Normocytic Anemias

What is aplastic anemia characterized by?

A pancytopenia of RBC, WBC, and platelets - ALL hematopoietic cell lines

What cell morphology would you see in myelophthisic anemia and marrow replacement?

Tear drop cells (darcocytes)

What would you see in renal disease?

decreased EPO and burr cells

Differentiate between pure red cell aplasia and aplastic anemia

• pure cell - only affects red blood cell production

• aplastic - involves failure of all 3 lines (RBC, WBC, platelets)

Hepcidin

a key regulator of iron in the circulation

Ferritin

the storage form of iron in the body

transferrin

the transport protein for iron

RPI >2

indicates hemolysis/hemorrhage (decreased in survival)

RPI <2

indicates proliferation defect - decreased production of cells

How can someone get acquired aplastic anemia?

• idiopathic (50-70% of cases)

• drugs (chloraphenicol)

• chemicals (benzene)

• radiation

• infections (hepatitis, EBV, CMV, HIV)

• Starvation

Fanconi’s Anemia

• all cell lines affected

• autosomal recessive disorder characterized by chromosomal instability

• develops between age 5-10 y/o in 90% of patients

• associated w/ development of acute leukemia & other tumors

• median survival: 25 years

Transient Erythroblastopenia of Childhood (TEC)

• self-limiting form of red cell aplasia found in children

• affect children from 1-4 y/o

• recover within months with supportive therapy

Diamond-Blackfan Syndrome

• just the RBC line

• affect infants to children up to 1 y/o

• severe anemia

• treat w/ transfusions

• associated with increased risk of maligancy (leukemia)

• must differentiate from TEC (diff age ranges)

What are the two types of ACDs we went over?

• anemia occurring in individuals with chronic infections, inflammatory disorders, or neoplasms

• patients with chronic conditions have increased inflammation leading to an increased in IL-6 in the liver

Anemia occurring in individuals with chronic infections, inflammatory disorders, or neoplasms

• 2nd most common anemia

• no cause like iron or vitamin deficiencies - rather the anemia will resolve when the underliving disease resolves

Patients with chronic conditions have increased inflammation leading to an increase in IL-6 in the liver

• hepcidin is released

• hepcidin keeps iron trapped in the macrophages & decreases erythropoiesis

• malignancies & some disorders require iron, so the body shuts off it’s iron supply by keeping it in the macrophages

• iron is present, but not available