ANEMIA SECONDARY TO

DIMINISHED ERYTHROPOIESIS
Iron Deficiency Anemia
 Iron Metabolism
IRON
Component
1. hemoglobin
2. myoglobin
3. enzymes
 IRON METABOLISM
ABSORPTION
- duodenum & upper jejunum
- majority as heme iron
- lesser absorption of inorganic iron
Enhanced by:
- Ascorbic acid
- citrate
 Iron Metabolism

Transferrin

Macrophages (RES)
• Ferritin
• Hemosiderin
 IRON METABOLISM
Iron in PLASMA
Total ave= 110 ug/dL
- majority are bound to
TRANSFERRIN
- very little in ferritin
TRANSFERRIN
capacity: 330 ug/dL of iron (1/3 saturated)
- Total Iron Binding Capacity (TIBC)
 IRON DEFICIENCY ANEMIA
• Iron loss > Iron intake
ETIOLOGY
1. increased need – infancy, childhood,
pregnancy
2. excessive blood loss
3. insufficient dietary iron
 IRON DEFICIENCY ANEMIA
STAGES
1.Iron Depletion
iron loss > iron intake
↓ storage iron & plasma ferritin
↑ TIBC
↑ iron absorption
2. Iron deficient Erythropoiesis
3. Iron Deficiecy Anemia
 IRON DEFICIENCY ANEMIA
• Clinical Features
- ANEMIA
- Lack of Iron
> numbness & tingling sensation
> atrophic glossitis
> angular stomatitis
> chronic gastritis
> pica
> koilonychia
> esophageal webs
 IRON DEFICIENCY ANEMIA
• LABORATORY FEATURES
1.BLOOD
- Microcytic Hhpochromic Anemia
- poikiloanisocytosis (↑ RDW)
- ↓ Reticulocytes
- low MCV, Hb & Hct are relatively lower than
RBC count
 IRON DEFICIENCY ANEMIA
2. Bone Marrow
- decreased erythropoiesis
- small normoblasts
- decreased STORAGE IRON
 IRON DEFICIENCY ANEMIA
3. Serum Iron
N= 50-160 ug/dL
4. Total Serum Iron Binding Capacity (TIBC)
N= 250 – 400 ug/dL
5. Percent Saturation of TIBC (serum iron:TIBC)
N = 20-55%
6. Serum Ferritin
7. Zinc Protoporphyrin (ZPP)
- distinguish Fe Def A from B-Thalassemia
Minor
 ANEMIA OF CHRONIC DISEASES
- Present in 50% of hospitalized patients
- Secondary to:
> chronic infections
> inflammatory diseases
> neoplasms
HIGH LEVELS OF CYTOKINES (TNF α)
- ↓ RBC survival
- alter iron metabolism
- direct inhibition of hematopoiesis
- ↓ Erythropoietin production
 ANEMIA OF CHRONIC DISEASES
• Normocytic Normochromic Anemia
• Microcytic Hypochromic (20-50%)
• No elevation of reticulocyte count
 ANEMIA IN RENAL INSUFFICIENCY
• NORMOCYTIC NORMOCHROMIC ANEMIA
Causes:
1. decreased EPO production
2. impaired ability of the marrow to respond
to EPO
3. hemolysis
 APLASTIC ANEMIA
PANCYTOPENIA
 APLASTIC ANEMIA
• DIAGNOSIS
Severe Aplastic Anemia
1. bone marrow less than 30% cellularity
plus (2 out of 3)
1. granulocytes (< 0.5 X 10⁹/L)
2. platelets (< 20 X 10⁹/L)
3. reticulocytes (< 1%)
Very Severe Aplastic Anemia
above + granulocytes (< 0.2 X 10⁹/L)
Moderate Aplastic Anemia
 APLASTIC ANEMIA
ETIOLOGY
1. Idiopathic (70%)
2. Chemical/toxic agents
- benzene, busulfan, urethane, antimetabolites
- DDT
3. Ionizing radiation
4. Drugs
antibiotics (chloramphenicol,sulfonamides,tetracycline)
anticonvulsants (phenytoin, trimethadione)
5. Infection
- viral hepatitis
- parvovirus
- AIDS
 APLASTIC ANEMIA
• BLOOD
- macrocytosis (response to EPO)
- leukopenia with relative lymphocytosis
- thrombocytopenia
• BONE MARROW
- hypocellular
- red cells, lymphocytes, plasma cells, mast
cells, fat particles (BMA)
 APLASTIC ANEMIA
• MECHANISM
1.Direct damage
2.Immune – mediated

• CLINICAL
- anemia, bleeding, infection
 ASSIGNMENT
1. Define Erythrocytosis & Polycythemia
2. Define Absolute Polycythemia & Relative
Polycythemia
3. Enumerate causes of Absolute Polycythemia
and Polycythemia