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Emerging use of molecular cyto\u2010genomics is helpful in delineating immune mediated AA from inherited bone marrow failures (IBMF). Camitta criteria is used to assess disease severity, which along with age and availability of human leucocyte antigen compatible donor are determinants for therapeutic decisions. Supportive care with blood and platelet transfusion support, along with anti\u2010microbial prophylaxis and prompt management of opportunistic infections remain key throughout the disease course. The standard first\u2010line treatment for newly diagnosed acquired severe\/very severe AA patients is horse anti\u2010thymocyte globulin and ciclosporin\u2010based immunosuppressive therapy (IST) with eltrombopag or allogeneic haemopoietic stem cell transplant (HSCT) from a matched sibling donor. Unrelated donor HSCT in adults should be considered after lack of response to IST, and up front for young adults with severe infections and a readily available matched unrelated donor. Management of IBMF, AA in pregnancy and in elderly require special attention. 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