Anemia
Types of anemia Hypoproliferative anemia
Etiology High epo:
 Fe deficiency
 Blockade of heme synthesis
(Pb, INH, or pyrazinamide,
sideroblastic anemia—
congenital or acquired)
 Anemia of chronic disease
 Myelophthisic disorders
1. Solid tumors, leukemia,
lymphoma
2. Intracellular infections:
TB, histoplasmosis,
sarcoidosis
3. Storage dz: Gaucher’s
4. Osteopetrosis,
myelofibrosis, myeloma.
 Aplastic anemia
Low epo:
 Chronic renal disease
 Cancer
 Rheumatoid arthritis
Ineffective hematopoiesis
Disordered cellular DNA
synthesis
 B12 metabolism
1. Malabsorption of B12 due Intravascular causes:
to pernicious anemia,
gastrectomy, absent
intrinsic factor
2. Intestinal malabsorption
due to ileal resection,
regional ileitis, infiltrative
intestinal disease
 Folate deficiency
1. Inadequate intake
2. Malabsoption
3. Alcohol
4. DHFR inhibitor
5. Cytotoxic chemotherapy,
AZT, hypothyroidism,
purine and pyrimidine
antagonists, inborn errors
of nucleic acid metabolism
 Myelodysplasia
Compensatory proliferative
erythropoiesis
Extramedullary cause of early
erythrocyte destruction (hemolytic
anemia)
 Vascular disorders
1. Physical agents: burns,
trauma (march
hemoglobinuria, valvular
heart disease, prosthetic
valves)
2. DIC
3. TTP/HUS – bacterial or
viral cause. Endothelial
injury triggers platelet
plug
4. Vasculitis
 Plasma Factors
1. Snake/insect venom
2. C. perfringens toxin
 Chemical Agents
1. Benzene
2. Hypotonic soln
 Extravascular hemolysis
 Membranopathy
1. Congenital (hereditary
spherocytosis,
elliptocytosis,
poikylocytosis)
2. Acquired (lymphoreticular
neoplasia, autoimmune dz,
drugs)
 Enzymopathy
1. G6PD
2. Pyruvate Kinase
 Hemoglobinopathy
1. Hgb SS
2. Hgb SC
Peripheral blood smear Reticulocytopenia, immature Reticulocytopenia Reticulocytosis
wbc/rbc, tear drop cells
Bone Marrow hypocellularity Hypercellularity Hypercellularity
Intramedullary hemolysis
Megaloblastic features
(hypersegmented PMNs and
macrocytosis)
Hypochromic Oval macrocytic Variable
Normo-/microcytic
LDH Low High (intramedullary hemolysis) High
Erythropoietin Variable High High