Hypoproliferative Anemia Study guide Flashcards
How are anemias categorized morphologically?
Classification: Morphology
- Microcytic
- Normocytic
- Macrocytic
How are anemias categorized functionall?
- Anemia of blood loss (acute or chronic)
- Hemolytic anemias
- Hypoproliferative anemias
characterized by ineffective erythropoiesis +/- hematopoiesis.
Hypoproliferative anemias
General categories within this group
of anemias includes: nutritional deficiency-related anemias, marrow failure syndromes, and anemias of chronic disease and renal failure.
Hypoproliferative anemias
is considered to be the most frequent cause of anemia overall in hospitalized patients.
ACD
The severity of ACD is related to the ______ of the chronic inflammatory disorder or the
______ in malignancy.
level of disease activity
In ACD, the anemia is generally _____ with
hemoglobin levels usually not lower than __ g/dL in uncomplicated cases.
mild or moderate,
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What do we see on PBsmear in ACD?
mild to moderate anemia without noticeable polychromasia or anisocytosis (understimulation of erythropoiesis ) IG normochromic, normocytic
iron transport to the erythroid precursors is characteristically diminished in ACD, resulting in functionally iron-deficient conditions even in light of the already reduced stimulation of erythropoiesis associated with ACD. As a result, anemia becomes
hypochromic and microcytic in approximately 10-20% of cases.
Why would a prussion blue stain help Dx ACD?
Iron stored as hemosiderin within macrophages will be normal or, more commonly increased, whereas nucleated red cells with iron-containing granules (i.e.
sideroblasts) will be absent…The lack of sideroblasts indirectly reflects diminished delivery of iron to
erythroid precursors, which is typical of ACD
Labs in ACD; Bone marrow iron stores serum ferritin serum Fe TIBC Transferin saturation
BM stores have increased stored iron and decreased sideroblastic iron Increased serum ferritin Decreased serum Fe TIBC is decreased or normal Transferin sat: decreased or normal
due to decreased erythropoietin production by the damaged kidneys.
Anemia of renal failure
It is a normocytic, normochromic anemia and is usually
responsive to recombinant erythropoietin therapy.
anemia of renal failure
i. Marrow infiltration by carcinoma
ii. Tear drop cells and leukoerythroblastic reaction
Myelophthisic Anemia
multifactorial and mechanisms are not
entirely clear. It is seen in chronic conditions, including chronic hepatitis or cirrhosis. Pancytopenia may be observed.
Anemia of liver disease
The RBCs tend to be_____ due to abnormal lipid processing in liver disease and the incorporation of lipids within the RBC membrane
macrocytic
rare condition in which there is selective inhibition of
erythropoiesis. Other lineages are not affected.
Pure red cell aplasia (PRCA)
Pure red cell aplasia (PRCA) produces ____, _____anemia due to no erythroid precursors in the marrow.
normocytic, normochromic
What is PRCA associated with?
It may be associated with thymic hyperplasia/thymomas, large granular lymphocytic leukemia, drugs, or autoimmune diseases.
What is the pathophysiology of PRCA?
autoimmune destruction of erythroid
precursors.
Pathophysiology of IDA
Iron is depleted in the diet,lost in chronic blood loss or by
malabsorption leading todecreased iron stores and
incorporation into hemoglobin
Microcytic, hypochromic anemia with pronounced anisopoikilocytosis
↓ serum ferritin, marrow iron stores, % saturation
↑TIBC
IDA
Most common nutritional disorder worldwide
IDA
IDA see in >50 yo is ______
gastrointestinal carcinoma until proven otherwise
Anemia of chronic disease:
Increased_____ levels, caused by inflammatory mediators:
blocks the transfer of iron from _______ to sideroblasts
(red cell precursors)
hepcidin
marrow macrophages
ACD: serum ferritin TIBC Marrow in iron stores Sideroblastic iron
Increased serum ferritin
decreased TIBC
Increased marrow iron stores
decreased sideroblastic iron
Most common anemia of hospitalized patients
Seen in inflammatory,infectious, and neoplastic conditions
Anemia of chronic disease
Normocytic, normochromic
Echinocytes
Anemia or renal fail
Decreased erythropoietin production secondary to
kidney disease leads to decreased erythropoiesis
Anemia of renal fail
Folate or vitamin B12 deficiency leading to impaired
DNA synthesis see in what type of anemia
Megaloblastic anemia
What is the result of Folate or Vit B 12 deficiency that causes impaired DNA synthesis
produces nuclear to cytoplasmic asynchrony in erythroid and granulocytic maturation
Macrocytic anemia
Macroovalocytes
Hypersegmented neutrophils
Nuclear to cytoplasmic asynchrony in marrow
Megaloblastic anemia
Unique cause of Vit B12 deficiency seen in Megaloblastic anemia
Pernicious anemia (atrophicvgastritis leading to vitamin B12 deficiency due to intrinsic factor deficiency)
In Megaloblastic anemia, what deficiet is associated with neurologic deficiets?
Neurologic deficits in vitamin B12 deficiency
Suppression of bone marrow
pluripotent stem cells likely by
autoreactive T cells
Aplastic Anemia
Cytopenias related to marrow infiltration by a carcinoma or
storage disorder
Myelophthisic anemia
Tear drop cells
Leukoerythroblastic reaction
seen in what type of hypoproliferative anemia?
Myelophthisic anemia
Anemia of the liver is macro or mircocytic
macrocytic
Unknown but hypothesized to be autoimmune destruction of erythroid precursors in the marrow
Pure red cell aplasia
PRCA is
Normocytic, microcytic, macrocytic
Hypochromic or normochromic
Normocytic
normochromic
May be associated with thymic hyperplasia or thymoma, large granular lymphocytic leukemia, or autoimmune diseases
PRCA
Why is serum Fe low in IDA and TIBC high?
serum Fe is low for obvious reasons, Fe is low
TIBC will increase (totol iron binding capacity) because teh body is TRYING to extract more iron
Why is Fe low in ACD?
Because ACD is an inflammation situation. You make hepcidin which encourages Fe to stay stored in Bone marrow instead of being released (thus the lack of sideroblats)
If Fe is low in ACD, why doesn’t TIBC increase?
TIBC won’t increase because the body doesn’t want to increase serum iron, it assumes that because there is inflammation it will make more FE available for bugs!
Why is ferritin increased in ACD?
because ferittin is an acute phase reactant and ACD is inflammatatory process
