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Normocytic Anemia

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181. Hematologic Disease and Pregnancy (Treatment)

or normocytic anemia etiologies are as follows: Hemorrhagic anemia Early iron deficiency anemia Anemia of chronic disease Anemia associated with bone marrow suppression Anemia associated with chronic renal insufficiency Anemia associated with endocrine dysfunction Autoimmune hemolytic anemia Anemia associated with hypothyroidism or hypopituitarism Hereditary spherocytosis Hemolytic anemia associated with paroxysmal nocturnal hemoglobinuria MCV greater than 100 fL or macrocytic anemia etiologies (...) Women: Implications for Preconception Care. Am J Preventive Medicine . 2010. 38 (4S):S459-67. Lee AI, Okam MM. Anemia in pregnancy. Hematol Oncol Clin North Am . 2011 Apr. 25(2):241-59, vii. . Koshy M, Burd L, Wallace D, et al. Prophylactic red-cell transfusions in pregnant patients with sickle cell disease. A randomized cooperative study. N Engl J Med . 1988 Dec 1. 319(22):1447-52. . Hendrickse JP, Watson-Williams EJ, Luzzatto L, Ajabor LN. Pregnancy in homozygous sickle-cell anaemia. J Obstet

2014 eMedicine.com

182. Dermatologic Manifestations of Cardiac Disease (Treatment)

, and serum ferritin are needed. In patients with severe anemia and abnormalities in RBC morphology, a bone marrow aspirate and biopsy may be required. In cases of increased RBC destruction or hemolysis, the anemia is easily identified from the increased reticulocyte count, along with normocytic RBC morphology. This indicates the capacity of the erythroid marrow to compensate for a blood loss with an increase in RBC production. Management Management begins at the time of assessment. When an anemia (...) ascites is frequently due to cirrhosis, right-sided venous hypertension raising the hepatic sinusoidal pressure, or hypoalbuminemic states (eg, nephrosis, protein-losing enteropathy). Strongly consider right-sided valvular diseases of the heart and, in particular, constrictive pericarditis. Establishing a diagnosis may require cardiac imaging and cardiac catheterization. Pallor Causes Patients with a prosthetic metallic aortic valve may exhibit pallor because of the development of anemia from RBC

2014 eMedicine.com

183. Cardiovascular Concerns in Spinal Cord Injury (Treatment)

the following: Hypovolemic shock Infection or septic shock Cardiac injury of dysfunction Adverse pharmacological effects or drug overdose Previous Next: Blood, Serum, and Urinary Studies Determine the hemoglobin concentration and/or hematocrit to evaluate for hypovolemia and blood loss. Of note, normochromic, normocytic anemia is not uncommon after SCI. Determine the white blood cell (WBC) count to rule out either an underlying infectious etiology of hypotension or noxious stimuli for autonomic dysreflexia

2014 eMedicine.com

184. Lecithin-Cholesterol Acyltransferase Deficiency (Treatment)

of the mutated gene product. However, numerous other lab studies can be used in the diagnosis of these diseases. Lab findings in familial LCAT deficiency include the following: Complete blood count (CBC) - Normochromic normocytic anemia with anisopoikilocytosis, target cells, stomatocytes, and hematologic evidence of hemolysis may be present Urinalysis - Proteinuria is commonly detected during the second or third decade of life; less common findings include hyaline and granular casts and red blood cells (...) , and erythrocytes. Patients may present with HDL deficiency, corneal opacification, hemolytic anemia, hypertension, hypertriglyceridemia, and proteinuria. Fish eye disease is characterized by partial reduction of LCAT and only manifests as progressive corneal opacification. Occurrence Familial LCAT deficiency and fish eye disease are rare. Out of 70 families screened worldwide, at least 60 patients with either familial LCAT deficiency or fish eye disease have been reported. [ ] Race- and age-related

2014 eMedicine.com

185. Pyruvate Kinase Deficiency (Treatment)

a splenectomy and cholecystectomy. In patients who had a splenectomy without simultaneous cholecystectomy, 48% later required a cholecystectomy. [ ] (See the image below.) Peripheral blood smear in a child with splenectomy and pyruvate kinase deficiency. Signs and symptoms The following are evident in pyruvate kinase deficiency: Mild to severe normochromic and normocytic anemia Reticulocytosis Symmetrical growth delay Failure to thrive Cholecystolithiasis: Usually after the first decade of life but possibly (...) Reticulocyte count Serum bilirubin level study Peripheral blood film examination Normochromic, normocytic, or macrocytic anemia, together with reticulocytosis in the absence of blood loss, is suggestive of hemolysis. A negative Coombs test result helps to exclude immune hemolysis. The enzyme activity rate in most patients with pyruvate kinase deficiency is 5-25% of normal, with measurement of the intermediates (2,3-diphosphoglycerol and glucose-6-phosphate) proximal to the enzyme defect helping to confirm

2014 eMedicine.com

186. Pyruvate Kinase Deficiency (Overview)

and cholecystectomy. In patients who had a splenectomy without simultaneous cholecystectomy, 48% later required a cholecystectomy. [ ] (See the image below.) Peripheral blood smear in a child with splenectomy and pyruvate kinase deficiency. Signs and symptoms The following are evident in pyruvate kinase deficiency: Mild to severe normochromic and normocytic anemia Reticulocytosis Symmetrical growth delay Failure to thrive Cholecystolithiasis: Usually after the first decade of life but possibly in childhood (...) Reticulocyte count Serum bilirubin level study Peripheral blood film examination Normochromic, normocytic, or macrocytic anemia, together with reticulocytosis in the absence of blood loss, is suggestive of hemolysis. A negative Coombs test result helps to exclude immune hemolysis. The enzyme activity rate in most patients with pyruvate kinase deficiency is 5-25% of normal, with measurement of the intermediates (2,3-diphosphoglycerol and glucose-6-phosphate) proximal to the enzyme defect helping to confirm

2014 eMedicine.com

187. Myxedema Coma or Crisis (Overview)

coagulopathy may occur. [ ] Hematologic Myxedema coma is associated with a higher risk of bleeding caused by coagulopathy related to an acquired von Willebrand syndrome (type 1) and decreases in factors V, VII, VIII, IX, and X. [ , ] Patients may also have microcytic anemia secondary to hemorrhage, or macrocytic anemia caused by vitamin B12 deficiency, or normocytic normochromic anemia, which may be secondary to decreased oxygen requirement and reduced erythropoietin. [ ] Previous Next: Epidemiology United

2014 eMedicine.com

188. Retroperitoneal Fibrosis (Overview)

Jaundice Small- or large-bowel obstruction Spinal cord compression Testing Laboratory studies and potential results for patients with suspected RPF include the following: Erythrocyte sedimentation rate level: Elevated C-reactive protein level: Elevated Urea and creatinine levels: Elevated Complete blood count: Normocytic normochromic anemia Alkaline phosphatase levels (also reported as a marker [ ] ) Antinuclear antibody levels (present in 60% of cases) [ ] Urinalysis: Usually normal; rarely

2014 eMedicine.com

189. Macrocytosis (Overview)

. This deposition effectively increases the surface area of the erythrocyte. Hypothyroidism is a manifestation of hormone deficiency. More commonly, hypothyroid patients exhibit a normocytic anemia. Artifactual elevation of the MCV must be considered in certain patients, although this occurs less frequently with newer cell-counting machines. Hyperglycemia and cold agglutinins may cause artificially elevated MCVs. [ ] Previous References Moore CA, Adil A. Anemia, Macrocytic. 2017 Jun. . . Kaferle J, Strzoda CE (...) : Vincent E Herrin, MD, FACP; Chief Editor: Emmanuel C Besa, MD Share Email Print Feedback Close Sections Sections Macrocytosis Overview Practice Essentials Macrocytosis is a term used to describe erythrocytes that are larger than normal, typically reported as mean cell volume (MCV) greater than 100 fL. The amount of hemoglobin increases proportionately with the increase in cell size. Therefore, if the increase in MCV is not related to macrocytic anemia, the mean cell hemoglobin concentration (MCHC

2014 eMedicine.com

190. Hematologic Disease and Pregnancy (Overview)

or normocytic anemia etiologies are as follows: Hemorrhagic anemia Early iron deficiency anemia Anemia of chronic disease Anemia associated with bone marrow suppression Anemia associated with chronic renal insufficiency Anemia associated with endocrine dysfunction Autoimmune hemolytic anemia Anemia associated with hypothyroidism or hypopituitarism Hereditary spherocytosis Hemolytic anemia associated with paroxysmal nocturnal hemoglobinuria MCV greater than 100 fL or macrocytic anemia etiologies (...) Women: Implications for Preconception Care. Am J Preventive Medicine . 2010. 38 (4S):S459-67. Lee AI, Okam MM. Anemia in pregnancy. Hematol Oncol Clin North Am . 2011 Apr. 25(2):241-59, vii. . Koshy M, Burd L, Wallace D, et al. Prophylactic red-cell transfusions in pregnant patients with sickle cell disease. A randomized cooperative study. N Engl J Med . 1988 Dec 1. 319(22):1447-52. . Hendrickse JP, Watson-Williams EJ, Luzzatto L, Ajabor LN. Pregnancy in homozygous sickle-cell anaemia. J Obstet

2014 eMedicine.com

191. Glucagonoma Syndrome (Overview)

erythema (NME) [ , ] ; diabetes mellitus; hypoaminoacidemia; cheilosis; a normochromic, normocytic anemia; venous thrombosis; weight loss; and neuropsychiatric features. The finding of NME was once considered pathognomonic for glucagonoma syndrome. However, publications have reported that neither glucagonoma nor hyperglucagonemia is necessary for NME. [ ] Pseudoglucagonoma syndrome refers to NME in the absence of a glucagon-secreting tumor. [ , ] Next: Pathophysiology Although the pathogenesis of NME (...) and the associated cachexia probably play a minor role in weight loss. Similar catabolic effects with respect to protein metabolism probably cause the normochromic, normocytic anemia and hypoaminoacidemia that often are seen at initial presentation. Previous Next: Etiology Hyperglucagonemia can be found as part of a polyfunctional endocrine tumor or an exclusively glucagon-producing tumor. The tumor may be part of a clinical syndrome (eg, ), or it may be asymptomatic. Although most glucagonomas appear

2014 eMedicine.com

192. Glucagonoma (Overview)

exists at diagnosis. The tumor's presence is characterized by glucagon overproduction, weight loss, diabetes mellitus, hypoaminoacidemia, normochromic and normocytic anemia, and necrolytic migratory erythema (NME), which is the most characteristic clinical sign (as opposed to symptom) of this pathology. NME presents as phlogistic damage to tissues in areas exposed to friction and pressure. See the image below. Necrolytic migratory erythema over the back with areas of healing and hyperpigmentation (...) be variation in the molecular species of glucagon that is present in each case, and the biologic potency of these molecular species of glucagon. Weight loss is due to the action of glucagon on lipid and protein metabolism; increased caloric expenditure, as determined by the proteic catabolism; and the consequent increase of gluconeogenesis and ureagenesis. This mechanism is probably also responsible for the anemia and hypoaminoacidemia observed in some patients with glucagonoma. Thromboembolism

2014 eMedicine.com

193. Dermatologic Manifestations of Cardiac Disease (Overview)

, and serum ferritin are needed. In patients with severe anemia and abnormalities in RBC morphology, a bone marrow aspirate and biopsy may be required. In cases of increased RBC destruction or hemolysis, the anemia is easily identified from the increased reticulocyte count, along with normocytic RBC morphology. This indicates the capacity of the erythroid marrow to compensate for a blood loss with an increase in RBC production. Management Management begins at the time of assessment. When an anemia (...) ascites is frequently due to cirrhosis, right-sided venous hypertension raising the hepatic sinusoidal pressure, or hypoalbuminemic states (eg, nephrosis, protein-losing enteropathy). Strongly consider right-sided valvular diseases of the heart and, in particular, constrictive pericarditis. Establishing a diagnosis may require cardiac imaging and cardiac catheterization. Pallor Causes Patients with a prosthetic metallic aortic valve may exhibit pallor because of the development of anemia from RBC

2014 eMedicine.com

194. Uremia (Overview)

to be older (mean age 71.4 years) than were the nonanemic patients with diabetes (mean age 64.4 years) and that a greater percentage were female (52.4% vs 44.4% of the nonanemic patients). In addition, 39% of the anemic patients had renal dysfunction. [ ] Anemia associated with chronic kidney disease is characteristically normocytic, normochromic, and hypoproliferative. Anemia in chronic renal failure In the setting of CKD, anemia may be due to other clinical factors or diseases, such as iron deficiency (...) associated with renal failure can be observed when the glomerular filtration rate (GFR) is less than 50 mL/min or when the serum creatinine level is greater than 2 mg/dL. Patients with diabetes may experience anemia with a GFR of less than 60 mL/min. In a study of 832 hospitalized patients with diabetes, Almoznino-Sarafian et al determined that 334 of the patients had anemia, a rate (40%) higher than that reported in ambulatory patient populations. The investigators found that the anemic patients tended

2014 eMedicine.com

195. Lecithin-Cholesterol Acyltransferase Deficiency (Follow-up)

of the mutated gene product. However, numerous other lab studies can be used in the diagnosis of these diseases. Lab findings in familial LCAT deficiency include the following: Complete blood count (CBC) - Normochromic normocytic anemia with anisopoikilocytosis, target cells, stomatocytes, and hematologic evidence of hemolysis may be present Urinalysis - Proteinuria is commonly detected during the second or third decade of life; less common findings include hyaline and granular casts and red blood cells (...) , and erythrocytes. Patients may present with HDL deficiency, corneal opacification, hemolytic anemia, hypertension, hypertriglyceridemia, and proteinuria. Fish eye disease is characterized by partial reduction of LCAT and only manifests as progressive corneal opacification. Occurrence Familial LCAT deficiency and fish eye disease are rare. Out of 70 families screened worldwide, at least 60 patients with either familial LCAT deficiency or fish eye disease have been reported. [ ] Race- and age-related

2014 eMedicine.com

196. Hematologic Disease and Pregnancy (Follow-up)

or normocytic anemia etiologies are as follows: Hemorrhagic anemia Early iron deficiency anemia Anemia of chronic disease Anemia associated with bone marrow suppression Anemia associated with chronic renal insufficiency Anemia associated with endocrine dysfunction Autoimmune hemolytic anemia Anemia associated with hypothyroidism or hypopituitarism Hereditary spherocytosis Hemolytic anemia associated with paroxysmal nocturnal hemoglobinuria MCV greater than 100 fL or macrocytic anemia etiologies (...) Women: Implications for Preconception Care. Am J Preventive Medicine . 2010. 38 (4S):S459-67. Lee AI, Okam MM. Anemia in pregnancy. Hematol Oncol Clin North Am . 2011 Apr. 25(2):241-59, vii. . Koshy M, Burd L, Wallace D, et al. Prophylactic red-cell transfusions in pregnant patients with sickle cell disease. A randomized cooperative study. N Engl J Med . 1988 Dec 1. 319(22):1447-52. . Hendrickse JP, Watson-Williams EJ, Luzzatto L, Ajabor LN. Pregnancy in homozygous sickle-cell anaemia. J Obstet

2014 eMedicine.com

197. Pyruvate Kinase Deficiency (Follow-up)

a splenectomy and cholecystectomy. In patients who had a splenectomy without simultaneous cholecystectomy, 48% later required a cholecystectomy. [ ] (See the image below.) Peripheral blood smear in a child with splenectomy and pyruvate kinase deficiency. Signs and symptoms The following are evident in pyruvate kinase deficiency: Mild to severe normochromic and normocytic anemia Reticulocytosis Symmetrical growth delay Failure to thrive Cholecystolithiasis: Usually after the first decade of life but possibly (...) Reticulocyte count Serum bilirubin level study Peripheral blood film examination Normochromic, normocytic, or macrocytic anemia, together with reticulocytosis in the absence of blood loss, is suggestive of hemolysis. A negative Coombs test result helps to exclude immune hemolysis. The enzyme activity rate in most patients with pyruvate kinase deficiency is 5-25% of normal, with measurement of the intermediates (2,3-diphosphoglycerol and glucose-6-phosphate) proximal to the enzyme defect helping to confirm

2014 eMedicine.com

198. Lead Poisoning

calcification in the cerebellar hemispheres and minor calcification in the subcortical area of the cerebral hemispheres and basal ganglia. In addition, T2-weighted MRI showed high signal intensity in the periventricular white matter, basal ganglia, insula, posterior thalamus, and pons. The patient in the study by Schrote et al had a 25-year history of normochromic normocytic anemia with moderate basophilic stippling, mild renal failure, hyperuricemia, and abnormal porphyrins. The patient also reported (...) and its owner. The patient had worked on refurbished houses, removing old paint, and complained of decreased cognition, fatigue, and muscle cramps. He had a depressed affect, postural tremor, right-arm weakness with partial denervation on electromyelography, and borderline-low sensory nerve action potential amplitudes. A mild anemia and elevated serum and urine lead levels supported a diagnosis of lead neuropathy. Chelation therapy led to an increase in urine lead excretion without symptomatic

2014 eMedicine Radiology

199. Dermatologic Manifestations of Cardiac Disease (Follow-up)

, and serum ferritin are needed. In patients with severe anemia and abnormalities in RBC morphology, a bone marrow aspirate and biopsy may be required. In cases of increased RBC destruction or hemolysis, the anemia is easily identified from the increased reticulocyte count, along with normocytic RBC morphology. This indicates the capacity of the erythroid marrow to compensate for a blood loss with an increase in RBC production. Management Management begins at the time of assessment. When an anemia (...) ascites is frequently due to cirrhosis, right-sided venous hypertension raising the hepatic sinusoidal pressure, or hypoalbuminemic states (eg, nephrosis, protein-losing enteropathy). Strongly consider right-sided valvular diseases of the heart and, in particular, constrictive pericarditis. Establishing a diagnosis may require cardiac imaging and cardiac catheterization. Pallor Causes Patients with a prosthetic metallic aortic valve may exhibit pallor because of the development of anemia from RBC

2014 eMedicine.com

200. Cardiovascular Concerns in Spinal Cord Injury (Follow-up)

the following: Hypovolemic shock Infection or septic shock Cardiac injury of dysfunction Adverse pharmacological effects or drug overdose Previous Next: Blood, Serum, and Urinary Studies Determine the hemoglobin concentration and/or hematocrit to evaluate for hypovolemia and blood loss. Of note, normochromic, normocytic anemia is not uncommon after SCI. Determine the white blood cell (WBC) count to rule out either an underlying infectious etiology of hypotension or noxious stimuli for autonomic dysreflexia

2014 eMedicine.com

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