normocytic anemia dr. fatin al-sayes, md, msc, mrcpath consultant hematology / assistant professor...
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Normocytic Anemia
Dr. Fatin Al-Sayes, MD, MSc, MRCPath
Consultant Hematology / Assistant Professor
King Abdulaziz University Hospital
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Definition:
(MCV 80-100 fL)
Differential diagnosis
(1) hemolysis, haemorrhage
(2) dual deficiency of iron + B12 or folate
(3) anemia of chronic disorders
(4) bone marrow aplasia
(5) bone marrow disease or replacement
(6) hypothyroidism
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Aplastic Anemia
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Definition:
Peripheral blood pancytopenia Bone marrow failure
Uncommon Peak incidence around 30 years Slight male predominance
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Etiology:
(1) Idiopathic(2) Drug induced
Dose dependant Idiosyncratic
(3) Chemical or toxin(4) Infection
Hepatitis Parvovirus TB HIV
(5) Pregnancy(6) Thymoma(7) Associated with MDS(8) Paroxysmal nocturnal
hemoglobinuria (PNH)(9) Constitutional
Fanconi anemia Familial aplastic anemia Dyskeratosis congenita
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Pathophyisology:
(1) Substantial reduction in the number of stem cells
(2) Immune mediated mechanism
(3) Defective hematopoietic microenvironment
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Clinical features:
Bleeding e.g. bruising, bleeding gum Weakness. Symptoms of anemia. Infection e.g. mouth.
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Physical examination:
Pallor Purpura: ecchymosis or petechiae Gingivitis, stomatitis, pharyngitis etc Absence of lymphadenopathy, hepatomegaly
and splenomegaly are common
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Laboratory features:
CBC: Normocytic-normochromic anemia ↓↓ reticulocyte count Leucopenia Thrombocytopenia
Peripheral blood film: Pancytopenia No abnormal cells
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Laboratory features (cont):
Bone marrow aspiration and trephine biopsy: Hypocellularity ↑↑ fat cells numbers Iron stores usually increased
Cytogenetic analysis:Certain abnormalities may suggest a higher risk of myelodysplasia and acute leukemia
Flow cytometry: CD56, CD59 may be absent, indicating the presence of PNH.
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Prognosis:
Median survival is about 12 months.
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Differential diagnosis of aplastic anemia:
Bone marrow infiltration Leukemia, MDS, myeloma Hypersplenism Megaloblastic anemia Myelofibrosis PNH
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Fanconi Anemia
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Congenital Recessive inheritance
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Clinical features:
Growth retardation Microcephaly, absent radii or thumbs Renal tract defect e.g. pelvic
Kidney or horseshoe kidney Skin defect e.g. cafe au lait patches
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Usual age of presentation:
5-10 years
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Complications:
10% of cases develop AML Malignancy of other organs e.g. skin