Hypochromic anemia: Difference between revisions

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VisualWikitext

Latest revision as of 16:52, 16 October 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Hypochromic anemia is a form of anemia characterized by a disproportionate reduction of red cell hemoglobin in proportion to the volume of the erythrocyte and an increased area of central pallor in the red cells.

Acquired forms

Hypochromic anemia may be caused by iron deficiency from a low iron intake, diminished iron absorption, or excessive iron loss. It can also be caused by infections or other diseases, therapeutic drugs such as Meropenem, and lead poisoning. One acquired form of anemia is also known as Faber's syndrome. It may also occur from severe stomach or intestinal bleeding caused by ulcers or medications such as aspirin.^[1]

Hereditary forms

It can also occur in certain forms of congenital developmental disorders, like Benjamin syndrome.

Differentiating Hypochromic Anemia from Other Diseases

To review the differential diagnosis of anemia, click here.

Disease	Genetics	Clinical manifestation					Lab findings
		History	Symptoms	Signs	Hemolysis	Intrinsic/Extrinsic	Hb concentration	MCV	RDW	Reticulocytosis	Haptoglobin levels	Hepcidin	Iron studies					Specific finding on blood smear
		History	Symptoms	Signs	Hemolysis	Intrinsic/Extrinsic	Hb concentration	MCV	RDW	Reticulocytosis	Haptoglobin levels	Hepcidin	Serum iron	Serum Tfr level	Transferrin or TIBC	Ferritin	Transferrin saturation	Specific finding on blood smear
Iron deficiency anemia^[2]	−	Menorrhagia GI loss GI surgery Pregnancy	Koilonychia Pica	Glossitis Cheilosis Dysphagia	−	−	Hypochromic	Microcytic	↑	Nl or ↓	Nl	Nl	↓	↑	↑	↓	↓↓↓	Central pallor
Lead poisoning^[3]	−	House painted with chipped paint	Burtonian lines Basophilic stippling Wrist drop Foot drop	Wrist drop Foot drop Burtonian lines	−	−	Hypochromic	Microcytic	Nl	Nl or ↓	Nl	Nl	Nl to ↓	Nl	Nl	Nl to ↓	−	RBCs retain aggregates of rRNA Basophilic stippling
Sideroblastic anemia^[4]	Defect in ALA synthase gene Autosomal dominant Autosomal recessive X-linked	Alcohol abuse Isoniazid use Chloramphenicol use Idiopathic	Seborrheic dermatitis Glossy Tongue Tingling	Patient present with symptoms of Vitamin B6, copper deficiency symptoms	−	−	Hypochromic	Microcytic	Nl	Nl or ↓	Nl	Nl	↑	Nl	Nl to ↓	↑	−	Ringed sideroblasts
Anemia of chronic disease^[5]	−	Rheumatoid arthritis SLE Neoplasm Chronic kidney disease	Headache Shortness of breath	−	−	−	Hypochromic	Microcytic	Nl	Nl or ↓	Nl	↑	↓	Nl	↓	↑	−	NA
Thalassemia^[6]	α-thalassemia α- globin gene deletions Cis deletions Trans deletions β-thalassemia Point mutation in splice sites and promoter sequences	Associated with parvovirus B19	α-thalassemia Hydrops fetalis β-thalassemia Skeletal deformities Chipmunk facies	Hepatomegaly Splenomegaly	−	−	Hypochromic	Microcytic	Nl	Thalassemia trait: Nl or ↓ Thalassemia Syndromes: ↑	Nl	Nl	Nl to ↑	Nl	Nl	↑	Nl to ↑	Target cells Anisopoikilocytosis
Disease	Genetics	History	Symptoms	Signs	Hemolysis	Intrinsic/Extrinsic	Hb concentration	MCV	RDW	Reticulocytosis	Haptoglobin levels	Hepcidin	Serum iron	Serum Tfr level	IBC	Ferritin	Transferrin saturation	Specific finding on blood smear

References

↑ Miale JB (1982). Laboratory Medicine: Hematology. (6th ed.) The CV Mosby Company, St. Louis ISBN 1-125-44734-6
↑ Camaschella C (May 2015). "Iron-deficiency anemia". N. Engl. J. Med. 372 (19): 1832–43. doi:10.1056/NEJMra1401038. PMID 25946282.
↑ Bain BJ (December 2014). "Lead poisoning". Am. J. Hematol. 89 (12): 1141. doi:10.1002/ajh.23852. PMID 25220013.
↑ Bottomley SS, Fleming MD (August 2014). "Sideroblastic anemia: diagnosis and management". Hematol. Oncol. Clin. North Am. 28 (4): 653–70, v. doi:10.1016/j.hoc.2014.04.008. PMID 25064706.
↑ Roy CN (2010). "Anemia of inflammation". Hematology Am Soc Hematol Educ Program. 2010: 276–80. doi:10.1182/asheducation-2010.1.276. PMID 21239806.
↑ Zainal NZ, Alauddin H, Ahmad S, Hussin NH (December 2014). "α-Thalassemia with Haemoglobin Adana mutation: prenatal diagnosis". Malays J Pathol. 36 (3): 207–11. PMID 25500521.

[1] Miale JB (1982). Laboratory Medicine: Hematology. (6th ed.) The CV Mosby Company, St. Louis ISBN 1-125-44734-6

[pmid25946282-2] Camaschella C (May 2015). "Iron-deficiency anemia". N. Engl. J. Med. 372 (19): 1832–43. doi:10.1056/NEJMra1401038. PMID 25946282.

[pmid25220013-3] Bain BJ (December 2014). "Lead poisoning". Am. J. Hematol. 89 (12): 1141. doi:10.1002/ajh.23852. PMID 25220013.

[pmid25064706-4] Bottomley SS, Fleming MD (August 2014). "Sideroblastic anemia: diagnosis and management". Hematol. Oncol. Clin. North Am. 28 (4): 653–70, v. doi:10.1016/j.hoc.2014.04.008. PMID 25064706.

[pmid21239806-5] Roy CN (2010). "Anemia of inflammation". Hematology Am Soc Hematol Educ Program. 2010: 276–80. doi:10.1182/asheducation-2010.1.276. PMID 21239806.

[pmid25500521-6] Zainal NZ, Alauddin H, Ahmad S, Hussin NH (December 2014). "α-Thalassemia with Haemoglobin Adana mutation: prenatal diagnosis". Malays J Pathol. 36 (3): 207–11. PMID 25500521.

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@@ Line 1: / Line 1: @@
+__NOTOC__
 {{SI}}
 {{CMG}}
 ==Overview==
-'''Hypochromic anemia''' is a form of [[anemia]] characterized by a disproportionate reduction of red cell [[hemoglobin]] in proportion to the volume of the [[erythrocyte]] and an increased area of central pallor in the red cells.
+Hypochromic anemia is a form of [[anemia]] characterized by a disproportionate reduction of red cell [[hemoglobin]] in proportion to the volume of the [[erythrocyte]] and an increased area of central pallor in the red cells.
 ==Acquired forms==
+Hypochromic anemia may be caused by [[iron]] deficiency from a low iron intake, diminished iron absorption, or excessive iron loss. It can also be caused by [[infection]]s or other [[disease]]s, therapeutic [[drug]]s such as [[Meropenem]], and [[lead poisoning]]. One acquired form of anemia is also known as Faber's syndrome. It may also occur from severe stomach or intestinal bleeding caused by [[ulcer]]s or medications such as [[aspirin]].<ref>Miale JB (1982). ''Laboratory Medicine: Hematology.'' (6th ed.) The CV Mosby Company, St. Louis ISBN 1-125-44734-6</ref>
-Hypochromic anemia may be caused by [[iron]] deficiency from a low iron intake, diminished iron absorption, or excessive iron loss. It can also be caused by [[infection]]s or other [[disease]]s, therapeutic [[drug]]s, and [[lead poisoning]]. One acquired form of anemia is also known as Faber's syndrome. It may also occur from severe stomach or intestinal bleeding caused by [[ulcer]]s or medications such as [[aspirin]].<ref>Miale JB (1982). ''Laboratory Medicine: Hematology.'' (6th ed.) The CV Mosby Company, St. Louis ISBN 1-125-44734-6</ref>
 ==Hereditary forms==
 It can also occur in certain forms of congenital [[developmental disorder]]s, like [[Benjamin syndrome]].
+==Differentiating Hypochromic Anemia from Other Diseases==
-==References==
+'''''To review the differential diagnosis of anemia, click [[Anemia#Differentiating Anemia from Other Diseases|here]].'''''
-{{reflist|2}}
+{|
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
+! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Genetics
+! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestation
+! colspan="12" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
+|-
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hemolysis
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Intrinsic/Extrinsic
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb concentration
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |MCV
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |RDW
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Reticulocytosis
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Haptoglobin levels
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hepcidin
+! colspan="5" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Iron studies
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum iron
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum Tfr level
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Transferrin or TIBC
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ferritin
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Transferrin saturation
+|-
+! align="center" style="background:#DCDCDC;" |[[Iron deficiency anemia]]<ref name="pmid25946282">{{cite journal |vauthors=Camaschella C |title=Iron-deficiency anemia |journal=N. Engl. J. Med. |volume=372 |issue=19 |pages=1832–43 |date=May 2015 |pmid=25946282 |doi=10.1056/NEJMra1401038 |url=}}</ref>
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* [[Menorrhagia]]
+* [[GI]] loss
+* [[Gastrointestinal tract|GI]] surgery
+* [[Pregnancy]]
+| align="left" style="background:#F5F5F5;" |
+* [[Koilonychia]]
+* [[Pica]]
+| align="left" style="background:#F5F5F5;" |
+* [[Glossitis]]
+* [[Cheilosis]]
+* [[Dysphagia]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | [[Hypochromic anemia|Hypochromic]]
+| align="center" style="background:#F5F5F5;" | [[Microcytic anemia|Microcytic]]
+| align="center" style="background:#F5F5F5;" | ↑
+| align="center" style="background:#F5F5F5;" | Nl or ↓
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | ↓
+| align="center" style="background:#F5F5F5;" | ↑
+| align="center" style="background:#F5F5F5;" | ↑
+| align="center" style="background:#F5F5F5;" | ↓
+| align="center" style="background:#F5F5F5;" | ↓↓↓
+| align="left" style="background:#F5F5F5;" |
+* Central [[pallor]]
+|-
+! align="center" style="background:#DCDCDC;" |[[Lead poisoning]]<ref name="pmid25220013">{{cite journal |vauthors=Bain BJ |title=Lead poisoning |journal=Am. J. Hematol. |volume=89 |issue=12 |pages=1141 |date=December 2014 |pmid=25220013 |doi=10.1002/ajh.23852 |url=}}</ref>
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* House painted with chipped paint
+| align="left" style="background:#F5F5F5;" |
+* Burtonian lines
+* [[Basophilic]] [[Stippling (dentistry)|stippling]]
+* [[Wrist drop]]
+* [[Foot drop]]
+| align="left" style="background:#F5F5F5;" |
+* [[Wrist drop]]
+* [[Foot drop]]
+* Burtonian lines
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | [[Hypochromic anemia|Hypochromic]]
+| align="center" style="background:#F5F5F5;" | [[Microcytic anemia|Microcytic]]
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl or ↓
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl to ↓
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl to ↓
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* [[Red blood cell|RBCs]] retain aggregates of [[Ribosomal RNA|rRNA]]
+* Basophilic stippling
+|-
+! align="center" style="background:#DCDCDC;" |[[Sideroblastic anemia]]<ref name="pmid25064706">{{cite journal |vauthors=Bottomley SS, Fleming MD |title=Sideroblastic anemia: diagnosis and management |journal=Hematol. Oncol. Clin. North Am. |volume=28 |issue=4 |pages=653–70, v |date=August 2014 |pmid=25064706 |doi=10.1016/j.hoc.2014.04.008 |url=}}</ref>
+| align="left" style="background:#F5F5F5;" |
+* Defect in [[ALA synthase]] gene
+* [[Autosomal dominant]]
+* [[Autosomal recessive]]
+* [[X-linked]]
+| align="left" style="background:#F5F5F5;" |
+* [[Alcohol]] abuse
+* [[Isoniazid]] use
+* [[Chloramphenicol]] use
+* [[Idiopathic]]
+| align="left" style="background:#F5F5F5;" |
+* [[Seborrheic dermatitis]]
+* Glossy Tongue
+* [[Tingling]]
+| align="left" style="background:#F5F5F5;" |
+* Patient present with symptoms of [[Vitamin B6]], [[copper deficiency]] symptoms
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | [[Hypochromic anemia|Hypochromic]]
+| align="center" style="background:#F5F5F5;" | [[Microcytic anemia|Microcytic]]
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl or ↓
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | ↑
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl to ↓
+| align="center" style="background:#F5F5F5;" | ↑
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* Ringed [[Sideroblastic|sideroblasts]]
+|-
+! align="center" style="background:#DCDCDC;" |[[Anemia of chronic disease]]<ref name="pmid21239806">{{cite journal |vauthors=Roy CN |title=Anemia of inflammation |journal=Hematology Am Soc Hematol Educ Program |volume=2010 |issue= |pages=276–80 |date=2010 |pmid=21239806 |doi=10.1182/asheducation-2010.1.276 |url=}}</ref>
+| align="center" style="background:#F5F5F5;" | −
+| align="left" style="background:#F5F5F5;" |
+* [[Rheumatoid arthritis]]
+* [[SLE]]
+* [[Neoplasm]]
+* [[Chronic kidney disease]]
+| align="left" style="background:#F5F5F5;" |
+* [[Headache]]
+* [[Shortness of breath]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | [[Hypochromic anemia|Hypochromic]]
+| align="center" style="background:#F5F5F5;" | [[Microcytic anemia|Microcytic]]
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl or ↓
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | ↑
+| align="center" style="background:#F5F5F5;" | ↓
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | ↓
+| align="center" style="background:#F5F5F5;" | ↑
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | NA
+|-
+! align="center" style="background:#DCDCDC;" |[[Thalassemia]]<ref name="pmid25500521">{{cite journal |vauthors=Zainal NZ, Alauddin H, Ahmad S, Hussin NH |title=α-Thalassemia with Haemoglobin Adana mutation: prenatal diagnosis |journal=Malays J Pathol |volume=36 |issue=3 |pages=207–11 |date=December 2014 |pmid=25500521 |doi= |url=}}</ref>
+| align="left" style="background:#F5F5F5;" | '''[[Thalassemia|α-thalassemia]]'''
+* '''''α'''''- globin gene deletions
+* [[Cis]] deletions
+* [[Trans]] deletions
+'''[[Thalassemia|β-thalassemia]]'''
+* [[Point mutation]] in [[Splice site|splice sites]] and promoter sequences
+| align="left" style="background:#F5F5F5;" |
+* Associated with [[parvovirus B19]]
+| align="left" style="background:#F5F5F5;" | [[Thalassemia|'''α-thalassemia''']]
+* [[Hydrops fetalis]]
+[[Thalassemia|'''β-thalassemia''']]
+* [[Skeletal]] deformities
+* Chipmunk facies
+| align="left" style="background:#F5F5F5;" |
+* [[Hepatomegaly]]
+* [[Splenomegaly]]
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | −
+| align="center" style="background:#F5F5F5;" | [[Hypochromic anemia|Hypochromic]]
+| align="center" style="background:#F5F5F5;" | [[Microcytic anemia|Microcytic]]
+| align="center" style="background:#F5F5F5;" | Nl
+| align="left" style="background:#F5F5F5;" |
+* Thalassemia trait: Nl or ↓
+* Thalassemia Syndromes: ↑
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl to ↑
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | Nl
+| align="center" style="background:#F5F5F5;" | ↑
+| align="center" style="background:#F5F5F5;" | Nl to ↑
+| align="left" style="background:#F5F5F5;" |
+* [[Target cell|Target cells]]
+* Anisopoikilocytosis
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Genetics
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hemolysis
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Intrinsic/Extrinsic
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb concentration
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MCV
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |RDW
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Reticulocytosis
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Haptoglobin levels
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hepcidin
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum iron
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Serum Tfr level
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |IBC
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ferritin
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Transferrin saturation
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
+|}
-[[Category:Hematology]]
+==References==
-[[Category:Genetic Disease]]
+{{Reflist|2}}
-{{WH}}
-{{WikiDoc Sources}}