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Aplastic Anaemia D002

Last amended 
10 September 2020
Current RMA Instruments
Reasonable Hypothesis SOP
58 of 2020
Balance of Probabilities SOP
59 of 2020
Changes from previous Instruments

SOP Bulletin 216

ICD Coding
  • ICD-9-CM Codes: 284.89, 284.9
  • ICD-10-AM Codes: D61
Brief description

Aplastic anaemia is a blood disorder in which the body's bone marrow doesn't make enough new blood cells. This results in a deficiency of all three types of blood cell: red blood cells (anaemia), white blood cells (leukopaenia), and platelets (thrombocytopaenia).  Collectively this is known as pancytopaenia.

Confirming the diagnosis

Diagnosis requires a bone marrow examination as well as a peripheral blood count. 

Temporary pancytopaenia is a common side effect of treatment for cancer.  Permanent destruction of bone marrow may even be an objective of treatment, ahead of bone marrow transplant.  In either case, where the patient recovers and bone marrow function is restored, a diagnosis of aplastic anaemia will generally not be warranted.

The relevant medical specialist is a haematologist.

Additional diagnoses that may be covered by SOP
  • pancytopaenia - aplastic anaemia is one of a number of causes.
Conditions not covered by SOP
  • Agranulocytosis – isolated white cell aplasia#
  • Inherited bone marrow failure syndromes#
  • Leukaemic bone marrow infiltration*
  • Myelodysplastic syndrome*
  • paroxysmal nocturnal haemoglobinuria#
  • Pure red cell aplasia*
  • Thrombocytopaenia – isolated platelet aplasia#

* another SOP applies

# non-SOP condition

Clinical onset

Clinical onset will be based on the laboratory findings.  Once the diagnosis has been confirmed, the clinical picture may allow backdating of onset to a slightly earlier time. Clinical manifestations include recurrent infections (from low white cell count), mucosal or other haemorrhage (from low platelets) and fatigue (from anaemia).

Clinical worsening

The only worsening factor is for inability to obtain appropriate clinical management.  Aplastic anaemia has a high mortality rate, even with appropriate treatment.