Guideline Video

Guideline Resources

  • Diagnosis and Management of Severe Acquired Aplastic Anemia
  • American Society of Hematology
  • March 24, 2026
  • Summary
  • Full-text

Video Transcription

Just published March 24th, 2026, the American Society of Hematology’s newest guideline on Diagnosis and Management of Severe Acquired Aplastic Anemia.

The objective of this guideline is to support clinical decision-making in the diagnosis and management of severe and very severe aplastic anemia. 

In today’s rapid update, we’ll just be going over a summary of the recommendations so for the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started.

Starting with the section on Diagnostic Tests 

  • The guideline suggests diagnostic testing for patients with severe or very severe aplastic anemia, including those that are refractory to immunosuppressive therapy. This includes paroxysmal nocturnal hemoglobinuria clone testing, somatic mutations testing, and telomere length testing. 

Then on to the section on Frontline Therapy

  • The guideline suggests hematopoietic cell transplant (HCT) over immunosuppressive therapy (IST) for patients with severe or very severe aplastic anemia who have a matched sibling donor available, unless the patient is over 40 years of age, where the guideline then suggests IST over HCT. 
  • In situations with a matched unrelated donor, the guideline suggests either matched unrelated HCT or IST, unless the patient is over 40 years of age, where the guideline suggests IST over matched unrelated HCT. 
  • For patients with a haploidentical donor, the guideline suggests IST over haploidentical HCT. 
  • For both children and adult patients undergoing IST, the guideline suggests adding eltrombopag. 

For the section on Second Line Therapy 

  • The guideline suggests HCT over second anti-thymocyte globulin-based therapy in patients under 60 years of age who have had no response to IST. For patients over 60 years of age, the guideline suggests either HCT or a second anti-thymocyte globulin-based therapy. 
  • For patients who initially respond to IST but relapse, the guideline suggests either HCT or a second anti-thymocyte globulin-based therapy for those under 60 years of age. In patients over 60 years of age, the guideline suggests second anti-thymocyte globulin-based therapy over HCT. 
  • The guideline suggests initiating second-line treatment within six months of anti-thymocyte globulin administration for patients who do not respond to IST. 

And last the section on Medical Management 

  • The guideline suggests both mold-active antifungal prophylaxis and antibiotic prophylaxis for patients with a neutrophil count below 500 per µl.

And there you have it. Make sure to check out the full guideline from the American Society of Hematology and other related clinical decision support tools at guidelinecentral.com.

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