Module 1: Anemia of Chronic Disease, Aplastic, Megaloblatic Flashcards
Anemia of chronic disease is usually normocytic, non hemolytic anemia, what can it also be?
Hypochromatic and microcytic
Anemia of chronic disease is the most common anemia in what population?
Hospitalized patients
What is the etiology of anemia of chronic disease?
- Chronic bacterial infection (lung abscess, TB, endocarditis)
- Chronic Immune Disorders (RA)
- Malignant Tumors
What is the pathogenesis for anemia of chronic disease?
Production of acute phase reactants (Hepcidin) from the liver
—inflammation – increased hepcidin sequesters iron in storage sites by: limiting iron transfer from macrophages to erythroid precursors and suppressing EPO production
What are the lab values for anemia of chronic diseases?
Increased ferritin
Decreased TIBC
Decreased MCV (microcytic)
Normal reticulocytes
Aplastic Anemia is a normochromic, normocytic anemia, what is the problem in this anemia?
Decreased number due to destruction
–defect in multipotent hematopoeitic stem cell
Aplastic Anemia affects all myeloid cells, what does this mean?
Pancytopenia (WBC,RBC, and platelets)
–destroys myeloblast, monocytes and megakaryocytes
What is the etiology for aplastic anemia?
Primary: idiopathic
Secondary: PMH (intravascular), Viruses (EBV,CMV,HIV,Hep E/TT/G), Drugs (chloramphenicol- abx, anti-thyroid -PTU) and Myelotoxic chemical (benzene, toluene and insecticides- DDT) and whole body radiation
What is the pathogenesis for aplastic anemia?
Autoreactive T cell destroying pluripotent myeloid stem cells in the bone marrow and in the extramedullary sites
–patients are not able to compensate via extramedullary hematopoiesis, so they get splenomegaly and hepatomegaly
What is the presentation for a patient with aplastic anemia?
Fatigue (normochromic normocytic anemia) Infections (granulocytopenia) Monocytopenia Bleeding - thrombocytopenia Petechiae, purpura, and ecchymosis Reticulocytopenia
What investigations are done for aplastic anemia?
- Bone marrow aspirate –Dry tap (due to more fat cells then actual hematopoietic cells
- Bone Marrow biopsy (Best investigation): hypocellular and more fat than hematopoietic cells and lymphocytes and reticulocytopenia
What is the most common cause of death for patients with aplastic anemia?
Recurrent infections because again pancytopenia
What are the other complications for aplastic anemia?
- CHF (due to chronic anemia)
- Bleeding due to thrombocytopenia
- Gingival bleeding
- Vaginal bleeding
What is the treatment for aplastic anemia?
Bone marrow transplant is definitive
- -also give immunosuppression drugs that target T cells
- -treat underlying cause
The next type of anemia that is to be discussed is megaloblastic anemia. What are the two types?
- Folate deficiency – presents earlier, because we dont have a large store
- B12 deficiency