insufficient hemoglobin production

→ decreased hemoglobin available Insufficient cell production

for erythrocytes  more hemoglobin available for erythrocytes
→ microcytic, hypochromic anemia  macrocytic anemia

s
Decreased erythropoiesis
or decreased blood
volume

Sideroblastic anemia

Bone marrow failure or

disease
e.g. myeloproliferative
disease;
myelodysplastic syndrome
 Microcytic hypochromic anemias MCV < 80 fL
Iron deficiency:
  iron due to chronic bleeding (eg, GI loss, menorrhagia), malnutrition, absorption
disorders, GI surgery (eg, gastrectomy);
 or  demand (eg, pregnancy)   final step in heme synthesis.

Labs:  iron,  TIBC,  ferritin,  free erythrocyte protoporphyrin,  RDW. Microcytosis and
hypochromasia ( central pallor).

Symptoms: fatigue, conjunctival pallor, pica (persistent craving and compulsive eating of
nonfood substances), spoon nails (koilonychia).
May manifest as glossitis, cheilosis, Plummer-Vinson syndrome (triad of iron defciency
anemia, esophageal webs, and dysphagia).

Normocytic normochromic anemia MCV 80-100 fL

 Normocytic normochromic anemias are classified as  nonhemolytic or hemolytic.
 The hemolytic anemias are further classified according to the cause of the hemolysis
(intrinsic vs extrinsic to the RBC) and by the location of the hemolysis (intravascular vs
extravascular).
 Hemolysis can lead to increases in LDH, reticulocytes, unconjugated bilirubin, pigmented
gallstones, and urobilinogen in urine.

Aplastic anemia:
- Pancytopenia with bone marrow insufficiency.
- Caused by failure or destruction of hematopoietic stem cells due to:
 Idiopathic >50% cases (immune mediated, 1° stem cell defect); may follow acute
hepatitis.
 Fanconi anemia (AR; DNA repair defect causing bone marrow failure; also short stature,
50% develop AML or myelodysplastic syndrome, café-au-lait spots, thumb/radial defects
 Radiation and drugs (eg, benzene, chloramphenicol, alkylating agents, antimetabolites)
 Viral agents (EBV, HIV, hepatitis viruses) – inhibiting hematopoiesis.
Diagnostic:
 LAB: pancytopenia,  reticulocyte count,  EPO.
 Bone marrow biopsy (hypocellular fat-filled marrow with normal RBC morphology)

Symptoms: Anemia (pallor, fatigue), Leukopenia (infections), Thrombocytopenia (Petechia,

purpura, gingival bleeding).

Treatment:
 Cessation of offending agent (Drugs that cause aplastic anemia Can’t Make New
Blood Cells Properly: Carbamazepine; Methimazole; NSAIDs; Benzenes,
Chloramphenicol; Propylthiouracil)
 RBC/platelet transfusion
 Immunosuppressive regimens (eg, antithymocyte globulin, cyclosporine)
 Bone marrow stimulation (eg, GM-CSF)
 Hematopoeitic cell transplantation