Clinical Pathway for Evaluation/Treatment of Children
with Suspected Aplastic Anemia

Goals and Metrics
Patient Education
Provider Education
Child with Suspected Aplastic Anemia
History and Physical
Contact Hematology Fellow, Bone Marrow Failure Team
prior to obtaining studies
Initial Laboratory Evaluation
Bone Marrow Evaluation
Subsequent Laboratory Evaluation
Classification of Bone Marrow
Aplasia with Cytopenias
  • Consider Other Diagnoses
    • Inherited Bone Marrow Failure Syndromes
    • Hemophagocytic lymphohistiocytosis (HLH)
    • Moderate Aplastic Anemia, Myelodysplastic syndromes (MDS)/Leukemia
Acquired Severe Aplastic Anemia
Available Matched Sibling Donor
Refer to Bone Marrow Transplant Team
No Matched Sibling Donor
Start Immune Suppression Therapy
(Equine ATG Protocol)
Standard Response Table
Response
No Response
Follow-up Care
Follow-up after Initiation of ATG
  • Care During the First 12 Months
  • Vaccine Recommendation after Initiation of ATG
  • One Year Evaluation and Wean Of Immune Suppression
  • Long-Term Follow-up
Refer to Bone Marrow Transplant Team for unrelated Donor Search
Unrelated
Donor Available,
Complete BMT
No Unrelated
Donor Available
Discuss Alternative Therapies:
  1. Rabbit ATG Protocol
  2. Haplo Stem Cell Transplant
  3. Eltrombopag
Posted: October 2017
Revised: November 2022
Authors: T. Olson, MD; P. Kurre, MD; J. Oved, MD