Aplastic Anemia Treatment in Israel
Aplastic anemia is a bone marrow failure disease. It is a rare and serious condition that happens when the bone marrow doesn’t produce enough red blood cells, white blood cells, or platelets. As a result, the body cannot supply itself with enough blood to stay healthy. Aplastic anemia can develop at any age, either appearing suddenly or worsening gradually over time. At Sheba Medical Center in Israel, specialists at our Hematology Division and Bone Marrow Transplantation Department diagnose and customize treatments for mild to severe aplastic anemia.
Risk Factors for Aplastic Anemia
In most cases of aplastic anemia, the precise cause cannot be identified. However, various environmental factors have been indicated as possible triggers for the body’s immune attack on bone marrow, which leads to aplastic anemia. These risk factors include:
- Chemotherapy or high-dose radiation therapy for cancer
- Exposure to toxic chemicals
- Certain prescription drugs, such as chloramphenicol for bacterial infections, and gold compounds used as treatment for rheumatoid arthritis
- Specific autoimmune disorders, serious infections, and blood disorders
- Viral infections, such as hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19, and HIV
- Pregnancy (very rare)
- Paroxysmal nocturnal hemoglobinuria, a rare disorder that causes red blood cells to deconstruct too soon
- Fanconi anemia, a rare genetic disease
Types of Aplastic Anemia
Aplastic anemia can be a temporary disease, or it can become chronic. It can also range from mild to life-threatening. There are three types of the condition:
- Moderate Aplastic Anemia (MAA): This type of the disease presents with low blood cell counts, but not as low as with severe cases. Few or no symptoms may occur, and moderate aplastic anemia does not always require treatment other than regular follow-up blood testing.
- Severe Aplastic Anemia (SAA): With severe aplastic anemia, the neutrophil count is less than 500 cells per microliter, the reticulocyte count is less than 20,000 per microliter, and the platelet count is less than 20,000 per microliter.
- Very Severe Aplastic Anemia (VSAA): In cases of very severe aplastic anemia, the neutrophil count is less than 200 per microliter, and all other blood counts are similar to those of severe aplastic anemia. This type of the condition can be life-threatening.
Symptoms of Aplastic Anemia
Mild aplastic anemia can have no symptoms. But when symptoms of this disease do occur, they can include:
- Irregular or fast heart rate
- Shortness of breath
- Frequent or prolonged infections
- Easy or unexplained bruising and/or prolonged bleeding from cuts
- Nosebleeds, bleeding gums
- Skin rash
Treatments for Aplastic Anemia
Blood transfusions of red blood cells or platelets can control bleeding and alleviate symptoms by infusing blood cells that the bone marrow isn’t producing on its own. Usually, there’s no limit to the amount of blood transfusions a person can receive. However, multiple transfusions sometimes lead to serious complications.
A bone marrow transplant is often the only successful treatment for people with severe aplastic anemia. Done while the patient is hospitalized, this treatment serves to rebuild the bone marrow. It is typically the preferred treatment for younger patients who have a matching donor (often a sibling).
Bone marrow transplants involve depleting the diseased bone marrow with radiation or chemotherapy and then injecting healthy donor stem cells intravenously into the patient. The new stem cells migrate to the bone marrow, where they produce new blood cells. At Sheba, we have a highly advanced and comprehensive Bone Marrow Transplantation Department.
When patients are not candidates for a bone marrow transplant, immunosuppressant drugs may be administered. These medications suppress the activity of immune cells that are causing damage to the bone marrow. This allows the bone marrow to recover and begin producing blood cells once again.
Medications that help to jumpstart the bone marrow’s production of new blood cells may be given. Often, growth factors and immune-suppressing drugs are used in conjunction with bone marrow stimulants.
Aplastic anemia weakens the body’s immune system, making the patient more susceptible to infections. Sometimes, antibiotics and antiviral medications are given to prevent infections in people with severe aplastic anemia.
Arnon Nagler, MD, MSc
Director of the Division of Hematology
Director of Bone Marrow Transplantation and Cord Blood Bank
Prof. Nagler specializes in hematology, bone marrow transplantation, and internal medicine. He has pioneered many treatments for malignant and non-malignant blood disorders in Israel. He established the first public cord blood bank at Sheba in 2001, and he performed the first cord blood transplantation in Israel. In addition to his role at Sheba Medical Center, Prof. Nagler is a Professor of Medicine at Tel Aviv University.
Prof. Nagler received his medical degree from the Hebrew University – Hadassah Medical School, in Jerusalem, Israel, and then completed a postdoctoral fellowship at Stanford University, in the United States. In addition to receiving numerous awards, he is widely published and a world-renowned speaker. Prof. Nagler has also been the lead investigator on over 15 clinical trials and holds over 40 patents and trademarks.
Amos Toren, MD, PhD, MHA
Director of the Pediatric Hemato-Oncology and Bone Marrow Transplant Division
Prof. Toren specializes in pediatrics, general hematology, and pediatric hemato-oncology. His particular areas of research are in CAR-T cell therapy for relapsed/resistant CD19 expressing leukemias and lymphomas, and treatment for pediatric brain tumors. Prof. Toren is also a world-renowned expert in bone marrow transplantations and the genetic aspects of hematological diseases. He received his medical degree from the Sackler Faculty of Medicine, Tel Aviv University. He also has a PhD in Genetics from Tel Aviv University, and a Master of Health Administration from the Recanati Business School, Tel Aviv.
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