Anemia of diminished erythropoeisis

Nutritional deficiencies

Anemia due to renal insufficiency

Anemia of chronic disease

Generalized bone-marrow disorders

Aplastic anemia

Primary hematopoeitic neoplasms

Infiltrative disorders due to marrow replacement

Aplastic and Hypoplastic Anemias

What happens when the bone marrow shuts down?

Aplastic anemia

Aplastic anemia is a severe, life threatening syndrome in which production of erythrocytes, WBCs, and platelets has failed.

Aplastic anemia may occur in all age groups and both genders.

The disease is characterized by peripheral pancytopenia,reticulocytopenia and accompanied by a hypocellular bone marrow.

Classification Acquired

Idiopathic

Chemical agents

Idiosyncratic

Physical agents

Viral infections

Miscellaneous

Inherited Fanconis anemia

Telomerase deficiency

Hypocellular bone marrow in aplastic anemia

Clinical manifestations

Fatigue Heart palpitations Pallor Infections Petechiae Mucosal bleeding NO SPLENOMEGALY

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Aplastic anemia

Lab findings

Severe pancytopenia with relative lymphocytosis (lymphocytes live a long time)

Normochromic, normocytic RBCs (may be slightly macrocytic)

Mild to moderate anisocytosis and poikilocytosis

Decreased reticulocyte count

Hypocellular bone marrow with > 70% yellow marrow

Treatment in untreated cases the prognosis is poor

Remove causative agent, if known

Anti-thymocyte globulin

Multiple transfusions

Bone marrow transplant

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Related disorders

Disorders in which there is peripheral pancytopenia, but the bone marrow is normocellular, hypercellular, or infiltrated with abnormal cellular elements

Myelopthesic anemia replacement of bone marrow by fibrotic, granulomatous, or neoplastic cells

Leuco-erythroblastic reaction

Bone-marrow granuloma

Related disorders

Myelodysplastic syndromes are primary, neoplastic stem cell disorders that tend to terminate in acute leukemia. The bone marrow is usually normocellular, or hypercellular with evidence of qualitative abnormalities in one or more cell lines resulting on ineffective erythropoiesis and/or granulopoiesis and/or megakaryopoiesis. The peripheral smear shows dysplastic (abnormality in development) cells including nucleated RBCs, oval macrocytes, pseudo-Pelger-Huet PMNs (hyposegmented neutrophils) with hyperchromatin clumping, hypogranulated neutrophils, and giant bizarre platlets.

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Pure Red Cell Aplasia

Pure red cell aplasia is characterized by a selective decrease in erythroid precursor cells in the bone marrow. WBCs and platelets are unaffected. Acquired

Transitory with viral or bacterial infections

Patients with hemolytic anemias may suddenly halt erythropoiesis

Patients with thymoma T-cell mediated responses against bone marrow erythroblasts or erythropoietin are sometimes produced.

Pure Red Cell Aplasia

Congenital

Diamond-Blackfan syndrome occurs in young children and is progressive. It is probably due to an intrinsic or regulatory defect in the committed erythroid stem cell.

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Other hypoproliferative anemias

Renal disease due to decreased erythropoietin

Endocrine deficiencies

Hepatocellular liver disease

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