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Managing aplastic anemia (AA) in resource-limited countries poses significant challenges due to inadequate diagnostic infrastructure, financial constraints, limited access to immunosuppressive therapy (IST), and few transplant centers. This chapter addresses the epidemiological variations, diagnostic hurdles, and practical therapeutic strategies tailored to constrained environments. With a younger age of presentation, limited availability of matched unrelated donors (MUDs), and reliance on family-based donors, management often necessitates adaptation. Cyclosporine (CsA) monotherapy, androgen therapy, and supportive care serve as critical alternatives when standard triple immunosuppression is unavailable. Matched related donor hematopoietic stem cell transplantation (MRD-HSCT) is often more feasible than immunosuppressive therapy in these settings. Haploidentical HSCT is gaining traction as a viable alternative due to broader donor availability. Strategic resource allocation, early referral, and regional collaboration are crucial to optimizing care. Despite limitations, survival outcomes of 70%–80% are achievable with a tailored approach, demonstrating that improved outcomes in AA are possible even in restricted-resource settings.

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Managing Bone Marrow Failure in Countries with Restricted Resources

  • 章节

  • 出版模式：

    开放获取

  • 发表日期：

    2026年

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  • Raheel Iftikhar,
  • Carmem Bonfim,
  • Moosa Patel,
  • Hazza Alzahrani,
  • Adetola Kassim,
  • Mahmoud Aljurf

摘要

Managing aplastic anemia (AA) in resource-limited countries poses significant challenges due to inadequate diagnostic infrastructure, financial constraints, limited access to immunosuppressive therapy (IST), and few transplant centers. This chapter addresses the epidemiological variations, diagnostic hurdles, and practical therapeutic strategies tailored to constrained environments. With a younger age of presentation, limited availability of matched unrelated donors (MUDs), and reliance on family-based donors, management often necessitates adaptation. Cyclosporine (CsA) monotherapy, androgen therapy, and supportive care serve as critical alternatives when standard triple immunosuppression is unavailable. Matched related donor hematopoietic stem cell transplantation (MRD-HSCT) is often more feasible than immunosuppressive therapy in these settings. Haploidentical HSCT is gaining traction as a viable alternative due to broader donor availability. Strategic resource allocation, early referral, and regional collaboration are crucial to optimizing care. Despite limitations, survival outcomes of 70%–80% are achievable with a tailored approach, demonstrating that improved outcomes in AA are possible even in restricted-resource settings.