Normocytic anemia: Difference between revisions
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__NOTOC__ | |||
{{SI}} | |||
{{CMG}} | |||
==Overview== | |||
==Differentiating Normocytic Anemia from Other Diseases== | |||
'''''To review the differential diagnosis of anemia, click [[Anemia#Differentiating Anemia from Other Diseases|here]].''''' | |||
{| | |||
! 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]] (early phase)<ref name="pmid24972460">{{cite journal |vauthors=De Andrade Cairo RC, Rodrigues Silva L, Carneiro Bustani N, Ferreira Marques CD |title=Iron deficiency anemia in adolescents; a literature review |journal=Nutr Hosp |volume=29 |issue=6 |pages=1240–9 |date=June 2014 |pmid=24972460 |doi=10.3305/nh.2014.29.6.7245 |url=}}</ref> | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Pica]] | |||
* [[Glossitis]] | |||
* [[Angular cheilitis|Cheilosis]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Fatigue]] | |||
* [[Headache]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Koilonychia]] | |||
* Conjunctival [[pallor]] | |||
* [[Xeroderma|Dry skin]] | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | ↓ | |||
| 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;" | | |||
* Pencil [[Cell (biology)|cells]] | |||
* [[Hereditary elliptocytosis|Elliptocytosis]] | |||
* Hypochromasia | |||
|- | |||
! align="center" style="background:#DCDCDC;" |[[Glucose 6 phosphate dehydrogenase deficiency|G6pd deficiency]]<ref name="pmid24372186">{{cite journal |vauthors=Luzzatto L, Seneca E |title=G6PD deficiency: a classic example of pharmacogenetics with on-going clinical implications |journal=Br. J. Haematol. |volume=164 |issue=4 |pages=469–80 |date=February 2014 |pmid=24372186 |pmc=4153881 |doi=10.1111/bjh.12665 |url=}}</ref> | |||
| align="left" style="background:#F5F5F5;" | | |||
* Defect in [[Glucose-6-phosphate dehydrogenase|G6PD]] enzyme | |||
* X-Linked [[recessive]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* History of using | |||
** [[Sulfonamide (medicine)|Sulfa drugs]] | |||
** [[Antimalarial drug|Antimalarials]] | |||
** [[Fava bean|Fava Beans]] | |||
* [[Infection|Infections]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Back pain]] | |||
* [[Hemoglobinuria]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Back pain]] | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" |Intrinsic | |||
| align="center" style="background:#F5F5F5;" |[[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" |[[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" |↑ | |||
| align="center" style="background:#F5F5F5;" |↑ but usually causes resolution within 4-7 days | |||
| align="center" style="background:#F5F5F5;" |↓ | |||
| align="center" style="background:#F5F5F5;" |↓ | |||
| align="center" style="background:#F5F5F5;" |Nl to ↑ | |||
| align="center" style="background:#F5F5F5;" |Nl | |||
| align="center" style="background:#F5F5F5;" |↑ | |||
| align="center" style="background:#F5F5F5;" |↑ | |||
| align="center" style="background:#F5F5F5;" |↑ | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Red blood cell|RBC]] with [[Heinz bodies]] | |||
* Bite [[Cell (biology)|cells]] | |||
* Blister [[Cell (biology)|cells]] | |||
* | |||
|- | |||
! align="center" style="background:#DCDCDC;" |[[Pyruvate kinase deficiency]]<ref name="pmid26087744">{{cite journal |vauthors=Grace RF, Zanella A, Neufeld EJ, Morton DH, Eber S, Yaish H, Glader B |title=Erythrocyte pyruvate kinase deficiency: 2015 status report |journal=Am. J. Hematol. |volume=90 |issue=9 |pages=825–30 |date=September 2015 |pmid=26087744 |pmc=5053227 |doi=10.1002/ajh.24088 |url=}}</ref> | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Mutation]] in the ''[[PKLR]]'' and ''[[PKM2|PKM]]'' gene | |||
* [[Autosomal recessive]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Gallstones]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Hydrops fetalis]] | |||
* [[Neonatal hyperbilirubinemia]] | |||
* [[Iron overload]] | |||
* [[Perinatal]] complications | |||
| align="left" style="background:#F5F5F5;" | | |||
* Skin [[ulcers]] | |||
* [[Splenomegaly]] | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Intrinsic | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| 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;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | | |||
* Prickle [[cells]] | |||
* Polychromatophilic [[erythrocytes]] | |||
|- | |||
! 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 | |||
|- | |||
! align="center" style="background:#DCDCDC;" |[[Sickle-cell disease|Sickle cell anemia]]<ref name="pmid25431087">{{cite journal |vauthors=Singh PC, Ballas SK |title=Emerging drugs for sickle cell anemia |journal=Expert Opin Emerg Drugs |volume=20 |issue=1 |pages=47–61 |date=March 2015 |pmid=25431087 |doi=10.1517/14728214.2015.985587 |url=}}</ref> | |||
| align="left" style="background:#F5F5F5;" | | |||
* Hbs [[point mutation]] causes a single [[Amino acid|amino acid]] replacement in β chain | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[High altitude]] | |||
* Low [[Oxygen]] | |||
* [[Acidosis]] | |||
* African-American race | |||
* [[Parvovirus B19]] infection | |||
| align="left" style="background:#F5F5F5;" | | |||
* Painful crisis | |||
** [[Dactylitis]] | |||
** [[Priapism]] | |||
** [[Acute chest syndrome]] | |||
** [[Avascular necrosis|Avascular Necrosis]] | |||
** [[Stroke]] | |||
* [[Autosplenectomy]] | |||
* [[Salmonella|Salmonella osteomyelitis]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Dactylitis]] | |||
* [[Priapism]] | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Intrinsic | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | ↓ | |||
| align="center" style="background:#F5F5F5;" | Nl or moderately ↑ | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl or moderately ↑ | |||
| align="center" style="background:#F5F5F5;" | ↓ | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="left" style="background:#F5F5F5;" | | |||
* Increased [[erythropoiesis]] | |||
* [[Howell-Jolly bodies]] | |||
* [[Anisocytosis]] | |||
|- | |||
! align="center" style="background:#DCDCDC;" |HbC disease<ref name="pmid25335812">{{cite journal |vauthors=Lemonne N, Billaud M, Waltz X, Romana M, Hierso R, Etienne-Julan M, Connes P |title=Rheology of red blood cells in patients with HbC disease |journal=Clin. Hemorheol. Microcirc. |volume=61 |issue=4 |pages=571–7 |date=2016 |pmid=25335812 |doi=10.3233/CH-141906 |url=}}</ref> | |||
| align="left" style="background:#F5F5F5;" | | |||
* Glutamic acid–to-lysine [[mutation]] in β-globin | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Gallstone]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Joint pains]] | |||
* Increased risk of [[Infection|infections]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Splenomegaly]] | |||
* [[Gallstone disease|Cholelithiasis]] | |||
* [[Avascular necrosis|Avascular necrosis of the femoral head]] | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Intrinsic | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | ↓ | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | ↓ | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | | |||
* Hemoglobin crystals inside [[RBCs]] | |||
* [[Target cell|Target cells]] | |||
|- | |||
! align="center" style="background:#DCDCDC;" |[[Paroxysmal nocturnal hemoglobinuria]]<ref name="pmid1402472">{{cite journal |vauthors=Bunyaratvej A, Butthep P |title=Cytometric analysis of paroxysmal nocturnal hemoglobinuria erythrocytes |journal=J Med Assoc Thai |volume=75 Suppl 1 |issue= |pages=237–42 |date=January 1992 |pmid=1402472 |doi= |url=}}</ref><ref name="pmid25553278">{{cite journal |vauthors=Kahng J, Kim Y, Kim JO, Koh K, Lee JW, Han K |title=A novel marker for screening paroxysmal nocturnal hemoglobinuria using routine complete blood count and cell population data |journal=Ann Lab Med |volume=35 |issue=1 |pages=35–40 |date=January 2015 |pmid=25553278 |pmc=4272963 |doi=10.3343/alm.2015.35.1.35 |url=}}</ref> | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[PIGA]] gene mutations | |||
* Impaired synthesis of [[GPI anchor]] for [[decay-accelerating factor]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* Associated with [[aplastic anemia]] | |||
* [[Thrombosis]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Fatigue]] | |||
* [[Chest pain]] | |||
* [[Dyspnea]] on exertion | |||
* [[Headache]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Hemolysis|Chronic hemolysis]] | |||
* [[Hepatomegaly]] | |||
* [[Ascites]] | |||
* [[Papilledema]] | |||
* Skin nodules | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Intrinsic | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| 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;" | 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;" |[[Hereditary spherocytosis]]<ref name="pmid23664421">{{cite journal |vauthors=Da Costa L, Galimand J, Fenneteau O, Mohandas N |title=Hereditary spherocytosis, elliptocytosis, and other red cell membrane disorders |journal=Blood Rev. |volume=27 |issue=4 |pages=167–78 |date=July 2013 |pmid=23664421 |doi=10.1016/j.blre.2013.04.003 |url=}}</ref> | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Mutations]] in [[Ankyrin]], [[Band 3]], [[Protein 4.2]], and [[spectrin]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* Associated with [[parvovirus B19]] | |||
* [[Cholelithiasis]] | |||
* Megaloblastic crisis | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Aplastic crisis]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Splenomegaly]] | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Intrinsic | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| 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;" | Nl | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | | |||
* Small, round [[Red blood cell|RBC]]s with less surface area and no central pallor | |||
|- | |||
! 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 | |||
|- | |||
! align="center" style="background:#DCDCDC;" |[[Microangiopathic hemolytic anemia]]<ref name="pmid26251142">{{cite journal |vauthors=Morishita E |title=[Diagnosis and treatment of microangiopathic hemolytic anemia] |language=Japanese |journal=Rinsho Ketsueki |volume=56 |issue=7 |pages=795–806 |date=July 2015 |pmid=26251142 |doi=10.11406/rinketsu.56.795 |url=}}</ref><ref name="pmid23390027">{{cite journal |vauthors=George JN, Charania RS |title=Evaluation of patients with microangiopathic hemolytic anemia and thrombocytopenia |journal=Semin. Thromb. Hemost. |volume=39 |issue=2 |pages=153–60 |date=March 2013 |pmid=23390027 |doi=10.1055/s-0032-1333538 |url=}}</ref> | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | Associated with | |||
* [[Disseminated intravascular coagulation|DIC]] | |||
* [[TTP]] | |||
* [[Hemolytic-uremic syndrome|HUS]] | |||
* [[SLE]] | |||
* [[HELLP syndrome]] | |||
* [[Hypertensive crisis|Hypertensive emergency]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Purpura]] | |||
* [[Confusion]] | |||
* [[Aphasia]] | |||
* [[Diplopia]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Paresthesia|Numbness]] of an arm or hand | |||
* [[Jaundice]] | |||
* [[Pallor|Pale conjunctiva]] | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Extrinsic | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| 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;" | Nl | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | | |||
* Helmet cells | |||
|- | |||
! align="center" style="background:#DCDCDC;" |Macroangiopathic hemolytic anemia<ref name="pmid5108522">{{cite journal |vauthors=Westphal RG, Azen EA |title=Macroangiopathic hemolytic anemia due to congenital cardiovascular anomalies |journal=JAMA |volume=216 |issue=9 |pages=1477–8 |date=May 1971 |pmid=5108522 |doi= |url=}}</ref> | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Autoimmunity|Autoimmune]] | |||
| align="left" style="background:#F5F5F5;" | Associated with | |||
* [[Artificial heart valve|Prosthetic heart valves]] | |||
* [[Aortic stenosis]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Pallor]] | |||
* [[Fatigue]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* Signs of [[anemia]] | |||
* Complications of [[hemolysis]] | |||
* Decreased vascular volume | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Extrinsic | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| 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;" | Nl | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Spherocytosis|Spherocytes]] or [[Red blood cell|schistocytes]] | |||
|- | |||
! align="center" style="background:#DCDCDC;" |[[Autoimmune hemolytic anemia]]<ref name="pmid26447931">{{cite journal |vauthors=Hill QA |title=Autoimmune hemolytic anemia |journal=Hematology |volume=20 |issue=9 |pages=553–4 |date=October 2015 |pmid=26447931 |doi=10.1179/1024533215Z.000000000401 |url=}}</ref> | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | Associated with: | |||
* [[SLE]] | |||
* [[Chronic lymphocytic leukemia|CLL]] | |||
* [[Mycoplasma pneumonia]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* Painful blue fingers and toes on exposure to cold temperature | |||
* [[Chest pain]] | |||
* [[Rigor|Chills]] | |||
* [[Dizziness]] | |||
* [[Tachycardia]] | |||
* [[Headache]] | |||
* [[Fatigue]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* Painful, blue fingers and toes with cold weather | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Extrinsic | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| 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;" | Nl | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Red blood cell|RBC]] agglutination | |||
|- | |||
! 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 | |||
|- | |||
! align="center" style="background:#DCDCDC;" |[[Aplastic anemia]]<ref name="pmid24424170">{{cite journal |vauthors=Dolberg OJ, Levy Y |title=Idiopathic aplastic anemia: diagnosis and classification |journal=Autoimmun Rev |volume=13 |issue=4-5 |pages=569–73 |date=2014 |pmid=24424170 |doi=10.1016/j.autrev.2014.01.014 |url=}}</ref> | |||
| align="left" style="background:#F5F5F5;" | | |||
* Constitutive expression of Tbet | |||
* [[Mutation|Mutations]] in the [[perforin]] gene | |||
* Mutations in ''SAP'' gene | |||
| align="left" style="background:#F5F5F5;" | | |||
* Exposure to [[Radiation]] | |||
* Drugs like [[Benzene]], [[chloramphenicol]], [[Alkylating agent|alkylating agents]] | |||
* Viral infections like [[EBV]], [[HIV]], [[Hepatitis]] | |||
* [[Fanconi anemia]] | |||
* Idiopathic like [[Immune]] mediated, primary stem cell defect | |||
| align="left" style="background:#F5F5F5;" | | |||
* Symptoms based on underlying condition | |||
| align="left" style="background:#F5F5F5;" | | |||
* Short stature | |||
* [[Cafe-au-lait spots]] | |||
* Thumb defects | |||
* [[Radius (bone)|Radial]] defects | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="center" style="background:#F5F5F5;" |− | |||
| align="center" style="background:#F5F5F5;" |[[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" |[[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" |↑ | |||
| align="center" style="background:#F5F5F5;" |↓ | |||
| 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;" |Nl | |||
| align="center" style="background:#F5F5F5;" |↑ | |||
| align="center" style="background:#F5F5F5;" |↓ | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Pancytopenia]] | |||
* Fatty [[Infiltration (medical)|infiltration]] | |||
|- | |||
! align="center" style="background:#DCDCDC;" |[[Infection|Infections]]<ref name="pmid23324217">{{cite journal |vauthors=Bustinduy AL, Parraga IM, Thomas CL, Mungai PL, Mutuku F, Muchiri EM, Kitron U, King CH |title=Impact of polyparasitic infections on anemia and undernutrition among Kenyan children living in a Schistosoma haematobium-endemic area |journal=Am. J. Trop. Med. Hyg. |volume=88 |issue=3 |pages=433–40 |date=March 2013 |pmid=23324217 |pmc=3592521 |doi=10.4269/ajtmh.12-0552 |url=}}</ref> | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="left" style="background:#F5F5F5;" | Associated with | |||
* [[Malaria]] | |||
* [[Babesia]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Fever]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Fever]] | |||
* Signs of [[shock]] | |||
* [[Headache]] | |||
| align="center" style="background:#F5F5F5;" | + | |||
| align="center" style="background:#F5F5F5;" | Extrinsic | |||
| align="center" style="background:#F5F5F5;" | [[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" | [[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | ↑ | |||
| align="center" style="background:#F5F5F5;" | ↓ | |||
| align="center" style="background:#F5F5F5;" | Nl | |||
| 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="left" style="background:#F5F5F5;" | | |||
* [[Trophozoite]] | |||
* Maltese crosses | |||
|- | |||
! align="center" style="background:#DCDCDC;" |[[Chronic renal failure|Chronic kidney disease]]<ref name="pmid26030647">{{cite journal |vauthors=Drawz P, Rahman M |title=Chronic kidney disease |journal=Ann. Intern. Med. |volume=162 |issue=11 |pages=ITC1–16 |date=June 2015 |pmid=26030647 |doi=10.7326/AITC201506020 |url=}}</ref> | |||
| align="center" style="background:#F5F5F5;" |− | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Pericarditis]] | |||
* [[Encephalopathy]] | |||
* [[Incontinence|Rectal incontinence]] | |||
* Decreased [[libido]] | |||
* [[Restless legs syndrome|Restless leg syndrome]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Polyuria]] | |||
* [[Hematuria]] | |||
* [[Edema]] | |||
| align="left" style="background:#F5F5F5;" | | |||
* [[Hypertension]] | |||
| align="center" style="background:#F5F5F5;" | − | |||
| align="center" style="background:#F5F5F5;" |− | |||
| align="center" style="background:#F5F5F5;" |[[Normochromic anemia|Normochromic]] | |||
| align="center" style="background:#F5F5F5;" |[[Normocytic anemia|Normocytic]] | |||
| align="center" style="background:#F5F5F5;" |↑ | |||
| 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="center" style="background:#F5F5F5;" |↓ | |||
| align="center" style="background:#F5F5F5;" |Nl | |||
|- | |||
! 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 | |||
|} | |||
==References== | |||
{{Reflist|2}} |
Latest revision as of 16:56, 16 October 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Differentiating Normocytic 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 | ||||||
Serum iron | Serum Tfr level | Transferrin or TIBC | Ferritin | Transferrin saturation | ||||||||||||||
Iron deficiency anemia (early phase)[1] | − |
|
− | − | Normochromic | Normocytic | ↑ | ↓ | Nl | Nl | ↓ | ↑ | ↑ | ↓ | ↓ |
| ||
G6pd deficiency[2] |
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ but usually causes resolution within 4-7 days | ↓ | ↓ | Nl to ↑ | Nl | ↑ | ↑ | ↑ |
| |||
Pyruvate kinase deficiency[3] |
|
|
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↑ | Nl | Nl | ↑ | − |
| |
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 |
Sickle cell anemia[4] |
|
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl or moderately ↑ | Nl | Nl | Nl or moderately ↑ | ↓ | Nl |
| ||
HbC disease[5] |
|
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | Nl | Nl | Nl | ↓ | − |
| ||
Paroxysmal nocturnal hemoglobinuria[6][7] |
|
|
|
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↓ | Nl | ↑ | ↓ | − | NA |
Hereditary spherocytosis[8] |
|
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↓ | Nl | ↑ | Nl | − |
| ||
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 |
Microangiopathic hemolytic anemia[9][10] | − | Associated with |
|
+ | Extrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↓ | Nl | − | ↑ | − |
| |
Macroangiopathic hemolytic anemia[11] | Associated with | + | Extrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↓ | Nl | − | − | − | ||||
Autoimmune hemolytic anemia[12] | − | Associated with: |
|
|
+ | Extrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↓ | Nl | − | − | − |
|
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 |
Aplastic anemia[13] |
|
|
|
− | − | Normochromic | Normocytic | ↑ | ↓ | Nl | Nl | ↓ | ↓ | Nl | ↑ | ↓ |
| |
Infections[14] | − | Associated with | + | Extrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | Nl | Nl | − | − | − |
| ||
Chronic kidney disease[15] | − | − | − | Normochromic | Normocytic | ↑ | Nl/↑ | Nl | ↑ | ↓ | − | ↓ | ↑ | ↓ | Nl | |||
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
- ↑ De Andrade Cairo RC, Rodrigues Silva L, Carneiro Bustani N, Ferreira Marques CD (June 2014). "Iron deficiency anemia in adolescents; a literature review". Nutr Hosp. 29 (6): 1240–9. doi:10.3305/nh.2014.29.6.7245. PMID 24972460.
- ↑ Luzzatto L, Seneca E (February 2014). "G6PD deficiency: a classic example of pharmacogenetics with on-going clinical implications". Br. J. Haematol. 164 (4): 469–80. doi:10.1111/bjh.12665. PMC 4153881. PMID 24372186.
- ↑ Grace RF, Zanella A, Neufeld EJ, Morton DH, Eber S, Yaish H, Glader B (September 2015). "Erythrocyte pyruvate kinase deficiency: 2015 status report". Am. J. Hematol. 90 (9): 825–30. doi:10.1002/ajh.24088. PMC 5053227. PMID 26087744.
- ↑ Singh PC, Ballas SK (March 2015). "Emerging drugs for sickle cell anemia". Expert Opin Emerg Drugs. 20 (1): 47–61. doi:10.1517/14728214.2015.985587. PMID 25431087.
- ↑ Lemonne N, Billaud M, Waltz X, Romana M, Hierso R, Etienne-Julan M, Connes P (2016). "Rheology of red blood cells in patients with HbC disease". Clin. Hemorheol. Microcirc. 61 (4): 571–7. doi:10.3233/CH-141906. PMID 25335812.
- ↑ Bunyaratvej A, Butthep P (January 1992). "Cytometric analysis of paroxysmal nocturnal hemoglobinuria erythrocytes". J Med Assoc Thai. 75 Suppl 1: 237–42. PMID 1402472.
- ↑ Kahng J, Kim Y, Kim JO, Koh K, Lee JW, Han K (January 2015). "A novel marker for screening paroxysmal nocturnal hemoglobinuria using routine complete blood count and cell population data". Ann Lab Med. 35 (1): 35–40. doi:10.3343/alm.2015.35.1.35. PMC 4272963. PMID 25553278.
- ↑ Da Costa L, Galimand J, Fenneteau O, Mohandas N (July 2013). "Hereditary spherocytosis, elliptocytosis, and other red cell membrane disorders". Blood Rev. 27 (4): 167–78. doi:10.1016/j.blre.2013.04.003. PMID 23664421.
- ↑ Morishita E (July 2015). "[Diagnosis and treatment of microangiopathic hemolytic anemia]". Rinsho Ketsueki (in Japanese). 56 (7): 795–806. doi:10.11406/rinketsu.56.795. PMID 26251142.
- ↑ George JN, Charania RS (March 2013). "Evaluation of patients with microangiopathic hemolytic anemia and thrombocytopenia". Semin. Thromb. Hemost. 39 (2): 153–60. doi:10.1055/s-0032-1333538. PMID 23390027.
- ↑ Westphal RG, Azen EA (May 1971). "Macroangiopathic hemolytic anemia due to congenital cardiovascular anomalies". JAMA. 216 (9): 1477–8. PMID 5108522.
- ↑ Hill QA (October 2015). "Autoimmune hemolytic anemia". Hematology. 20 (9): 553–4. doi:10.1179/1024533215Z.000000000401. PMID 26447931.
- ↑ Dolberg OJ, Levy Y (2014). "Idiopathic aplastic anemia: diagnosis and classification". Autoimmun Rev. 13 (4–5): 569–73. doi:10.1016/j.autrev.2014.01.014. PMID 24424170.
- ↑ Bustinduy AL, Parraga IM, Thomas CL, Mungai PL, Mutuku F, Muchiri EM, Kitron U, King CH (March 2013). "Impact of polyparasitic infections on anemia and undernutrition among Kenyan children living in a Schistosoma haematobium-endemic area". Am. J. Trop. Med. Hyg. 88 (3): 433–40. doi:10.4269/ajtmh.12-0552. PMC 3592521. PMID 23324217.
- ↑ Drawz P, Rahman M (June 2015). "Chronic kidney disease". Ann. Intern. Med. 162 (11): ITC1–16. doi:10.7326/AITC201506020. PMID 26030647.