Presentation
(coughing of blood), and hematuria are generally obvious and reported while uterine bleeding or GI bleeding can be overlooked or occult and may present as unexplained anemia Post-hemorrhagic Anemia: Blood loss -Excessive menstrual bleeding often goes [cram.com]
My MCV has actually dropped from 91.1 in XXXXXXX to 83.7 at present, so megaloblastic anemia seems rather unlikely to me. [healthmagic.gq]
The most common cause of this is folic acid or B12 deficiency Folic Acid Deficiency Causes Decreased intake likely secondary to alcohol abuse Decreased absorption – intake of folic acid antagonist (Methotrexate) Pregnancy Hemolytic anemia Clinic Presentation [physicianassistantexamreview.com]
Presentation on theme: "Normocytic Normochromic Anemias"— Presentation transcript: 1 Normocytic Normochromic Anemias M H Qari, MD, FRCPA Associate Professor of Hematology 2 Aplastic anemia Aplastic anemia is a severe, life threatening syndrome in which [slideplayer.com]
MICROCYTIC ANEMIA Presented by- Dr. Monika Nema Dr. [slideshare.net]
Entire Body System
- Inflammation
Ferritin (an acute phase reactant) may be elevated in inflammation. Low-normal levels of ferritin in a patient with acute inflammation may be consistent with Fe deficiency. [med-ed.virginia.edu]
In virtually any disease, inflammation occurs in the body. Inflammation is characterized by the release of all sorts of factors and molecules that initiate, promote, or stop the process of inflammation. [study.com]
Secondary anemias Anemia of chronic inflammation: a. Connective tissue diseases. b. Chronic infection Anemia or chronic renal failure Anemias associated with endocrinopathies: a. Hypothyroidism. b. Addison's disease. c. Hypogonadism. d. [enotes.tripod.com]
[…] production of EPO Anemia of chronic disease: investigations Iron studies - Ferritin increase - Transferrin decrease - Iron decrease - TIBC normal or increase MCV no change or low Inappropriately low EPO due to decreased responsiveness to EPO Evidence of inflammation [quizlet.com]
- Pallor
Maslak Category: Red Cell : Hemolytic Anemia (HA) > HS/HE and RBC membrane or enzyme Disorders Published Date: 10/01/2008 Despite a reduction in the total number of red cells, the RBC indices are normal, and the cells have the typical area of central pallor [imagebank.hematology.org]
A normal red blood cell will have an area of pallor in the center, but in patients with hypochromic anemia, this area of central pallor will be increased in size. [novusbio.com]
When changes in the pallor of the skin, nail beds, and conjunctiva are all noticed, the cause is likely anemia. [innvista.com]
Familial aplastic anemia – a subset of Fanconi’s anemia in which the congenital defects are absent. 8 Clinical manifestations Fatigue Heart palpitations Pallor Infections Petechiae Mucosal bleeding 9 Aplastic anemia Lab findings Severe pancytopenia with [slideplayer.com]
- Disability
Vitamin B 12 deficiency in older people: improving diagnosis and preventing disability [Editorial]. J Am Geriatr Soc. 1998;46:1317–9. 24. Nexo E, Hansen M, Rasmussen K, Lindgren A, Grasbeck R. How to diagnose cobalamin deficiency. [aafp.org]
For this reason, the patient should be able to make a decision based on her own desires as to family size, taking into account the genetic disability of the infant, the risk of the therapy during pregnancy, and her potentially decreased longevity. [glowm.com]
- Malaise
[…] bone marrow stem cell failure/mutation and dysplasia Decreased RBC Production: Hyperplastic bone marrow -Refractory anemia may exist for months or years and may be silent or may be associated with increasing symptoms of fatigue, weakness, asthenia and malaise [cram.com]
Symptoms of mild anemia, such as easy fatigability and malaise, are common in normal pregnancy. Patients with anemia during pregnancy of mild-to-moderate degree may have no additional manifestations. [glowm.com]
- Surgical Procedure
These crises usually last 2–6 days, may be associated with fever as well as leukocytosis, and may lead to unnecessary surgical procedures unless the hematologic diagnosis is suspected. [glowm.com]
Respiratoric
- Dyspnea
Common symptoms and signs of anemia include General fatigue Weakness Dyspnea on exertion Pallor History and physical examination are followed by laboratory testing with a complete blood count and peripheral smear. [merckmanuals.com]
When symptoms do develop, they are pretty much what you would expect given the precarious state of oxygen delivery to the tissues: dyspnea on exertion, easy fatigability, fainting, lightheadedness, tinnitus, and headache. [web2.airmail.net]
Typical symptoms of anemia, such as fatigue, weakness and dyspnea, are not specific and in elderly patients tend to be attributed to advancing age. Pallor can be a helpful diagnostic clue, but pallor can be hard to detect in the elderly. [aafp.org]
Immediate reactions may include headache; dyspnea; flushing; chest, abdominal, or back pain; nausea and vomiting; fever; hypotension; seizures; urticaria; and anaphylaxis. [ahcmedia.com]
Patients presenting with the classic symptoms of tachycardia, exertional dyspnea, pallor, and palpitations should be carefully evaluated. [glowm.com]
- Yawning
By Richard Klasco, M.D Photo Credit Ask Well Photo Credit Why Do We Yawn? Reading about yawning makes people yawn. You are probably yawning right now. By Roni Caryn Rabin Latest Search Latest Articles Search Articles 13843 results for sorted by [nytimes.com]
Gastrointestinal
- Blood in Stool
[…] smear Red blood cell Count Red cell indices Hemoglobin Hematocrit Reticulocyte count Platelet count whit blood cell count blood in stool & urine Peripheral Blood smear Laboratory Evaluation of anemia starts with the hemogram, that is the complete blood [pitt.edu]
They may run blood tests to check for celiac disease. They may test your blood and stool for H. pylori bacterial infection. [healthline.com]
[…] donation, blood loss from non-gastrointestinal sources, e.g. nosebleeds, trauma, surgery Ask about weight loss and gastrointestinal symptoms such as altered bowel habits, dyspepsia and visible blood in stool. [bpac.org.nz]
- Hematochezia
[…] patient is asked about the duration of bleeding, presence of clots, ... of the abdomen, overloading of tampons, or the high number of pads used, or inter-menstrual bleeding -GI bleeding is usually an occult process; it may be recognized if it presents as hematochezia [cram.com]
For example, melena, epistaxis, hematochezia, hematemesis, or menorrhagia indicates bleeding. Jaundice and dark urine, in the absence of liver disease, suggest hemolysis. Weight loss may suggest cancer. [merckmanuals.com]
Cardiovascular
- Palpitations
Familial aplastic anemia – a subset of Fanconi’s anemia in which the congenital defects are absent. 8 Clinical manifestations Fatigue Heart palpitations Pallor Infections Petechiae Mucosal bleeding 9 Aplastic anemia Lab findings Severe pancytopenia with [slideplayer.com]
Signs and symptoms of anemia may include pallor of the skin and mucous membranes, shortness of breath, palpitations of the heart, soft systolic murmurs, lethargy, and fatigability. [icd10data.com]
Very severe anemia prompts a compensatory response where cardiac output is markedly increased, leading to palpitations and sweatiness; this process can lead to heart failure in elderly people. [copacabanarunners.net]
- Orthostatic Hypotension
In rapidly developing anemia (as from hemorrhage and certain catastrophic hemolytic anemias), additional symptoms and signs are noted: syncope on rising from bed, orthostatic hypotension (i.e., the blood pressure falls when the patient is raised from [web2.airmail.net]
Skin
- Purpura
Thrombotic thrombocytopenic Purpura, B. Disseminated intravascular Coagulation C. Aortic valve replacement D. [pitt.edu]
Hepatic and renal disease Collagen vascular disease Malignancies: Particularly hematologic neoplasia Transfusion of incompatible blood Hemolytic disease of the newborn Cold hemagglutinin disease Autoimmune hemolytic anemia Thrombotic thrombocytopenic purpura [emedicine.medscape.com]
[…] artificial heart valve) or "clotheslined" by innumerable fibrin strands in such microangiopathic conditions as disseminated intravascular coagulation (better known by the machonym "DIC," covered later in the heme bloc) or thrombotic thrombocytopenic purpura [web2.iadfw.net]
Autoimmune diseases such as lupus erythematosus and polyarthritis have been associated with this disorder, as has preeclampsia, HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome, acute glomerular nephritis, and idiopathic thrombocytopenia purpura [glowm.com]
Neurologic
- Headache
Patients with Hypochromic Anemia may have a distinct green skin tinge, and other symptoms include lack of energy, shortness of breath, dyspepsia, headaches, and amenorrhea. [novusbio.com]
Contra-indications for erythropoetin treatment include uncontrolled hypertension. [ 7 ] Potential side-effects of erythropoetin include increase in blood pressure or aggravation of hypertension, headache, increase in platelet count, influenza-like symptoms [patient.info]
Clinical Picture Symptoms: general symptoms of anaemia as; easy fatigability, headache, dyspnoea, palpitation. Signs: Pallor which can be detected in the face, palm of the hand, nail bed and mucus membranes of the mouth and conjunctiva. [gfmer.ch]
- Dizziness
You should make an appointment to see your doctor as soon as possible if you experience severe dizziness or shortness of breath. Microcytic anemias can be further described according to the amount of hemoglobin in the red blood cells. [healthline.com]
If the anemia starts more suddenly or gets really bad, you might feel dizzy or weak. How does my doctor find out that I have normocytic anemia? Most often, normocytic anemia is found on routine tests that are part of a physical exam. [aafp.org]
Because it is a form of anemia you may feel weak and dizzy periodically. With the blood flow failing, you may look very pale and feel tired most of the time. [newhealthguide.org]
[…] inherited disorders a diet that does not have enough iron, folic acid or vitamin b12 blood disorders such as sickle cell anemia and thalassemia, or cancer aplastic anemia, a condition that can be inherited or acquired anemia can make you feel weak, cold, dizzy [icd10data.com]
Workup
An initial anemia workup includes CBC, iron, and ferritin testing to determine the underlying cause of the disease. [arupconsult.com]
The doctor may also decide to take some other screening blood tests that might identify the cause of fatigue; glucose levels, ESR, ferritin, renal function tests and electrolytes may be part of such a workup. [copacabanarunners.net]
A bowel workup may be required if the patient has iron deficiency. I get more likely to investigate if the anemia is under 9-10 g/dl, but will investigate earlier if there has been a change compared to a previously known baseline level. [arthritis.co.za]
Routine workup of the patient with anemia, advise: Hemoglobin and hematocrit. Red blood cell count. Blood indices. peripheral blood smear. Reticulocyte count. White blood cells count and platelets count. [labpedia.net]
Serum
- Cytopenia
The term aplastic anemia commonly implies a panhypoplasia of the marrow with cytopenias in at least two hematopoietic lineages. In contrast, pure RBC aplasia is restricted to the erythroid cell line. [merckmanuals.com]
Waldenström macroglobulinemia hyperviscosity syndrome and cytopenia. Fatigue related to normochromic normocytic anemia is the most common presenting... [evidence.nhs.uk]
[…] related exposures to agents such as arsenic, benzene, radiation, and several chemotherapy agents are associated with pancytopenia -Idiosyncratic agents may cause ... with a small exposure; chloramphenicol can produce pancytopenia but solitary cell line cytopenias [cram.com]
[…] disturbances, visual disturbances and cognitive changes ranging from memory loss to dementia and psychiatric symptoms. 3 Red flags in people with macrocytic anaemia requiring referral to a Clinical Haematologist include: 29 MCV > 100 fL with accompanying cytopenia [bpac.org.nz]
Microbiology
- Helicobacter Pylori
Iron deficiency anemia can be caused by: inadequate iron intake, usually as a result of your diet being unable to absorb iron due to conditions like celiac disease or Helicobacter pylori infection chronic blood loss due to frequent or heavy periods in [healthline.com]
Pernicious anemia and Helicobacter pylori infection in Japan: Evaluation in a country with a high prevalrnce of infection. Am J Gastroenterol 1995;90:1107-1110. 41. Varis O, et al. [ahcmedia.com]
A test for Helicobacter pylori may detect a bacterium that can cause ulcers in the GI tract that may be a cause of chronic bleeding. [labtestsonline.org]
pylori infection Pharmacological – medicines that cause gastric erosions/ulceration, e.g. non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and medicines that interfere with coagulation/platelet function leading to an increased risk of [bpac.org.nz]
Treatment
Treatment of aplastic anemia is a twofold process. [britannica.com]
[…] evidenced as atypical bone marrow and blood differential; requires treatment of the underlying disorder Treatment of Disorders of Hyperplastic Bone Marrow: Withdraw methotrexate or other DNA synthesis ... if present When related to confirmed myelodysplasia [cram.com]
HbS in red cells Treatment There is no specific treatment for the disease. [physicianassistantexamreview.com]
Treatment with recombinant erythropoietin increased their hemoglobin and hematocrit levels. These common points have a possibility to be brought about by tubulointerstitial damage and microangiopathy may be involved in it. [ncbi.nlm.nih.gov]
Prognosis
The prognosis of these patients is excellent. [ncbi.nlm.nih.gov]
[…] 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 [slideplayer.com]
Prognosis By treating the underlying condition, white blood cell counts usually return to normal Resources BOOKS Holland, Steven M., and John I. Gallin. "Disorders of Granulocytes and Monocytes." [encyclopedia.com]
Prognosis Untreated anaemia of CKD is strongly associated with cardiovascular and renal complications, resulting in increased hospitalisations and mortality.Therefore, correcting anaemia is considered an important part of slowing or even stopping the [patient.info]
Effect on pregnancy: ß-Thalassaemia major is rarely encountered in pregnant women, but if this happened the prognosis is poor. Anaemia becomes severe in mid-pregnancy and may result in heart failure. [gfmer.ch]
Etiology
Classification Morphological Characteristics Etiology Bone Marrow Response 5. [slideshare.net]
Showing a similar RBC abnormality (eg, spherocytes, abnormal Hb, G-6-PD deficiency) among family members establishes the basic etiology. [emedicine.medscape.com]
Etiology TABLE 2: ETIOLOGICAL CLASSIFICATION OF ANAEMIA Blood loss: Acute Chronic Decreased iron assimilation: Nutritional deficiency Hypoplastic or aplastic anemia Bone marrow infiltration like leukemia & other malignancies, myelodysplastic syndrome [pediatriconcall.com]
In rare instances it is the result of abnormal hormonal stimulation of stem cell proliferation or the result of a defective bone marrow microenvironment or from cellular or humoral immunosuppression of hematopoiesis. 5 Aplastic anemia Etiology Acquired [slideplayer.com]
Epidemiology
The pathogenesis, epidemiological and clinical characteristics of normocytic normochromic anemia of unknown cause are not well established. [ncbi.nlm.nih.gov]
Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology [brainscape.com]
Hemolyticuremic Syndrome [ Epidemiology | Incidence and Prevalence | Laboratory Evaluation of Anemia ] [ Clinical Assessment of Anemia | Casual and Risk Factors | Prevention | Exercises | Lecture on Anemia ] [pitt.edu]
Pathophysiology
The disease is characterized by peripheral pancytopenia and accompanied by a hypocellular bone marrow. 3 Hypocellular bone marrow in aplastic anemia 4 Aplastic anemia Pathophysiology: The primary defect is a reduction in or depletion of hematopoietic [slideplayer.com]
These particular diseases are covered either because they are common or because they illustrate important pathophysiologic features (or both). A. [web2.iadfw.net]
Pathophysiologic Consequences, Classification, and Clinical Investigation Ed Uthman, MD Diplomate, American Board of Pathology I. [web2.airmail.net]
Anemias can be classified using two basic approaches: etiology (pathophysiology) : the causes of erythrocyte and hemoglobin depletion morphology : the characteristic changes in the erythrocytes red blood cells (RBCs), size, shape, and color An etiologic [innvista.com]
Prevention
Rh isoimmunization can be prevented if an Rh negative mother is given an intramuscular injection of anti Rho(D) immune globulin within 72 hours of the birth of an Rh positive baby or in any situation in which significant fetal maternal hemorrhage may [quizlet.com]
The best way to prevent microcytic anemia is to get enough iron in your diet. Increasing your vitamin C intake can also help your body absorb more iron. You can also consider taking a daily iron supplement. [healthline.com]
Abnormalities of Fe mobilization from marrow stores are also recognized which may prevent reutilization of Fe salvaged from dead RBCs. [med-ed.virginia.edu]
Epoetin beta is also used for the prevention of anaemia in preterm neonates of low birth weight. Darbepoetin: Is a hyperglycosylated derivative of epoetin which has a longer half-life and may be administered less frequently than epoetin. [patient.info]
Hemolyticuremic Syndrome [ Epidemiology | Incidence and Prevalence | Laboratory Evaluation of Anemia ] [ Clinical Assessment of Anemia | Casual and Risk Factors | Prevention | Exercises | Lecture on Anemia ] [pitt.edu]