Bone marrow failure develops when one does not produce adequate amounts of white blood cells, red blood cells or platelets. White blood cells fight off infections which enter the body. Red blood cells regulate how much oxygen needs to be distributed in the body. Platelets help stop the flow of blood when there’s been an injury.
Bone marrow failure is associated with Aplastic anemia, Fanconi anemia and Dyskeratosis. Fanconi anemia is an inherited blood disorder due to DNA mutations. Dyskeratosis Congenita is seen as skin pigmentation, leukoplakia and abnormal nail growth. Aplastic anemia is an autoimmune disorder and is characterized by an inadequate production of new blood cells in the body.
Bone Marrow Failure Symptoms And Diagnosis
The two common signs and symptoms are bleeding and bruising. There will be blood in the gums, nose or the skin, and it will last longer than normal. Children may see blood in their urine or stools. Other commonly seen symptoms are shortness of breath, fatigue and recurrent colds.
- The complete blood count will show – normocytic, normochromic anemia with low count of reticulocyte in aplastic anemia.
- WBC count will indicate whether leukemia or megaloblastic anemia is the cause.
- There will be thrombocytopenia.
- Aspiration of bone marrow and biopsy will give an indication of the cause of its failure.
- MRI and PET scan helps to check the bone marrow activity.
Treatment Options For Bone Marrow Failure
The type of treatment that your health care provider will suggest depends up on the severity of the failure.
- Transfusion with packed red cells and platelets is usually recommended; severe cases need transplantation of bone marrow.
- Start a blood transfusion using specific cells – packed RBC for anemia and platelets for thrombocytopenia. Red cell transfusions is done in severe anemia and bleeding from thrombocytopenia. Supportive care will provide short term relief of symptoms and will not treat the primary disease.
- Losing too much blood calls for blood transfusion. Blood transfusion helps replace the lost blood and also gives the patient whole blood. Blood enters through a tube and ends up in a bag that is hooked to an IV catheter, which is introduced in to a vein. Blood transfusions are safe and acquiring a disease through a transfusion is rather rare. The blood is collected from a donor who agrees to let the physician gather blood stem cells from the blood or bone marrow for transplantation. Stem cells are those cells which make all the body’s blood cells. Once the stem cells are introduced in to the receiver’s body via an intravenous, they mature and become blood cells. Before the blood donation, a medicine is injected in to the donor, which enhances the number of stem cells in their body.
- Severe cases need a bone marrow transplant. Bone marrow transplantation is advised in patients who are younger than 55 years and have a severe disease and a matched, related donor. With the current regimens, most patients with severe aplastic anemia have 70 % long term survival rate. Improvement in transplant prognosis is attainable with improved HLA tissue typing to recognize better matched donors, upgrading in the conditioning regime, especially, fludarabine-based regimes, and enhanced supportive care.
- Febrile neutropenia is a medical emergency and needs forceful anti-biotic management.
- In those cases, where bone marrow transplant is not possible, intensive immuno-suppressive therapy is employed, occasionally in conjunct with hemopoietic growth factors, though there benefit is debated.