What Are the Signs and Symptoms of Aplastic Anemia?

Most of the signs and symptoms of aplastic anemia are caused by low numbers of each of the three main types of blood cells—red blood cells, white blood cells, and platelets. Other signs and symptoms are not linked to a shortage of any particular blood cell type.

Too Few Red Blood Cells

The most common symptom of a low red blood cell count is low energy and feeling tired. This is caused by lack of enough hemoglobin, an iron-rich protein contained in red blood cells that carries oxygen to the body. A lack of enough oxygen in the blood can cause people to feel short of breath and dizzy, especially when standing up. Since the heart must work harder to circulate the reduced amount of oxygen, symptoms also can include a rapid or irregular heartbeat or an extra or unusual sound heard during the heartbeat (heart murmur).

The hemoglobin in red blood cells gives blood its red color. Lack of hemoglobin due to a low red blood cell count can lead to pale skin, gums, and nail beds.

Too Few White Blood Cells

White blood cells help fight infections. Signs and symptoms of a low white blood cell count are fevers, frequent infections which can be severe, and flu-like illnesses that linger.

Too Few Platelets

People who do not have enough platelets tend to bruise and bleed easily, and the bleeding may be hard to stop. Common types of bleeding related to too few platelets include nosebleeds, bleeding gums, pinpoint red bleeding spots on the skin, and blood in the stool. Women also may have heavy menstrual bleeding.

Other Signs and Symptoms

Aplastic anemia can cause other signs and symptoms as well. Some occur in the area of the head. These signs and symptoms include headache, tender sinuses, and white patches in the mouth (oral thrush). Other signs and symptoms are nausea and rash. A person with aplastic anemia also may have an enlarged spleen or liver.

Paroxysmal Nocturnal Hemoglobinuria

About one-third of people with aplastic anemia have a condition called paroxysmal (par-ok-SIZ-mal) nocturnal hemoglobinuria (PNH). This is a disorder of the red blood cells. Most people with PNH don’t have any signs or symptoms. If they do occur, they may include:

• A low number of red blood cells, which can lead to shortness of breath
• Swelling or pain in the abdomen or swelling in the legs caused by blood clots
• Blood in the urine
• Headache
• Jaundice (yellowish color of the eyes or skin)

Some people have PNH first and then develop aplastic anemia. But this process can also happen in reverse. People may have aplastic anemia first and then develop PNH later.