treat the frequent infections associated with Aplastic Anemia.

FAQ – Frequently Asked Questions

Q. Can Aplastic Anemia be prevented?
While temporary forms of Aplastic Anemia that are caused by toxins, radiation, and drugs can be prevented by avoiding exposure, the overall cause of Aplastic Anemia, particularly chronic Aplastic Anemia, is unknown and cannot be prevented.

Q. Is it safe to donate bone marrow? Is it safe for my family member to donate bone marrow?
Donating bone marrow is a very safe procedure which rarely produces long-term complications or side effects. The most common side effect of donation is pain and weakness in the hip the marrow was collected from. Donors typically recover fully in a few weeks.

Q. Do I need chemotherapy before a bone marrow transplant?
Chemotherapy may be used in two ways prior to bone marrow transplant. Chemotherapy may be used to help kill the damaged bone marrow and make room for the donor marrow. Chemotherapy combined with an antibody is often used to suppress the immune system prior to a bone marrow transplant to reduce the risk of rejection.

Q. Which activities should I avoid during treatment for Aplastic Anemia?
During periods when the red blood cells are low patients should avoid any activity that results in an elevated heart rate or shortness of breath such as strenuous or excessive exercise. High altitudes should be avoided because the thin air can add to difficult breathing. Due to the fact that infection and excessive bleeding are common side effects of Aplastic Anemia patients should avoid unhygienic conditions and activities that could lead to injuries or trauma.

Q. What are the possible complications/side effects of bone marrow transplants?
Immediately following a bone marrow or stem cell transplant patients may experience fatigue, nausea, diarrhea or sores of the mucous membranes (particularly in the mouth). Long-term side effects can include ongoing issues with the immune system as well as infections. Hair loss and sterility have also been reported as a result of bone marrow transplants. Bone marrow and stem cell transplant do not always lead to a cure. In many cases, although long-term alleviation of the disease is achieved, the condition will reemerge in time.

Q. How long is the drug therapy for the treatment of Aplastic Anemia?
It will typically take between three and six months for a patient undergoing drug therapy to begin to notice an elevation in their blood count. Doctor(s) will either increase or decrease the dose based on the patient’s response to the drug. As the condition improves the doctor will lower the recommended drug dosage. If the patient is suffering from a temporary form of Aplastic Anemia they may be weaned off of the drug after their bone marrow and blood count has recovered. For patients with chronic or recurring Aplastic Anemia drug therapy may be an ongoing necessity to maintain health.

Q. What is the rate of success of bone marrow/stem cell transplant for Aplastic Anemia? The survival rate for patients who received compatible bone marrow from a sibling is over 70%. If the donor is unrelated to the patient the survival rate is approximately 50%

Q. Are there alternatives to bone marrow/stem cell transplants?
If a transplant is not possible due to age, health or lack of donor immunosuppressive drugs are generally the alternatives. While half of all patients respond well to drug therapy alone they run the risk of the Aplastic Anemia developing into cancer over time.

Q. What is the best way to prevent infections at home?
Aplastic Anemia increases the rate of infection and many of the medications used to treat the condition can further compromise the immune system. It is important to keep your home as clean as possible. Doctors or other health care providers should be able to recommend appropriate cleaning solutions that will kill germs but will not complicate the condition.

Q. What is the best way to prevent infections at home?
Aplastic Anemia increases the rate of infection and many of the medications used to treat the condition can further compromise the immune system. It is important to keep your home as clean as possible. Doctors or other health care providers should be able to recommend appropriate cleaning solutions that will kill germs but will not complicate the condition.

Q. Do I need special vaccinations to travel to India?
The vaccinations that are required when traveling to India depend on which country the person is traveling from. Individuals traveling from South America, and Africa will require proof of a yellow fever vaccination. Travelers from parts of Africa and the Middle East require a Polio Vaccine. The World Health Organization website, http://www.who.int/ith/vaccines/en/ has information about required vaccines for international travel.

Q. Do I need a visa to travel to India for medical treatment?
Yes, a visa is required for travel to India. Individuals with a passport from certain countries are able to get a medical visa upon arrival in India. These countries include Cambodia, Finland, Indonesia, Japan, Luxembourg, Myanmar, New Zealand, Philippines, Singapore, South Korea, and Vietnam.

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