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Normocytic Anemia

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161. Chronic Myelogenous Leukemia (Overview)

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 marrow findings Ph (...) 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 smear Bone marrow

2014 eMedicine.com

162. 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 (...) . Next: Pathophysiology Normally, the kidney is the site of hormone production and secretion, acid-base homeostasis, fluid and electrolyte regulation, and waste-product elimination. In the presence of renal failure, these functions are not performed adequately and metabolic abnormalities, such as anemia, acidemia, hyperkalemia, , , and , can occur. [ ] Uremia usually develops only after the creatinine clearance falls to less than 10 mL/min, although some patients may be symptomatic at higher

2014 eMedicine.com

163. 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

164. Hyperglucagonemia (Overview)

, necrolytic migratory erythema (NME), and diabetes. [ , , , , , , ] The diabetes mellitus associated with glucagonoma syndrome tends to be mild and usually can be controlled with diet and/or oral hypoglycemic agents. Typically, the associated anemia is normochromic normocytic, although macrocytic anemia has been described in some patients. is thought to occur in as many as 30% of patients with glucagonoma syndrome. Diagnosis is aided by the typical skin appearance of patients with NME

2014 eMedicine.com

165. 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 (...) Hematologic Disease and Pregnancy (Overview) 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

166. Lecithin-Cholesterol Acyltransferase Deficiency (Overview)

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

167. Wegener Granulomatosis (Overview)

squamous cell carcinoma have been reported Additional findings Cardiac: Pericardial rub, myocardial infarction, or sudden death Gastrointestinal: Abdominal pain may be present with splanchnic vasculitis See for more detail. Diagnosis Routine laboratory tests are nonspecific in GPA. Results may include the following: Abnormal kidney function tests and urinalysis in patients with renal involvement Rheumatoid factor is positive in a low titer in two thirds 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 and specificity of a diagnosis of an ANCA-associated

2014 eMedicine.com

168. 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

169. 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

170. 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

171. 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

172. 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

173. 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

174. 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

175. 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 (...) Hematologic Disease and Pregnancy (Follow-up) 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

176. 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 Pediatrics

177. Pyruvate Kinase Deficiency (Diagnosis)

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 Pediatrics

178. Myelofibrosis (Diagnosis)

blood abnormalities (eg, normocytic anemia, thrombocytopenia, or leukocytosis with left shift) Endocrinologic testing (eg, hyper- or hypoparathyroidism) Rheumatologic evaluation Blood urea nitrogen (BUN) and creatinine testing (to rule out renal dysfunction) Coombs (direct antiglobulin) test Purified protein derivative (PPD) test Chromosomal analysis in any child with onset before age 2 years The following imaging studies may be helpful: Abdominal ultrasonography Abdominal computed tomography (CT (...) relative. Clinical symptoms may be mild; some patients are asymptomatic at presentation. Manifestations of disease may include, but are not limited to, the following: Pallor (anemia) Bruising, petechiae, or bleeding (thrombocytopenia) Fever Weight loss Night sweats Bone pain Left upper quadrant pain Splenomegaly (frequent), hepatomegaly, or lymphadenopathy [ ] Stigmata of a predisposing condition See for more detail. Diagnosis Laboratory testing may include the following: Evaluation for peripheral

2014 eMedicine Pediatrics

179. Crohn Disease (Diagnosis)

the large joints (eg, hips, knees, ankles) See for more detail. Diagnosis Laboratory data for Crohn disease are nonspecific, as follows: The CBC may show hypochromic microcytic anemia, from iron deficiency due to GI blood loss, or normocytic anemia of chronic disease levels of acute-phase reactants (ESR and CRP) are often elevated in patients with Crohn disease but may be normal Hypoalbuminemia is common Additional common deficiencies include iron and micronutrients (eg, folic acid, vitamin B-12, serum (...) in approximately 45% of patients Tanner staging may indicate pubertal delay, which may precede the onset of intestinal symptoms The most common cutaneous manifestations are erythema nodosum and pyoderma gangrenosum Skin examination may also reveal pallor in patients with anemia or jaundice in those with concomitant liver disease The most common ocular findings are episcleritis and anterior uveitis The most common extraintestinal manifestations of Crohn disease are arthritis and arthralgia, typically involving

2014 eMedicine Pediatrics

180. Acute Myelocytic Leukemia (Overview)

and additional marrow studies. The World Health Organization (WHO) classifies AML into groups as follows (rarely used in pediatrics): AML with characteristic cytogenetic translocations AML with multilineage dysplasia AML and myelodysplasia syndromes secondary to therapy AML not otherwise categorized Testing The hallmark of AML is the reduction or absence of normal hematopoietic elements. Anemia is usually normocytic, with a lower-than-expected reticulocyte count for the hemoglobin level. The decrease (...) with notable morbidity and mortality. Signs and symptoms Signs and symptoms of pediatric acute myelocytic leukemia (AML) can be divided into the following: (1) those caused by a deficiency of normally functioning cells, (2) those due to the proliferation and infiltration of the abnormal leukemic cell population, and (3) constitutional symptoms. Symptoms due to a deficiency of normally functioning cells include the following: Cytopenias: Can result from a deficiency of normally functioning cells Anemia

2014 eMedicine Pediatrics

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