hematology and oncology
Overview of Decreased Erythropoiesis
Introduction
Anemia, a decrease in the number of red blood cells (RBCs), hemoglobin (Hb) content, or hematocrit (Hct), can result from decreased Red Blood Cell Production (erythropoiesis), increased RBC destruction, blood loss, or a combination of these factors. (See also Anemias due to decreased erythropoiesis (termed hypoproliferative anemias) are recognized by a reticulocyte count that is inappropriately low for the degree of the anemia. The Testing , mainly the mean corpuscular volume (MCV), can narrow the differential diagnosis of deficient erythropoiesis and help determine what further testing is necessary. Microcytic anemiasresult from deficient or defective heme or globin synthesis. Microcytic, hypoproliferative anemias include Iron Deficiency Anemia None Myelodysplasia and Iron-Transport Deficiency Anemia None Iron-utilization anemias (including some Sideroblastic Anemias and Patients with a microcytic anemia typically require Testing . Normocytic anemiasare characterized by a normal MCV (80 to 100 fL) and normochromic indices. The two most common causes are (EPO) due to Anemia of Chronic Disease or Anemia of Chronic Disease or inflammation (although, if severe, can be microcytic) Acquired primary bone marrow disorders such as Aplastic Anemia , Macrocytic anemiascan be caused by impaired DNA synthesis leading to megaloblastosis, as occurs with Deficiencies of vitamin B12 or folate (see Megaloblastic Macrocytic Anemias ) Other causes of macrocytic anemia include Alcohol Toxicity and Withdrawal None Medications (eg,zidovudine,azathioprine,methotrexate,hydroxyurea,imatinib) or toxins Hemolysis with reticulocytosis Liver disease Myelodysplastic Syndrome (MDS) (MDS) Some patients with Hypothyroidism have macrocytic RBC indices, including some without anemia. Anemias can have variable findings on the Peripheral smear . Treatment of deficient RBC production depends on the cause. 