Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient diagnosed with aplastic anaemia, management is primarily conducted in secondary care by a haematologist and a multidisciplinary team NICE CKS. Aplastic anaemia, particularly transient aplastic crisis linked to Parvovirus B19 infection, can be life-threatening if left untreated, and individuals with haematological disorders are at increased risk NICE CKS.
The role of primary care for patients with severe haematological conditions, such as aplastic anaemia, would generally involve supportive measures and prompt referral for specialist input:
- Prompt Referral and Specialist Advice: If a person develops symptoms of suspected severe or aplastic anaemia, further management information should be sought NICE CKS. If there is uncertainty about ongoing management, advice should be sought from the local virology, microbiology, or infectious diseases department NICE CKS.
- Infection Management: Ensuring that infections are treated promptly with a broad-spectrum antibiotic, in line with local protocols and/or Public Health England guidance, is crucial NICE CKS. Aminoglycosides should be avoided wherever possible due to the risk of renal toxicity NICE CKS.
- Vaccinations: Ensuring the person has been offered annual vaccination against seasonal influenza and the one-off pneumococcal vaccination is recommended NICE CKS.
- Pain Assessment and Management: If the person reports bone pain, consider possible complications and advise on the use of paracetamol and/or codeine if tolerated and not contraindicated NICE CKS. Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended due to the risk of renal toxicity NICE CKS. If pain persists despite simple analgesia, specialist advice should be sought NICE CKS.
- Mental Health Support: Assessing the person for signs of depression and anxiety is an important aspect of care NICE CKS.
- Information and Support: Offering advice and information to the person and their family/carers on the disease process, symptoms, and identifying and reporting new symptoms (such as pain or infection) is beneficial NICE CKS. Providing sources of information and self-help, such as patient support groups, is also part of supportive care NICE CKS.