The clinical features derive from the decrease in peripheral blood cells and are non-specific. The patient may be feeling completely well at the time when easy bruising or petechiae appear or may have a more or less prolonged period of feeling tired from anaemia. Sometimes infection is the presenting feature, but this is less common in idiosyncratic aplastic anaemia than bleeding manifestations. The spleen, liver and lymph nodes are not enlarged and jaundice is only a feature in those patients with post-hepatitis aplasia who have a prolonged cholestatic phase after the infection.
At presentation, it is necessary to take a detailed drug, occupational and symptomatic history to try to establish any aetiological agent so that this may be avoided in the future. Unfortunately, this is not always easy. It is difficult to dissuade someone who may have been exposed to industrial chemicals, for example, to give up work on the possibility that the chemicals just might be involved in the cause of the disease.
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