TAILIEUCHUNG - Chapter 058. Anemia and Polycythemia (Part 9)

The physiologic classification of anemia. CBC, complete blood count. | Chapter 058. Anemia and Polycythemia Part 9 Figure 58-17 Renal osease Vitamin B12 deficiency Drug toxicity Refractory anemia Source Faud AS. Katpar DU. Braunwald E Hauxar SL. Longe OL. Jamaion JL. Loscalzo J Marnson s Prtnctplts of Jnt rn M dtcrn 17th Edition http Copyright O Th a McGraw-Hill Comparées Inc. AJI nghtc étar ad The physiologic classification of anemia. CBC complete blood count. In the first branch point of the classification of anemia a reticulocyte production index indicates that hemolysis is most likely. A reticulocyte production index 2 indicates either a hypoproliferative anemia or maturation disorder. The latter two possibilities can often be distinguished by the red cell indices by examination of the peripheral blood smear or by a marrow examination. If the red cell indices are normal the anemia is almost certainly hypoproliferative in nature. Maturation disorders are characterized by ineffective red cell production and a low reticulocyte production index. Bizarre red cell shapes macrocytes or hypochromic microcytes are seen on the peripheral blood smear. With a hypoproliferative anemia no erythroid hyperplasia is noted in the marrow whereas patients with ineffective red cell production have erythroid hyperplasia and an M E ratio 1 1. Hypoproliferative Anemias At least 75 of all cases of anemia are hypoproliferative in nature. A hypoproliferative anemia reflects absolute or relative marrow failure in which the erythroid marrow has not proliferated appropriately for the degree of anemia. The majority of hypoproliferative anemias are due to mild to moderate iron deficiency or inflammation. A hypoproliferative anemia can result from marrow damage iron deficiency or inadequate EPO stimulation. The last may reflect impaired renal function suppression of EPO production by inflammatory cytokines such as interleukin 1 or reduced tissue needs for O2 from metabolic disease such as hypothyroidism. Only occasionally is the marrow .

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