What are the recommended management strategies for a patient diagnosed with aplastic anaemia in primary care?

For a patient diagnosed with aplastic anaemia, management is primarily conducted in secondary care by a haematologist and a multidisciplinary team ². 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 ¹.

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 ¹. If there is uncertainty about ongoing management, advice should be sought from the local virology, microbiology, or infectious diseases department ¹.
• 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 ². Aminoglycosides should be avoided wherever possible due to the risk of renal toxicity ².
• Vaccinations: Ensuring the person has been offered annual vaccination against seasonal influenza and the one-off pneumococcal vaccination is recommended ².
• 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 ². Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended due to the risk of renal toxicity ². If pain persists despite simple analgesia, specialist advice should be sought ².
• Mental Health Support: Assessing the person for signs of depression and anxiety is an important aspect of care ².
• 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 ². Providing sources of information and self-help, such as patient support groups, is also part of supportive care ².