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4. Normocytic Hypochromic & Normocytic Normochromic anemia

Terms in this set (39)

What are some chronic systemic diseases that could cause production defects in normal bone marrow?
Anemia of chronic inflammation (infxn, CT dz, malignancy),
Anemia of uraemia,
Anemia due to endo failure,
Anemia of liver disease
Anemia of chronic disease has what kind of bone marrow
Normal
(Underlying chronic problems cause bone marrow to not process RBC's properly, but bone marrow itself is NORMAL)
In anemia of chronic disease, what is serum iron
Decreased
In anemia of chronic disease, what is transferrin (TIBC and % saturation)?
Decreased
In anemia of chronic disease, what is ferritin?
Normal, or
Increased (can actually increase in infl., like sed rate!)
In anemia of chronic disease, what is erythropoietin
Decreased
(as a result of Hepcidin!!)
In anemia of chronic disease, what is CFU-E
Decreased
In anemia of chronic disease, what is reticulocyte response
Lacking
(Low retic count)
In anemia of chronic disease, why is iron trapped in RES cells?
Lactoferrin traps iron and is removed by macrophages;
Elevated hepcidin due to inflammation leads to increased macrophage apoferritin which binds iron (TRAPS iron so it can't be utilized & serum iron goes down)
What is the mechanism of anemia of chronic disease
Impaired erythropoietic response to anemia (suppressed EPO) &
Decreased red cell survival
What is the hepcidin level in anemia of chronic disease?
Increased
What is the iron level in red cells and macrophages in anemia of chronic disease (normochromic, normocytic anemia) ?
Less red cell iron,
More macrophage iron
How do you treat anemia of chronic disease/ chronic inflammation?
Correct the underlying disorder
(DECREASE the inflm and DECREASE hepcidin)
What should you never give to treat anemia of chronic disease?
Iron, folic acid, B12
(not responsive to hematinic agents)
In anemia of uraemia (kidney failure), what is reticulocyte count
Normal
-- this is an ABNORMAL response to anemia b/c should be going UP (NOT normal or low)
What is the severity of anemia of uremia linked to?
degree of azotemia
In anemia of uremia, what is bone marrow
Normal
What type of cells can be in the periphery in anemia of uremia?
Burr cells
(if anemia severe)
What is the cause of anemia of uremia (major mechanism)? & 3 other ones that contribute also?
Decreased erythropoietin (EPO is hormone made in kidney!);
Impaired iron into RBC,
Hemolysis (rare)- micro hemoangiopathies like TTP, HUS causing kidney impairment,
Blood loss- Dialysis, platelet dysfunction
How do you treat anemia of uraemia? (2)
Correct renal failure,
Exogenous erythropoietin (EPO),
(Maybe Fe & folic acid supplement)
What kind of cells are found in anemia of liver disease
Target cells,
Stomatocytes,
Spurr cells (have abnormal looking membranes; b/c of cirrhosis)
Why would liver disease cause anemia
The liver makes cell membrane components
(so anemia of liver dz will cause cells w/ abnormal looking membranes; b/c of cirrhosis)
Why would alcoholism (Alcoholic liver disease) cause anemia
Alcohol is a director suppressor of erythropoiesis &
Usually also dietary deficiencies and blood loss (esophageal varicose, gastritis, etc.)
What types of cells are seen in the bone marrow in anemia of liver disease due to alcohol?
Vacuoles in cytoplasm or red/ white cell precursors,
Ringed sideroblasts (rings of Fe), increased iron stores
What is the treatment of anemia of liver disease? Liver disease due to alcohol?
Correct hepatic function;
Supplemental vitamins, NO iron unless found deficient (Fe can damage liver like a "magnet"!!), stop alcohol
In normocytic-normochromic anemia with bone marrow issues, what are the 2 types of pathophysiology that lead to production defects?
Marrow replacement (Replacement of normal pluripotent stem cells with tumor or fibrosis);
Marrow aplasia (Aplastic bone marrow; BM not producing cells)
What are the 3 hematologic descriptions of normocytic-normochromic anemia with production defects associated with marrow replacement (tumor, fibrosis, etc. is removing precursor cells)?
1. Pancytopenia (deficiency of all three cellular components of the blood (red cells, white cells, and platelets)
2. Low retic count
3. Leukoerythroblastic blood smear (extramedullary hematopoiesis) ---This is BM replacement only!! (BLASTIC b/c normal cells are being pushed out by whatever is crowding the BM, so earlier cells are being released too soon!!!)
What is pancytopenia
A reduction in the number of RBC, WBC, and platelets
Where is pancytopenia seen
Marrow replacement, marrow aplasia, hypersplenic states
What has leukoerythroblastic blood smear
Marrow replacement disorder (normocytic-normochromic anemia)
What is the causes/ pathophysiology of marrow aplasia? (2)
1. Toxin-related suppression of pluripotent stem cells (chemo)
2. Immune suppression of pluripotent stem cells by T lymphocytes (autoimmune)
What are the 3 hematologic descriptions of marrow aplasia (normocytic-normochromic anemia)?
1. Pancytopenia
2. Low reticulocyte count/ index
3. "Empty" bone marrow-- This is ATYPIA ONLY!! There's NOTHING in there!! No RBC's, Hg, no leukoerythroblastic blood smear, BM is just EMPTY!
How do you make definitive diagnosis of marrow disorder
Bone marrow biopsy
What has empty bone marrow
Marrow aplasia
What are common drugs that can cause aplastic anemia
Chemotherapy
(Any cancer drugs like chemo can damage BM)
What is the therapy for bone marrow failure
Replacement therapy (RBC, platelet transfusions; Use washed RBCs to prevent autoimmunity);
Possibly bone marrow transplant
How do hypersplenic states cause anemia (KNOW THIS)
Rapid removal & splenic sequestration of all 3 myeloid lines
What is the common cause of hyperspenic states (normocytic-normochromic anemia)?
Liver cirrhosis which causes Portal hypertension (Blood can't go to the liver so it goes to the spleen. & You get splenomegaly, hyperactive spleen that starts consuming RBC's, etc. like crazy)
What are the 2 hematologic descriptions for hyperspenic states (normocytic-normochromic anemia)?
1. Pancytopenia
2. Marrow hyperplasia of cell lines
(b/c remember.. rapid removal & splenic sequestration of all 3 myeloid lines!!)
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