Aplastic Anaemia: Management

Key points

• Supportive care: blood products (irradiated, to avoid alloimmunisation and transfusion-associated GVHD) and prevention/treatment of infection.
• Immunosuppressive therapy for severe aplastic anaemia not suitable for transplant: antithymocyte globulin (ATG) plus ciclosporin, now combined with eltrombopag (a TPO-RA), which improves response rates.
• ATG/ALG is prepared in animals (rabbits or horses) by injecting human lymphocytes.
• ATG is highly allergenic and may cause serum sickness (fever, rash, arthralgia), so steroid cover is usually given.
• Allogeneic haematopoietic stem cell transplantation is first-line for younger patients with severe aplastic anaemia and a matched sibling donor.