How is Aplastic Anemia Diagnosed
Signs and Symptoms of Aplastic Anemia
If you have aplastic anemia, you may have the following signs or symptoms:
- shortness of breath and fatigue, which is caused by anemia (too few red blood cells)
- serious infections because of not enough infection-fighting white blood cells (neutropenia/leukopenia)
- bruising or bleeding because of a shortage of platelets (thrombocytopenia)
Some people may not have any symptoms, but results of a routine blood test may suggest a diagnosis of aplastic anemia. There are other conditions in which blood formation may be abnormal. These are all considered when your doctor is determining your diagnosis.
Two tests are used to diagnose aplastic anemia. The first is a blood count, which confirms that the red cell count, white cell count, and platelet count are low. The next step is a bone marrow test, which includes an aspiration and a biopsy.
In bone marrow aspiration a small amount of liquid bone marrow (about 1 teaspoon) is sucked out with a thin needle and a syringe. During a bone marrow biopsy procedure, a small cylinder-shaped piece of bone and marrow (about 1/16 inch in diameter and 1/3 inch long) is removed with a slightly larger needle. Both samples usually are taken at the same time from the back of the pelvic bone.
The procedure is done with you lying on your stomach. The prominent part of the pelvic bone (about 2 inches to the side of the spine) and skin are numbed with local anesthetic. A small incision is made in the skin — about one-eighth inch. Then the biopsy needle is placed into the bone and a core of bone marrow removed. After that another needle, attached to a syringe, is placed into the marrow and marrow is sucked out. In spite of anesthesia, the procedure may still be uncomfortable, particularly when the marrow is sucked out.
Usually a pathologist, a doctor specializing in diagnosing disease by laboratory tests, examines the bone marrow under a microscope. A hematologist, internist who specializes in blood diseases, or a hematopathologist, pathologist who specializes in blood diseases, could also review the bone marrow sample. Finding an “empty” bone marrow, that is, one that lacks normal blood-producing cells, confirms the diagnosis. Leukemia or sometimes other kinds of cancers can also cause low blood counts, but in that case the bone marrow would be filled with leukemia or other cancer cells.