Normocytic anemia (decreased production) Notes

Contents

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Normocytic anemia (decreased production) essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Normocytic anemia (decreased production) by visiting the associated Learn Page.
NOTES NOTES NORMOCYTIC ANEMIA (DECREASED PRODUCTION) GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Insufficient production of erythrocytes AKA red blood cells (RBCs) CAUSES ▪ Chronic diseases most common cause (e.g. kidney disease, cancer, rheumatoid arthritis) SIGNS & SYMPTOMS ▪ Variable depending on degree of hypoxia, pallor; fatigue; dyspnea; activity intolerance; cardiorespiratory compromise DIAGNOSIS LAB RESULTS ▪ ▪ ▪ ▪ ▪ Complete blood count (CBC) Peripheral blood smear analysis Blood chemistry Iron studies Genetic testing (rarely) TREATMENT MEDICATIONS ▪ Dietary changes OTHER INTERVENTIONS ▪ Supplementation (address iron deficiency) ANEMIA OF CHRONIC DISEASE (ACD) osms.it/anemia-of-chronic-disease PATHOLOGY & CAUSES ▪ Deficient RBC production due to chronic diseases (e.g. infection, inflammation, malignancy) ▪ AKA anemia of chronic inflammation CAUSES ▪ Inflammatory processes in iron homeostasis ▪ Systemic inflammation → ↑ circulation cytokines, interleukin 1 (IL1), interleukin 6 (IL6), tumor necrosis factor alpha (TNF alpha), interferon beta (IFN beta), interferon gamma (IFN gamma) ▫ ↑ hepcidin secretion by liver → ↓ iron absorption from gastrointestinal (GI) tract, ↓ iron sequestration in reticuloendothelial system → ↓ iron available for erythropoiesis ▫ ↓ secretion of erythropoietin ▫ Direct inhibition of erythropoiesis ▫ ↓ erythrocyte lifespan OSMOSIS.ORG 421
RISK FACTORS ▪ Advanced age, physical trauma SIGNS & SYMPTOMS ▪ Hypoxia, pallor; fatigue; dyspnea; activity intolerance; cardiorespiratory compromise ▪ Variable depending on degree of hypoxia DIAGNOSIS ▪ ▪ ▪ ▪ ▪ ▪ ▪ (ESR), C-reactive protein (CRP), IL6 Decreased serum iron levels High ferritin Decreased serum transferrin saturation Decreased total iron binding capacity Low serum erythropoietin concentration Decreased reticulocyte count Bone marrow examination ▫ Increased iron in macrophages (related to actions of hepcidin), erythroid precursors LAB RESULTS ▪ RBCs normochromic, normocytic ▪ Microcytic, hypochromic RBCs (rarely) ▪ Leukocytosis ▫ Underlying disorder ▪ Normal/low mean corpuscular hemoglobin (MHC), mean corpuscular volume (MCV) ▪ Normal mean corpuscular hemoglobin concentration (MCHC) ▪ Normal/increased red cell distribution width (RDW) normal/increased ▪ Erythrocyte hypoproliferation ▫ Decreased RBC count ▫ Mild to moderate decrease in hemoglobin ▪ Elevated erythrocyte sedimentation rate 422 OSMOSIS.ORG TREATMENT MEDICATIONS ▪ Supplemental iron ▫ IV more effective than oral iron for systemic inflammation ▪ Erythropoiesis-stimulating agents (e.g. epoetin alfa, darbepoetin alpha) ▫ For severe anemia OTHER INTERVENTIONS ▪ Transfusion of packed RBCs ▫ For severe anemia
Chapter 53 Normocytic Anemia (Decreased Production) APLASTIC ANEMIA osms.it/aplastic-anemia PATHOLOGY & CAUSES ▪ Pancytopenia due to bone marrow hypoplasia/aplasia ▪ Idiopathic/inherited/acquired CAUSES ▪ Inherited ▫ Fanconi anemia; Shwachman–Diamond syndrome; familial aplastic anemias; reticular dysgenesis ▪ Acquired ▫ Immune processes (e.g. systemic lupus erythematosus, graft-versushost disease, paroxysmal nocturnal hemoglobinuria) ▫ Drugs (e.g. cytotoxic cancer chemotherapy, carbamazepine, phenytoin, indomethacin, sulfonamides, chloramphenicol) ▫ Viruses (e.g. Epstein–Barr, HIV, hepatitis, herpes) ▫ Toxic chemicals (e.g., solvents, benzene, pesticides) ▫ Ionizing radiation ▪ Acquired or idiopathic ▫ Insidious onset of bone marrow hypoplasia/aplasia, hematopoietic cell loss → ↓ production of cell lineages (thrombocytes, leukocytes, erythrocytes) → peripheral pancytopenia COMPLICATIONS ▪ Impairment of blood’s immunity, hemostasis, oxygen-carrying capacities SIGNS & SYMPTOMS ▪ Deficient thrombocytes, leukocytes ▫ Shorter lifespan ▪ Neutropenia ▫ Increased frequency/severity of infections ▫ Neutropenia-related sepsis common cause of death ▪ Thrombocytopenia ▫ Mucosal hemorrhage (e.g. gingival, nares, ecchymosis, petechiae, heavy menstrual flow, occult blood in stool, intracranial hemorrhage) ▪ Anemia ▫ Pallor, fatigue, dyspnea, activity intolerance, cardiorespiratory compromise DIAGNOSIS LAB RESULTS Prolonged bleeding time Decreased hemoglobin, hematocrit Absolute neutrophil count decreased Platelet count decreased Reticulocyte count decreased ▫ Normal erythrocyte morphology ▪ Bone marrow biopsy ▫ Some lymphocytes, plasma cells, stromal elements (e.g. blastoid cells) ▫ No increase in blasts/dysplasia ▪ ▪ ▪ ▪ ▪ TREATMENT ▪ Treat underlying cause ▫ Discontinue offending drug treatment ▪ Varies by age, severity of symptoms, likelihood of finding donor match MEDICATIONS ▪ Manage cytopenias ▪ Antimicrobials for infections ▫ Medical emergency: fever + low absolute neutrophil count ▪ Growth factors ▫ Granulocyte colony-stimulating factor OSMOSIS.ORG 423
(G-CSF): frequent/severe infections ▫ Thrombopoietin (TPO) receptor agonists with immunosuppressive therapy ▫ Hematopoietic growth factors (rarely) ▪ Immunosuppressive therapy (IST) ▫ Consists of antithymocyte globulin (ATG) + cyclosporin A ▫ Administer glucocorticoid with ATG: steroid reduces risk of serum sickness; immunosuppressive properties ▫ Cyclosporin A: immunosuppressive ▫ Eltrombopag (thrombopoietic agent) to increase platelet count OTHER INTERVENTIONS ▪ Hematopoietic stem cell transplant ▫ Curative if effective ▪ Transfusions ▫ Platelets, packed red blood cells ▫ Increased risk of alloimmunization, graft rejection after bone marrow transplant 424 OSMOSIS.ORG Figure 53.1 A bone marrow biopsy from an individual with aplastic anemia. The bone marrow spaces contain large amounts of fat and minimal hematopoietic tissue is present.

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Normocytic anemia (decreased production) essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Normocytic anemia (decreased production) by visiting the associated Learn Page.