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Normocytic Anemia

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141. Retroperitoneal Fibrosis (Diagnosis)

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

142. Myxedema Coma or Crisis (Diagnosis)

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

143. Dermatologic Manifestations of Cardiac Disease (Diagnosis)

, 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

144. Glucagonoma Syndrome (Diagnosis)

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

145. Glucagonoma (Diagnosis)

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

146. Wegener Granulomatosis (Diagnosis)

of patients CBC: Mild normochromic normocytic anemia is present in 50% of patients; leukocytosis is common, with a neutrophil predominance Elevated inflammatory markers (ESR, CRP) Antineutrophil cytoplasmic antibody (ANCA) testing Cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) directed against PR3 is most specific for GPA Some patients with GPA express perinuclear-staining ANCA (p-ANCA) specific for myeloperoxidase (MPO) Combining immunofluorescence and ELISA enhances the sensitivity

2014 eMedicine.com

147. Macrocytosis (Diagnosis)

. 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

148. Cardiovascular Concerns in Spinal Cord Injury (Diagnosis)

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

149. Amyloidosis, Transthyretin-Related (Diagnosis)

deposition. See the image below. Congo Red staining of a cardiac biopsy specimen containing amyloid, viewed under polarized light. Laboratory results for different types of amyloidosis are generally nonspecific, including the following: Complete blood count: Normochromic normocytic anemia Chemistry panel: Electrolyte abnormalities (due to heart failure or malabsorption) Renal function tests: Evidence of varying degrees of proteinuria and diminished glomerular filtration rate in patients with renal

2014 eMedicine.com

150. Chronic Renal Failure (Diagnosis)

normocytic anemia principally develops from decreased renal synthesis of erythropoietin, the hormone responsible for bone marrow stimulation for red blood cell (RBC) production. The anemia starts early in the course of the disease and becomes more severe as, with the shrinking availability of viable renal mass, the GFR progressively decreases. Using data from the National Health and Nutrition Examination Survey (NHANES), Stauffer and Fan found that anemia was twice as prevalent in people with CKD (15.4 (...) < 30 mL/min/1.73 m²) that endocrine/metabolic derangements or disturbances in water or electrolyte balance become clinically manifest. Signs of metabolic acidosis in stage 5 CKD include the following: Loss of lean body mass Muscle weakness Signs of alterations in the way the kidneys are handling salt and water in stage 5 include the following: Peripheral edema Pulmonary edema Hypertension Anemia in CKD is associated with the following: Fatigue Reduced exercise capacity Impaired cognitive and immune

2014 eMedicine.com

151. Chronic Myelogenous Leukemia (Diagnosis)

smear Bone marrow analysis Blood count and peripheral smear findings Total WBC count 20,000-60,000 cells/μL, with mildly increased basophils and eosinophils Mild to moderate anemia, usually normochromic and normocytic Platelet counts low, normal, or increased Leukocyte alkaline phosphatase stains very low to absent in most cells Leukoerythroblastosis, with circulating immature cells from the bone marrow Early myeloid cells (eg, myeloblasts, myelocytes, metamyelocytes, nucleated red blood cells) Bone (...) are signs and symptoms of progressive disease: Bleeding, petechiae, and ecchymoses during the acute phase Bone pain and fever in the blast phase Increasing anemia, thrombocytopenia, basophilia, and a rapidly enlarging spleen in blast crisis See for more detail. Diagnosis The diagnosis of CML is based on the following: Histopathologic findings in the peripheral blood Philadelphia (Ph) chromosome in bone marrow cells The workup for CML consists of the following: CBC with differential Peripheral blood

2014 eMedicine.com

152. 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

153. 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 (...) Hematologic Disease and Pregnancy (Treatment) Anemia and Thrombocytopenia in Pregnancy: Anemias in Pregnancy, Sickle Cell Hemoglobinopathies in Pregnancy, Thalassemias in Pregnancy Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache

2014 eMedicine.com

154. Pure Red Cell Aplasia (Overview)

: May 03, 2017 Author: Paul Schick, MD; Chief Editor: Emmanuel C Besa, MD Share Email Print Feedback Close Sections Sections Pure Red Cell Aplasia Overview Practice Essentials Pure red cell aplasia (PRCA) is an uncommon disorder in which maturation arrest occurs in the formation of erythrocytes. [ , ] Erythroblasts are virtually absent in bone marrow; however, white blood cell and platelet production are normal. The anemia due to PRCA is usually normocytic but can be macrocytic. In 1922, Kaznelson (...) recognized that this condition was a different entity from , which presents as pancytopenia. The characteristics of PRCA (see ) include the following: Severe anemia Reticulocyte count <1% The presence of less than 0.5% mature erythroblasts in the bone marrow Normocellular bone marrow in most cases The etiology of PRCA is heterogeneous. A congenital form of PRCA was initially described by Joseph in 1936 and by Diamond and Blackfan in 1938. Congenital PRCA is a lifelong disorder and is associated

2014 eMedicine.com

155. 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

156. 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

157. 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

158. 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

159. Cardiovascular Concerns in Spinal Cord Injury (Overview)

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

160. Chronic Renal Failure (Overview)

normocytic anemia principally develops from decreased renal synthesis of erythropoietin, the hormone responsible for bone marrow stimulation for red blood cell (RBC) production. The anemia starts early in the course of the disease and becomes more severe as, with the shrinking availability of viable renal mass, the GFR progressively decreases. Using data from the National Health and Nutrition Examination Survey (NHANES), Stauffer and Fan found that anemia was twice as prevalent in people with CKD (15.4 (...) < 30 mL/min/1.73 m²) that endocrine/metabolic derangements or disturbances in water or electrolyte balance become clinically manifest. Signs of metabolic acidosis in stage 5 CKD include the following: Loss of lean body mass Muscle weakness Signs of alterations in the way the kidneys are handling salt and water in stage 5 include the following: Peripheral edema Pulmonary edema Hypertension Anemia in CKD is associated with the following: Fatigue Reduced exercise capacity Impaired cognitive and immune

2014 eMedicine.com

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