Normocytic Anaemia Flashcards
Anaemia of Chronic Disease
-Mechanism
AOCD is most common cause of normocytic anaemia.
Inflammation leads to rise in cytokines, e.g. IL-6, which upregulate hepicidin expression.
This causes: decreased iron release from splenic macrophages, decreased intestinal iron absorption, decreased repsonse to EPO (reduced synthesis) and reduced RBC lifespan
Diseases that cause AOCD
Inflammatory conditions, e.g. RA, SLE
Malignancy, e.g. lymphoma, lung cancer
Chronic infections, e.g. TB
Labs in AOCD
L Fe, L TIBC and transferrin saturation
H ferritin
N MCV but longstanding can progress to L
Treatment of AOCD
Address underlying cause
Blood transfusion if req.
ESA if no response
CKD and Anaemia
- mechanism
- labs
- treatment
In CKD, low EPO leading to reduced RBC production
Labs: L reticulocyte count, L serum EPO, N/L Fe
Rx. ESA (ensure iron stores sufficient) and Iron supplements
Avoid blood transfusion if transplantation possibility to avoid allosensitisation
Aplastic Anaemia
-Mechanism
Aplastic anaemia= non-haemolytic, normocytic anaemia
Rare stem cell disorder: reduced or absent haematopoietic stem cells causing pancytopenia and bone marrow aplasia
Causes of Aplastic Anaemia
Drugs: benzene, chloramphenicol, anti-epileptics, alcohol
Irradiation
Insecticides
Viruses: parvovirus B19, EBV, HIV, CMV, HCV
Inherited: Fanconi anaemia
Idiopathic
Paroxysmal nocturnal haemoglobinuria (PNH)
SLE
Fanconi Anaemia
- Mode of inheritance
- Anatomical defects
- Risk of other diseases
Autosomal recessive HLA-DRB1*04 –> defective stem cell repair and chromosomal fragility causing aplastic anaemia
Anatomical defects: short stature, microcephaly, syndactyly
Assoc: increased risk AML, breast cancer and skin pigmentation
Presentation of Aplastic Anaemia
Fatigue, malaise and pallor
Thrombocytopenia: mucosal bleeding, petechiae
Leukopenia: infections
Diagnosis and Treatment of Aplastic Anaemia
Diagnosis by bone marrow biopsy
Rx. supportive therapy (e.g. transfusions), bone marrow transplant from HLA-matched sibling, immunosuppression (anti-thymocyte globulin + ciclosporin)