What Are the Signs and Symptoms of Aplastic Anemia?

Lower than normal numbers of red blood cells, white blood cells, and platelets cause most of the signs and symptoms of aplastic anemia.

Signs and Symptoms of Low Blood Cell Counts


Red Blood Cells

The most common symptom of a low red blood cell count is fatigue (tiredness). A lack of hemoglobin in the blood causes fatigue. Hemoglobin is an iron-rich protein in red blood cells. It helps carry oxygen to the body.

A low red blood cell count also can cause shortness of breath; dizziness, especially when standing up; headaches; coldness in your hands or feet; pale skin; and chest pain.

If you don't have enough hemoglobin-carrying red blood cells, your heart has to work harder to move the reduced amount of oxygen in your blood. This can lead to arrhythmias (irregular heartbeats), a heart murmur, an enlarged heart, or even heart failure.

White Blood Cells

White blood cells help fight infections. Signs and symptoms of a low white blood cell count include fevers, frequent infections that can be severe, and flu-like illnesses that linger.


Platelets stick together to seal small cuts or breaks on blood vessel walls and stop bleeding. People who have low platelet counts tend to bruise and bleed easily, and the bleeding may be hard to stop.

Common types of bleeding associated with a low platelet count include nosebleeds, bleeding gums, pinpoint red spots on the skin, and blood in the stool. Women also may have heavy menstrual bleeding.

Other Signs and Symptoms

Aplastic anemia can cause signs and symptoms that aren't directly related to low blood cell counts. Examples include nausea (feeling sick to your stomach) and skin rashes.

Paroxysmal Nocturnal Hemoglobinuria

Some people who have aplastic anemia have a condition called paroxysmal (par-ok-SIZ-mal) nocturnal hemoglobinuria (HE-mo-glo-bi-NOO-re-ah), or PNH. This is a red blood cell disorder. Most people who have PNH don't have any signs or symptoms.

If symptoms do occur, they may include:

  • Shortness of breath
  • Swelling or pain in the abdomen or swelling in the legs caused by blood clots
  • Blood in the urine
  • Headaches
  • Jaundice (a yellowish color of the skin or whites of the eyes)

In people who have aplastic anemia and PNH, either condition can develop first.


Source: National Heart, Lung, and Blood Institute, National Institutes of Health.