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Normocytic, normochromic anemia

Terms in this set (9)

Differentials
1. Anemia of chronic disease
2. Problems with production: aplastic anemia, hypoplastic anemia, marrow infiltration with leukaemia
3. Blood loss
Anemia of chronic disease: causes
Chronic inflammatory disease: RA, SLE, rheumatoid arthritis, inflammatory bowel disease

Neoplastic disorders

Chronic kidney disease
Anemia of chronic disease: pathogenesis
Il-6, IL-1, IFN-y, TNF-a --> increased hepcidin production by liver --> decreased iron transport in body --> decreased Hb production

Decreased EPO responsiveness

Decreased production of EPO
Anemia of chronic disease: investigations
Iron studies
- Ferritin increase
- Transferrin decrease
- Iron decrease
- TIBC normal or increase

MCV no change or low

Inappropriately low EPO due to decreased responsiveness to EPO

Evidence of inflammation
- High inflammatory markers e.g. ESR, CRP, ferritin
Anemia of chronic disease: management
EPO (chronic kidney disease only)
Aplastic anemia: causes
Mnemonic: Idiopathic Aplastic Anemia = Very Few RBC.
- Idiopathic
- Anti-metabolites e.g. methotrexate, other cancer therapy
- Alkylating agents e.g. cancer therapy
- Virus e.g. parvovirus B19, EBV, HIV, HCV
- Fanconi's anemia: autosomal recessive disorder
- Radiation
- Benzene
- Chloramphenicol (antibiotic)
Aplastic anemia: features
Pancytopenia
- Anemia
- Thrombocytopenia
- Leucopenia
Aplastic anemia: investigations
Blood count
- Pancytopenia
- Absence of reticulocytes

Bone marrow trephine
- Hypocellular marrow with increased fat spaces
Aplastic anemia: management
Withdrawal of offending agents
Transfusions
Antibiotics
Immunosuppressants
Growth factors e.g. GM-CSF, EPO, G-CSF
Bone marrow transplant
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