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Blood disorders can affect any of the components of blood, including red blood cells, white blood cells, platelets, and clotting factors. Blood disorders can also affect the bone marrow, where immature cells called stem cells develop into the specialized cells of blood. Each component of blood has unique functions. White blood cells help fight infection and cancer. Platelets and clotting factors help the blood to clot, preventing both excessive bleeding and excessive clotting.

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Hypo-proliferative Anemias

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The most common error in approaching anemias is to think of all the causes that come to mind and try to fit one to the situation. Forgetting uncommon diagnoses, missing simultaneous multiple etiologies or simply being overwhelmed by the possibilities are all common outcomes.

Fortunately, the evaluation of anemia lends itself to a systematic approach. Anemias are either hypoproliferative relative or absolute bone marrow failure or hyperproliferative increased loss or destruction with a resultant shortened red cell survival. In a patient with a stable but inappropriately low hemoglobin, this is most easily assessed by the reticulocyte count. There are three possibilities:. Low reticulocytes or inappropriately normal reticulocyte count as seen with a bone marrow failure.

The reticulocyte count may be elevated, consistent with a shortened red cell survival e. If the reticulocyte count is inappropriately low then the bone marrow production of red blood cells RBCs is inadequate. Bone marrow failures can be segregated by red cell size — the mean cellular volume MCV. The MCV is tightly regulated and even modest variation of this commonly ignored lab result is of clinical significance.

Usually due to either iron deficiency or a thalassemia; although lead poisoning, congenital sideroblastic anemia, severe chronic disease anemia, or rare hereditary fragmentation syndromes can present this way. Something interfering with normal nuclear maturation, e. Specific dyslipidemias which enlarge the RBC lipid bilayer membrane — liver disease, ethanol use, severe hypothyroidism. Mixed macrocytic and microcytic process e.

B12 with atrophic gastritis causing iron deficiency. Intrinsic bone marrow disease including: myeloma, aplastic anemias, lymphoma, infections and metastatic non-hematologic malignancies. This is less overwhelming than it sounds since the diagnosis is usually in the bone marrow biopsy. The approach to a hypo-proliferative anemia depends on the MCV with a few wrinkles.

For example, a patient with a thalassemia trait may have a very low MCV e. B12 deficiency or new ethanol use. Similarly, a normal MCV in a chronic alcoholic or a patient with liver disease may reflect new iron deficiency or a different microcytic process. Particularly in patients with a severe anemia, a normal MCV may reflect a combined macrocytic and microcytic process.

This is most likely iron deficiency or thalassemia. In iron deficiency, the MCV falls progressively as the anemia worsens. In thalassemia however, even a patient with the trait and a normal hemoglobin will have severe microcytosis.

So a well maintained hemoglobin with microcytosis is likely to be thalassemia trait. Always check the iron studies first since iron deficiency may mask beta-thalassemia trait.

Note that normal iron studies with an MCV under 77 is almost certainly thalassemia. When evaluating iron studies in hospitalized or ill patients, some authors will recommend checking ferritin, iron and transferrin or total iron binding capacity TIBC. A low ferritin is always iron deficiency except in the very rare congenital aferritinemia. It is possible to have both iron deficiency and thalassemia in the same patient.

Thalassemia is usually obvious because of the normal iron studies and chronic microcytosis with or without anemia. Rarely, with hematologic malignancy, you can see acquired thalassemia. Identify the source. After repletion, confirm normalization of the anemia. Malabsorption, non-compliance and secondary causes of anemia need to be dealt with. Rarely, microcytic anemia will be lead poisoning.

A lead level is diagnostic. It may be seen in patients due to occupational or home exposure needs to be inhaled or ingested. Heavy construction, plumbing, and battery production are a few examples of professions at higher risk of lead exposure.

These patients require chronic lead chelation to be started as soon as possible after increased exposure. Congenital sideroblastic anemia is uncommon but often microcytic — when presenting in the adult it is typically mild and stable.

The more common myelodysplastic syndrome MDS sideroblastic anemia is usually macrocytic. Very rarely, congenital RBC fragmentation syndromes may present with marked microcytosis but the smear makes it obvious. There is a limited differential here, so the approach is quite straight forward. A good history will help evaluate the most common causes of macrocytic anemia.

A trial of complete abstinence from Alcohol may resolve macrocytosis during follow up labs. B12 level is very helpful, but can be functionally deficient with low normal levels perhaps even up to If the B12 is above but below without other explanation for macrocytosis, then check a methylmalonic acid which is dependent on B12 for its metabolism and will be elevated if the B12 is functionally deficient.

A peripheral smear can be useful in creating a strong suspicion of a megaloblastic anemia. Hypersegmented neutrophils and oval macrocytic RBCs are suggestive but can also be seen in MDS, chemotherapy and in septic patients, so ultimately, the answer is in the B12 level.

Folate deficiency is very uncommon since folate was added to our food ca but may still be seen in the rare patient with malabsorption. A recent study at a single US institution looked at the serum folate level testing between and and found an extremely low rate of folate deficiency.

A recent choosing wisely article concluded that Folate levels in North American population are highly unlikely to be low in the post fortification era.

At risk patients should be started on folate supplementation regardless of the serum folate levels. Hypothyroidism can cause macrocytosis but usually the thyroid disease is so severe as to be clinically obvious. Immaturity, even to blasts, may be seen. Platelets may be decreased or rarely increased in number and may be large or hypogranulated. This is the most difficult sub-group of the anemias to approach. Lab testing will usually take you to the diagnosis with micro and macrocytic anemias but normocytic often reflects an underlying medical illness and a thorough H and P may be needed.

Historical information important in the diagnosis of normocytic anemia. Past medical history:. Medical problems which are now beginning to worsen i. Neurologic changes neuropathy, possible spinal cord lesions, sub-acute combined degeneration, dementia.

If the patient has pancytopenia then a bone marrow biopsy is more likely to be needed to look for aplastic anemia, myelofibrosis, primary hematologic malignancies, etc. A common error is to fail to look at the globulin in this setting. If the patient is unstable, at risk or the rate of fall of the hemoglobin is rapid, then the patient should be admitted and transfused. Most information can be retrieved after the transfusion but it is very helpful to obtain a direct Coombs, iron study, B12 study, lactate dehydrogenase LDH and a peripheral smear prior to the transfusion if possible.

Be cautious in transfusion since chronically anemic patients may be in high output failure and may also increase their plasma volume, putting them at increased risk for volume overload.

If, in the setting of a hypoproliferative anemia, the patient also has: a globulin greater than 4, renal failure, severe bone pain, neurologic symptoms, or severe neutropenia absolute neutrophil count less than ; then you are dealing with a possible medical emergency and a hematologist should be involved immediately without waiting for lab results to return.

Evaluation of microcytic or macrocytic anemia usually reveals a diagnosis. Normocytic anemias are often occult even after a bone marrow biopsy. In that case, supportive care and re-evaluation over a period of time will almost always be revealing. In patients over 50, the diagnosis will often be myelodysplasia but be aware of occult malignancies. If a patient with an unexplained anemia then develops other, even mild, focal symptoms, they should be further evaluated immediately.

Brad Lewis. The chapter was revised for this program by Dr. Nargiz Muganlinskaya and Dr. Tahir Mehmood. All rights reserved.

No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Login Register. We want you to take advantage of everything Cancer Therapy Advisor has to offer. To view unlimited content, log in or register for free. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. Hypo-proliferative Anemias I. Diagnostic Approach A.

How to approach a hypo-proliferative anemia The most common error in approaching anemias is to think of all the causes that come to mind and try to fit one to the situation. Powered By Decision Support in Medicine. Jump to Section Hypo-proliferative Anemias I. How to approach a hypo-proliferative anemia Microcytic anemia Normocytic anemia B. Laboratory tests that are likely to be useful in diagnosing normocytic anemia A. Management of hypoproliferative anemia. Popular Emailed Recent Loading Please login or register first to view this content.

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Sickle Cell Trait & Other Hemoglobinopathies & Diabetes (For Providers)

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The most common error in approaching anemias is to think of all the causes that come to mind and try to fit one to the situation. Forgetting uncommon diagnoses, missing simultaneous multiple etiologies or simply being overwhelmed by the possibilities are all common outcomes. Fortunately, the evaluation of anemia lends itself to a systematic approach.

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ICSE Class 8 Biology Selina Solutions Chapter 8 - Disease and First Aid

A new study shows that a protein found in blood alleviates anemia, a condition in which the body's tissues don't get enough oxygen from the blood. In this animal study, injections of the protein, known as transferrin, also protected against potentially fatal iron overload in mice with thalassemia, a type of inherited anemia that affects millions of people worldwide. Implications of the study, published in the January 24 online edition of Nature Medicine, could extend well beyond thalassemia to include other types of anemia including sickle cell anemia and myelodysplastic syndromes bone marrow disorders that often precede leukemia if proven in humans. Fabry, Ph. Our study suggests that treatment with transferrin could prevent this. It's projected that over the next 20 years, more than , children with thalassemia will be born each year. Ninety-five percent of thalassemia births are in Asian, Indian, and Middle Eastern regions.

Zinc in Human Biology

Actinic keratosis. Acute coronary syndrome. Acute lymphoblastic or lymphocytic leukemia. Acute lymphocytic leukemia.

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Diagnosing bacterial infection BI remains a challenge for the attending physician. An ex vivo infection model based on human fixed polymorphonuclear neutrophils PMNs gives an autofluorescence signal that differs significantly between stimulated and unstimulated cells. We took advantage of this property for use in an in vivo pneumonia mouse model and in patients hospitalized with bacterial pneumonia. A 2-fold decrease was observed in autofluorescence intensity for cytospined PMNs from broncho-alveolar lavage BAL in the pneumonia mouse model and a 2.

Hematology and Oncology Blood Disorders

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SEE VIDEO BY TOPIC: How a rare blood disorder made me a mother - Dana-Farber/Boston Children's

Anemia is a condition where there are not enough red blood cells. The red blood cells transport oxygen throughout the body. The majority of anemia cases are either hereditary not ratable or caused by another condition, like hypothyroidism. If the anemia is caused by another condition, then only that other condition can be rated. The anemia is considered a symptom of that condition, and thus is covered under a rating for that condition.

Blood protein offers help against anemia

The hemoglobin A1C A1C test can be unreliable for diagnosing or monitoring diabetes and prediabetes in people with inherited hemoglobin variants, also called hemoglobinopathies. These variants interfere with some A1C tests—both laboratory and point-of-care tests. If A1C tests are at odds with blood glucose testing results, interference should be considered. Reliable A1C tests that do not cause interference with hemoglobin variants are available. More information about appropriate assay methods to use for hemoglobin variants is available from the NGSP at www. Also, alternative tests may be needed for people with any disorder that affects red blood cells or hemoglobin. Most people who are heterozygous—having one variant gene and one standard hemoglobin gene—for a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin. Health care providers should suspect the presence of a hemoglobinopathy when.

is to think of all the causes that come to mind and try to fit one to the situation. Normocytic anemia is by far the most complex anemia to sort out and may be: Rarely, with hematologic malignancy, you can see acquired thalassemia. nucleated RBCs or other odd RBC forms; neutrophils may be hypogranulated.

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