What are the symptoms of aplastic anemia?

Sep 19, 2025 Source: Cainiu Health

Dr. Liu Feng

Introduction

In general, aplastic anemia is a disease characterized by bone marrow failure in blood cell production. Symptoms include progressive fatigue and dizziness, mucocutaneous bleeding, recurrent infections and fever, palpitations and shortness of breath upon exertion, as well as abnormalities in skin, hair, and nails. If the above symptoms appear and progressively worsen, timely bone marrow aspiration should be performed to confirm the diagnosis. Early standardized treatment can reduce the risk of complications.

In general, aplastic anemia is a disease characterized by bone marrow failure in hematopoiesis. Its symptoms include progressive fatigue and dizziness, mucocutaneous bleeding, recurrent infections and fever, palpitations and shortness of breath upon exertion, as well as abnormalities in skin, hair, and nails. A detailed analysis is as follows:

1. Progressive fatigue and dizziness: Due to insufficient red blood cell production leading to severe anemia, the blood's oxygen-carrying capacity decreases, resulting in hypoxia in brain tissue and skeletal muscles. Patients experience fatigue even during routine activities, accompanied by persistent dizziness and tinnitus. Positional visual obscurations often occur when rising from a lying position. Symptoms are not significantly relieved by rest and progressively worsen as anemia intensifies.

2. Mucocutaneous bleeding: Reduced platelet production leads to coagulation dysfunction, causing spontaneous bleeding or bleeding triggered by minor trauma. Common manifestations include scattered petechiae and ecchymoses on the skin, recurrent gum bleeding, epistaxis, and in female patients, sudden increase in menstrual flow. Severe cases may present with gastrointestinal bleeding.

3. Recurrent infections and fever: Leukopenia impairs immune defenses, making patients susceptible to secondary bacterial and viral infections. Respiratory tract infections are most common, followed by oral and perianal infections. Fever is typically moderate to high-grade, tends to recur after standard anti-infective treatment, and in severe cases may progress to sepsis.

4. Palpitations and shortness of breath upon exertion: Anemia causes the heart to compensate by increasing its rate to maintain organ perfusion. Patients may be asymptomatic at rest but develop palpitations with mild activity such as climbing stairs or brisk walking. Severe cases may also involve chest tightness and dyspnea. Long-term anemia can lead to anemia-related heart disease, manifesting as arrhythmias or cardiac enlargement.

5. Abnormalities in skin, hair, and nails: Chronic anemia results in poor nutrition of the skin, hair, and nails. This manifests as pallor, dry and flaky skin, brittle and easily broken hair, thinning and fragile nails, and in some patients, koilonychia (spoon-shaped nails).

If the above symptoms appear and progressively worsen, timely bone marrow aspiration should be performed to confirm diagnosis. Early standardized treatment, such as immunosuppressive therapy or hematopoietic stem cell transplantation, can effectively improve hematopoietic function and reduce the risk of complications.

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