History
appears abruptly or insidiously
most common early symptom: Bleeding: a complaint of d-ws of easy bruising, oozing from gums, nose bleeds, heavy menstrual flow, and sometimes petechiae
W/ thrombocytopenia, massive hemorrhage unusual, but small amounts of bleeding in CNS--> catastrophic intracranial or retinal hemorrhage
Symptoms of anemia also frequent: lassitude, weakness, shortness of breath, a pounding sensation in ears
Infection an unusual first symptom in AA (unlike in agranulocytosis, where pharyngitis, anorectal infection, or frank sepsis occurs early)
Pxs often feel and look remarkably well despite drastically reduced blood counts-->Systemic complaints & weight loss--> other etiologies of pancytopenia
Prior medical drug use, chemical exposure, and preceding viral illnesses must often be elicited w/ directed questioning
A family hx of hematologic diseases or blood abnormalities, of pulmonary or liver fibrosis, or of early hair graying--> a telomeropathy; a family hx of unusual infections and warts--> GATA2 deficiency.