Normochromic, Normocytic Anaemias Flashcards
Causes of normochromic normocytic anaemia
If reticulocyte high - haemolysis, acute blood loss
If reticulocyte low - secondary anaemia, hypoplasia, marrow infiltration
If someone with normochromic normocytic anaemia was found to have an increased reticulocyte count, what would you be thinking as a possible cause for their anaemia?
- Blood loss
- Haemolysis
If someone had normochromic, normocytic anaemia, what first line investigation would you do to determine the cause?
Reticulocyte count
What are causes of normochromic, normocytic anaemia?
- Acute blood loss
- Anaemia of Chronic Disease (70%)
- Bone marrow failure
- Renal Failure
- Hyperthyroidism
- Haemolysis
- Pregnancy
How does acute blood loss cause an increased reticulocyte count?
Lose red blood cells - bone marrow reacts by increasing RBC production, leading to increased reticulocyte count
What is anaemia of chronic disease?
Anaemia occurring in patients with chronic infections such as tuberculosis or chronic inflammatory disease such as Crohn’s disease, rheumatoid arthritis, systemic lupus erythematosus (SLE), polymyalgia rheumatica and malignant disease.
What is the general pathophysiology behind anaemia caused by chronic disease?
- Poor iron utilisation in erythropoesis
- Cytokine-induced shortening of RBC survival
- Decreased production of and response to erythropoeitin - e.g. renal failure
- Hepcidin synthesised in hepatocytes in response to inflammation - Blocks ferroportin - reduces intestinal iron absorption and mobilisation from reticuloendothelial cells
What is the iron profile of someone with anaemia of chronic disease?
- Serum Iron - reduced
- TIBC - reduced
- Serum ferritin - normal/raised
Do those with anaemia of chronic disease respond to iron therapy?
No - treatment involves treating the cause and possible EPO treatment
What are causes of anaemia of chronic disease?
- Chronic infection
- Vasculitis
- Rheumatoid Arthritis
- Malignancy
- Renal Failure
If you suspected someone had anaemia of chronic disease, what investigations would you do?
- Hb
- MCV/MCH
- Blood Film
- B12
- Folate
- TSH
- Test for haemolytic anaemia
What are side effects to EPO?
- Flu-like symptoms
- Hypertension
- Mild rise in platelet count
- Thromboembolism
What happens to the iron profile of someone that is pregnant?
- Iron - Increased
- TIBC - Increaed
- Ferritin - Normal
How does renal failure lead to anaemia?
When kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anaemia.
Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of the following nutrients found in food: iron.
Why might someone with hypothyroidism have microcytic, hypochromic anaemia?
Due to excessive menorrhagia
Why might someone who is pregnant have normocytic, normochromic anaemia?
Relative anaemia - plasma volume increases more relative to blood constituents, therefore become diluted
