Clinical features of severe bone marrow failure

The cardinal features of severe marrow failure are:

• anaemia - resulting in weakness and fatigue. Usually of slower onset than other features due to the longer survival of red cells compared to platelets and neutrophils, except bleeding is significant.
  
  
• bleeding - from mucosa and skin, due to thrombocytopenia. Purpura and petechiae are common. There may be retinal bleeding, sometimes leading to blindness. Spontaneous bleeding indicates severe marrow failure with platelet counts less than 20 x 10^9 per litre.
  
  
• bacterial infection - due to neutropenia. Usually with commensal organisms of the skin and GI tract. Recurrent infections in a previously fit person may be a clue.

Septicaemia is a risk in patients with severe neutropenia. Focal signs of infection may be absent, with malaise and fever the only features. Coliforms, Klebsiella spp., Pseudomonas spp., and Staphylococcal are usually responsible.

Hepatosplenomegaly, lymphadenopathy or bone tenderness are uncommon in aplastic anaemia but are characteristic of bone marrow failure due to leukaemia, myelofibrosis etc.d