MLAB 1315 Hematology Keri BrophyMartinez

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MLAB 1315- HematologyKeri Brophy-Martinez

• Unit 17 Anemia Associated with Systemic,
  Nonhematologic Disorders

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• The most common anemias are those produced by
  inflammation and systemic diseases. These
  anemias are caused by the effect of a systemic
  disease on the bone marrow. Treatment is
  specific for the causative agent.

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Anemia associated with chronic disorders and
inflammation (AOI)

• Some chronic inflammatory disorders are
  neoplasms, rheumatoid arthritis, systemic lupus
  erythematosus, uremia and chronic liver disease.
  Best test to measure inflammation is erythrocyte
  sedimentation rate (ESR).

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Anemia associated with chronic disorders and
inflammation (AOI)

• Decreased red cell survival and life span
• Possibly caused by activated RE system (due to
  inflammation) which increases phagocytosis of red
  cells
• Red cell survival reduced to 90 days
• RE iron block
• Iron accumulates in the RE system, but is
  unavailable to the marrow resulting in decrease
  heme production.
• Decreased eyrthropoietin (EPO) levels
• Etilogy is unclear, but it appears that EPO
  production by the kidneys is increased, but the
  bone marrow response to EPO is less than expected
• Suppression of erythropoiesis and the role of
  cytokines
• Monokines and lymphokines which are produced to
  protect the host from infections and tissue
  injury may actually suppress early erythrocytic
  progenitors.

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Anemia associated with infection

• Caused by bacterial, fungal and viral infections
  that persist more than 2 weeks
• Bacterial
• Septicemia, meningitis, endocarditis, pulmonary
  disease, peritonitis, osteomyelitis
• Viral
• HIV, parvovirus
• Fungus
• Candida, histoplasma, Mycobacteria (TB),
  Cryptococcus

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Anemia associated with connective tissue
(collagen) disorders

• Rheumatoid arthritis (RA), Systemic lupus
  erythematosus (SLE), mixed connective tissue
  disease (MCTD), scleroderma, dermatomyositis and
  Sjogrens syndrome
• Many factors contribute to this anemia

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Anemia associated with malignancy

• Infiltration of the marrow by malignancy
  (myelophthisis) can cause leukoerythroblastosis
  (presence of both immature WBC and RBC
  precursors) often referred to as marrow fibrosis.
• Teardrop red cells are characteristic.
• Chronic blood loss caused by malignant organs
  results in hematuria, DIC or GI bleeding.
• Treatment of malignancy can cause anemia by
  inhibiting rapidly dividing cells which include
  RBC precursors.

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Anemia associated with renal disease and renal
failure

• Erythropoietin, produced by the kidney, is
  decreased.
• Hemolytic anemia results from uremic toxins
• Fluid retention causes dilution of red cells
• Blood loss during dialysis
• Common red cell is burr cell

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Anemia associated with liver disease

• Altered lipid production causes target cells,
  acanthocytes and macrocytes.
• Loss of coagulation factors produced in the liver
  results in chronic blood loss which leads to iron
  deficiciency. In this case, red cells are
  hypochromic-microcytic.
• Hypersplenism occurs with cirrhosis and advanced
  liver disease. Platelets are sequestered and the
  result is chronic bleeding from GI tract and
  mucus membranes. Also leads to decreased red
  cell survival.
• Folate deficiency accompanies alcoholism and poor
  nutrition.

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Anemia associated with alcoholism

• Ethanol has a toxic effect on precursor cells.
• Red cells are macrocytic.

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Anemia associated with endocrine disease and
disorders

• Glands involved are pituitary, adrenal, thyroid
  and gonads.
• Almost all of these anemias are
  normocytic-normochromic