Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Monitoring a patient with aplastic anaemia during treatment involves assessing for complications related to the disease itself, its treatments (such as immunosuppressants and erythropoietin-stimulating agents), and supportive care like blood transfusions.
- Monitoring related to Immunosuppressive Therapy:
- If the patient is on azathioprine, monitor their Full Blood Count (FBC), renal function (creatinine/calculated GFR), and Liver Function Tests (LFTs: ALT and/or AST and albumin) every 2 weeks until the dose is stable for 6 weeks, then monthly for 3 months, and thereafter at least every 12 weeks NICE CKS. More frequent monitoring is required for people at higher risk of toxicity or if the dose is increased NICE CKS.
- If the patient is on ciclosporin, monitor their FBC, renal function (creatinine/calculated GFR), LFTs (ALT and/or AST and albumin), blood glucose, and blood pressure every 2 weeks until the dose is stable for 6 weeks, then monthly NICE CKS. For patients stable for 12 months, reduced monitoring frequency (every 3 months) can be considered on an individual basis NICE CKS. Monitor more frequently in people at higher risk of toxicity or if the dose is increased NICE CKS.
- Monitoring for Anaemia and Erythropoietin-Stimulating Agent (ESA) Response:
- If erythropoietin analogues are used, monitor haemoglobin (Hb) every 2 to 4 weeks during the induction phase of ESA therapy and every 1 to 3 months during the maintenance phase NICE NG203. Monitor Hb more frequently after an ESA dose adjustment NICE NG203.
- Pure red cell aplasia (PRCA), a specific type of aplasia, is indicated by a low reticulocyte count, together with anaemia and the presence of neutralising antibodies NICE NG203. PRCA is confirmed by the presence of anti-erythropoietin antibodies together with a lack of pro-erythroid progenitor cells in the bone marrow NICE NG203. Consider specialist referral for people with ESA-induced PRCA NICE NG203.
- If an underlying haematological disorder is suspected, particularly in cases of ESA resistance, consider referring the patient to a haematology service NICE NG203.
- Monitoring for Bleeding Complications:
- An unexplained fall in haemoglobin and/or haematocrit may indicate occult bleeding NICE CKS. Patients should be carefully monitored for signs of bleeding NICE CKS. Counsel patients on the signs and symptoms of bleeding NICE CKS.
- Monitoring for Iron Overload:
- To prevent iron overload, especially in patients receiving frequent blood transfusions, carry out routine monitoring of iron stores using serum ferritin at intervals of 1 to 3 months NICE NG203.
- General Monitoring:
- Regular full blood count and renal function tests are important for monitoring haematological conditions NICE NG35.