Anemia of diminished

erythropoeisis

Nutritional deficiencies
Anemia due to renal insufficiency
Anemia of chronic disease
Generalized bone-marrow disorders

Aplastic anemia
Primary hematopoeitic neoplasms
Infiltrative disorders due to marrow
replacement

Aplastic and Hypoplastic

Anemias
What happens when the bone
marrow shuts down?

Aplastic anemia

Aplastic anemia is a severe, life threatening

syndrome in which production of
erythrocytes, WBCs, and platelets has failed.
Aplastic anemia may occur in all age groups
and both genders.
The disease is characterized by peripheral
pancytopenia,reticulocytopenia and
accompanied by a hypocellular bone marrow.

Classification

Acquired

Idiopathic
Chemical agents
Idiosyncratic
Physical agents
Viral infections
Miscellaneous

Inherited

Fanconis anemia
Telomerase deficiency

Hypocellular bone marrow in

aplastic anemia

Clinical manifestations

Fatigue
Heart palpitations
Pallor
Infections
Petechiae
Mucosal bleeding
NO SPLENOMEGALY

Aplastic anemia

Lab findings
Severe pancytopenia with relative lymphocytosis
(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 is poor
Remove causative agent, if known
Anti-thymocyte globulin
Multiple transfusions
Bone marrow transplant

Related disorders

Disorders in which there is peripheral

pancytopenia, but the bone marrow is
normocellular, hypercellular, or
infiltrated with abnormal cellular
elements

Myelopthesic anemia replacement of

bone marrow by fibrotic, granulomatous,
or neoplastic cells

Leuco-erythroblastic reaction

Bone-marrow granuloma

Related disorders

Myelodysplastic syndromes are primary, neoplastic stem

cell disorders that tend to terminate in acute leukemia. The
bone marrow is usually normocellular, or hypercellular with
evidence of qualitative abnormalities in one or more cell
lines resulting on ineffective erythropoiesis and/or
granulopoiesis and/or megakaryopoiesis. The peripheral
smear shows dysplastic (abnormality in development) cells
including nucleated RBCs, oval macrocytes, pseudo-PelgerHuet PMNs (hyposegmented neutrophils) with
hyperchromatin clumping, hypogranulated neutrophils, and
giant bizarre platlets.

Pure Red Cell Aplasia

Pure red cell aplasia is characterized by a

selective decrease in erythroid precursor cells
in the bone marrow. WBCs and platelets are
unaffected.

Acquired

Transitory with viral or bacterial infections

Patients with hemolytic anemias may suddenly halt
erythropoiesis
Patients with thymoma T-cell mediated responses
against bone marrow erythroblasts or erythropoietin are
sometimes produced.

Pure Red Cell Aplasia

Congenital

Diamond-Blackfan syndrome occurs in young

children and is progressive. It is probably due
to an intrinsic or regulatory defect in the
committed erythroid stem cell.

Other hypoproliferative anemias

Renal disease due to decreased

erythropoietin
Endocrine deficiencies
Hepatocellular liver disease

thank you!!