Wartime Occurrence of Severe Aplastic Anemia in Previously Healthy Military Service Members: A Case Series

Wartime conditions present major challenges to the timely diagnosis and management of severe aplastic anemia (SAA). We describe 3 previously healthy military service members who developed idiopathic SAA during active duty. In all 3 patients, no chronic illnesses were documented in the medical records, and no specific toxin exposures or prior hepatitis were recorded. All experienced a gradual onset of cytopenias accompanied by hemorrhagic symptoms, initial misclassification as immune thrombocytopenia or myelodysplastic syndrome, and war-related delays to definitive therapy. Each required prolonged transfusion support and broad-spectrum antibiotics for neutropenic complications. Two patients received immunosuppressive therapy (antithymocyte globulin plus cyclosporine A) four to 5 months after diagnosis, while the youngest underwent urgent allogeneic bone marrow transplantation. Despite severe logistical constraints, all survived the acute phase but remained transfusion-dependent at discharge. These cases underscore the need to strengthen medical logistics and ensure early access to specialized hematologic care to improve SAA outcomes during wartime.