Normocytic Anemia

Question 1

What is the first thing to check in normocytic anemia?

Answer 1

Reticulocytes

Low = production problem
High = loss/destruction

Question 2

What to consider when reticulocytes are low?

Answer 2

Production problem

Pancytopenia or isolated anemia?

Question 3

Ddx for pancytopenia?

Answer 3

Aplastic anemia
MDS
Leukemia
Myelofibrosis
TB
Amyloidosis
Drugs

Question 4

Ddx for isolated anemia?

Answer 4

Chronic renal or liver disease

Question 5

What is myelodysplastic syndrome?

Answer 5

Group of stem cell disorders characterized by impaired blood cell production (ineffective maturation), causing peripheral cytopenias

Question 6

How is MDS diagnosed?

Answer 6

Bone marrow aspirate + biopsy, cytogenetic analysis

Bone marrow is dysplastic, often normocellular/hypercellular

Question 7

What is aplastic anemia?

Answer 7

Destruction of hematopoietic cells in bone marrow

Pancytopenia + hypocellular bone marrow

Question 8

What would you expect to see on peripheral blood film and biopsy in aplastic anemia?

Answer 8

Blood film: low number of normal RBCs

Bone marrow: hypocellular, fat replacement

Question 9

Ddx for normocytic anemia with high retics?

Answer 9

Hemolysis or bleeding (GI, GU, other)

Question 10

What do schistocytes on peripheral blood film suggest?

Answer 10

TTP

Any age
Always on differential for anemia with thrombocytopenia

Question 11

What is the treatment for TTP?

Answer 11

Plasmapheresis