Aplastic anemia often develops from an injury or damage to the stem cells that inhibit red blood cell (RBC) production. A less common development occurs when damaged bone marrow microvasculature creates an unfavorable environment for cell growth and maturation, resulting in aplastic anemia. Approximately 80% of aplastic anemias are acquired; it is caused by drugs such as antibiotics and anticonvulsants, toxic agents such as benzene and chloramphenicol, pregnancy, or radiation. Other causes include severe disease such as hepatitis, viral illnesses, and preleukemic and neoplastic infiltration of the bone marrow. Some forms of aplastic anemia are congenital (see Genetic Considerations).

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