Anemia of prematurity differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Anemia_of_prematurity]] | |||
{{CMG}}; {{AE}} {{Asra}} | {{CMG}}; {{AE}} {{Asra}} | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
[[Anemia of prematurity]] should be differentiated from [[anemia]] due to increased [[red blood cell]] destruction, increased [[blood loss]], and decreased [[red blood cell]] production. [[Anemia of prematurity]] should also be differentiated from other causes of [[normocytic]] [[normochromic]] anemia. | [[Anemia of prematurity]] should be differentiated from [[anemia]] due to increased [[red blood cell]] destruction, increased [[blood loss]], and decreased [[red blood cell]] production. [[Anemia of prematurity]] should also be differentiated from other causes of [[normocytic]] [[normochromic]] anemia.<ref>{{cite web |url=https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/pediatrics/anemia-of-prematurity/#:~:text=Anemia%20of%20prematurity%20is%20a,cell%20transfusions%20to%20replace%20loss. |title=www.cancertherapyadvisor.com |format= |work= |accessdate=}}</ref> | ||
===Increased RBC destruction=== | ===Increased RBC destruction=== | ||
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==Differentiating Anemia of prematurity from other diseases== | ==Differentiating Anemia of prematurity from other diseases== | ||
[[Anemia of prematurity]] must be differentiated based on different laboratory findings including [[mean cell volume]] ([[MCV]]), [[reticulocytosis]], and [[hemolysis]]. | |||
[[Anemia of prematurity]] must be differentiated based on different laboratory findings including [[mean cell volume]] ([[MCV]]), reticulocytosis, and hemolysis. | |||
'''''To review the differential diagnosis of anemia, see below table.''''' | '''''To review the differential diagnosis of anemia, see below table.''''' | ||
{| | {| | ||
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease | ! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Transferrin saturation | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Transferrin saturation | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Anemia of prematurity]] | ! align="center" style="background:#DCDCDC;" |[[Anemia of prematurity]] <ref>{{cite journal |vauthors=Strauss RG |title=Anaemia of prematurity: pathophysiology and treatment |journal=Blood Rev. |volume=24 |issue=6 |pages=221–5 |date=November 2010 |pmid=20817366 |pmc=2981681 |doi=10.1016/j.blre.2010.08.001 |url=}}</ref> | ||
| align="center" style="background:#F5F5F5;" | − | | align="center" style="background:#F5F5F5;" | − | ||
| align=" | | align="left" style="background:#F5F5F5;" | | ||
*[[Preterm|Premature birth]] | *[[Preterm|Premature birth]] | ||
*[[Low birth weight]] | *[[Low birth weight]] | ||
*[[Phlebotomy]] | *[[Phlebotomy]] | ||
*[[NICU]] admission | *[[NICU]] admission | ||
| align=" | | align="left" style="background:#F5F5F5;" | | ||
*[[Pale skin|Pallor]] | *[[Pale skin|Pallor]] | ||
*[[Lethargy]] | *[[Lethargy]] | ||
Line 130: | Line 107: | ||
| align="center" style="background:#F5F5F5;" | Predominant [[red blood cell]] precursors | | align="center" style="background:#F5F5F5;" | Predominant [[red blood cell]] precursors | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Iron deficiency anemia]] | ! 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="center" style="background:#F5F5F5;" | − | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
Line 160: | Line 137: | ||
* Central [[pallor]] | * Central [[pallor]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Iron deficiency anemia]] (early phase) | ! 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="center" style="background:#F5F5F5;" | − | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
Line 191: | Line 168: | ||
* Hypochromasia | * Hypochromasia | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Lead poisoning]] | ! 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="center" style="background:#F5F5F5;" | − | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
Line 221: | Line 198: | ||
* Basophilic stippling | * Basophilic stippling | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Sideroblastic anemia]] | ! 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;" | | | align="left" style="background:#F5F5F5;" | | ||
* Defect in [[ALA synthase]] gene | * Defect in [[ALA synthase]] gene | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Anemia of chronic disease]] | ! 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="center" style="background:#F5F5F5;" | − | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
Line 302: | Line 279: | ||
| align="center" style="background:#F5F5F5;" | NA | | align="center" style="background:#F5F5F5;" | NA | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Thalassemia]] | ! 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]]''' | | align="left" style="background:#F5F5F5;" | '''[[Thalassemia|α-thalassemia]]''' | ||
* '''''α'''''- globin gene deletions | * '''''α'''''- globin gene deletions | ||
Line 338: | Line 315: | ||
* Anisopoikilocytosis | * Anisopoikilocytosis | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Glucose 6 phosphate dehydrogenase deficiency|G6PD deficiency]] | ! 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;" | | | align="left" style="background:#F5F5F5;" | | ||
* Defect in [[Glucose-6-phosphate dehydrogenase|G6PD]] enzyme | * Defect in [[Glucose-6-phosphate dehydrogenase|G6PD]] enzyme | ||
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* | * | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Pyruvate kinase deficiency]] | ! 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;" | | | align="left" style="background:#F5F5F5;" | | ||
* [[Mutation]] in the ''[[PKLR]]'' and ''[[PKM2|PKM]]'' gene | * [[Mutation]] in the ''[[PKLR]]'' and ''[[PKM2|PKM]]'' gene | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Sickle-cell disease|Sickle cell anemia]] | ! 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;" | | | align="left" style="background:#F5F5F5;" | | ||
* Hbs [[point mutation]] causes a single [[Amino acid|amino acid]] replacement in β chain | * Hbs [[point mutation]] causes a single [[Amino acid|amino acid]] replacement in β chain | ||
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* [[Anisocytosis]] | * [[Anisocytosis]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |HbC disease | ! 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;" | | | align="left" style="background:#F5F5F5;" | | ||
* Glutamic acid–to-lysine [[mutation]] in β-globin | * Glutamic acid–to-lysine [[mutation]] in β-globin | ||
Line 493: | Line 470: | ||
* [[Target cell|Target cells]] | * [[Target cell|Target cells]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Paroxysmal nocturnal hemoglobinuria]] | ! 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;" | | | align="left" style="background:#F5F5F5;" | | ||
* [[PIGA]] gene mutations | * [[PIGA]] gene mutations | ||
Line 526: | Line 503: | ||
| align="center" style="background:#F5F5F5;" | NA | | align="center" style="background:#F5F5F5;" | NA | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Hereditary spherocytosis]] | ! 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;" | | | align="left" style="background:#F5F5F5;" | | ||
* [[Mutations]] in [[Ankyrin]], [[Band 3]], [[Protein 4.2]], and [[spectrin]] | * [[Mutations]] in [[Ankyrin]], [[Band 3]], [[Protein 4.2]], and [[spectrin]] | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Microangiopathic hemolytic anemia]] | ! 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="center" style="background:#F5F5F5;" | − | ||
| align="left" style="background:#F5F5F5;" | Associated with | | align="left" style="background:#F5F5F5;" | Associated with | ||
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* Helmet cells | * Helmet cells | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |Macroangiopathic hemolytic anemia | ! 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;" | | | align="left" style="background:#F5F5F5;" | | ||
* [[Autoimmunity|Autoimmune]] | * [[Autoimmunity|Autoimmune]] | ||
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* [[Spherocytosis|Spherocytes]] or [[Red blood cell|schistocytes]] | * [[Spherocytosis|Spherocytes]] or [[Red blood cell|schistocytes]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Autoimmune hemolytic anemia]] | ! 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="center" style="background:#F5F5F5;" | − | ||
| align="left" style="background:#F5F5F5;" | Associated with: | | align="left" style="background:#F5F5F5;" | Associated with: | ||
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* [[Red blood cell|RBC]] agglutination | * [[Red blood cell|RBC]] agglutination | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Aplastic anemia]] | ! 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;" | | | align="left" style="background:#F5F5F5;" | | ||
* Constitutive expression of Tbet | * Constitutive expression of Tbet | ||
Line 725: | Line 702: | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Folate deficiency]] | ! align="center" style="background:#DCDCDC;" |[[Folate deficiency]]<ref name="pmid25663227">{{cite journal |vauthors=Koike H, Takahashi M, Ohyama K, Hashimoto R, Kawagashira Y, Iijima M, Katsuno M, Doi H, Tanaka F, Sobue G |title=Clinicopathologic features of folate-deficiency neuropathy |journal=Neurology |volume=84 |issue=10 |pages=1026–33 |date=March 2015 |pmid=25663227 |doi=10.1212/WNL.0000000000001343 |url=}}</ref> | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
* Impaired [[DNA]] synthesis | * Impaired [[DNA]] synthesis | ||
Line 761: | Line 738: | ||
* | * | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Vitamin B12 deficiency]] | ! align="center" style="background:#DCDCDC;" |[[Vitamin B12 deficiency]]<ref name="pmid25189324">{{cite journal |vauthors=Hunt A, Harrington D, Robinson S |title=Vitamin B12 deficiency |journal=BMJ |volume=349 |issue= |pages=g5226 |date=September 2014 |pmid=25189324 |doi= |url=}}</ref> | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
* Impaired [[DNA synthesis]] | * Impaired [[DNA synthesis]] | ||
Line 801: | Line 778: | ||
* [[Ovalocytosis|Ovalocytes]] | * [[Ovalocytosis|Ovalocytes]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Orotic aciduria]] | ! align="center" style="background:#DCDCDC;" |[[Orotic aciduria]]<ref name="pmid25757096">{{cite journal |vauthors=Grohmann K, Lauffer H, Lauenstein P, Hoffmann GF, Seidlitz G |title=Hereditary orotic aciduria with epilepsy and without megaloblastic anemia |journal=Neuropediatrics |volume=46 |issue=2 |pages=123–5 |date=April 2015 |pmid=25757096 |doi=10.1055/s-0035-1547341 |url=}}</ref> | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
* [[Autosomal recessive]] | * [[Autosomal recessive]] | ||
Line 828: | Line 805: | ||
| align="center" style="background:#F5F5F5;" |NA | | align="center" style="background:#F5F5F5;" |NA | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Fanconi anemia]] | ! align="center" style="background:#DCDCDC;" |[[Fanconi anemia]]<ref name="pmid25455269">{{cite journal |vauthors=Alter BP |title=Fanconi anemia and the development of leukemia |journal=Best Pract Res Clin Haematol |volume=27 |issue=3-4 |pages=214–21 |date=2014 |pmid=25455269 |pmc=4254647 |doi=10.1016/j.beha.2014.10.002 |url=}}</ref> | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
* [[Autosomal recessive]] | * [[Autosomal recessive]] | ||
Line 878: | Line 855: | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Diamond-Blackfan anemia]] | ! align="center" style="background:#DCDCDC;" |[[Diamond-Blackfan anemia]]<ref name="pmid24665981">{{cite journal |vauthors=Vlachos A, Blanc L, Lipton JM |title=Diamond Blackfan anemia: a model for the translational approach to understanding human disease |journal=Expert Rev Hematol |volume=7 |issue=3 |pages=359–72 |date=June 2014 |pmid=24665981 |doi=10.1586/17474086.2014.897923 |url=}}</ref> | ||
| align="left" style="background:#F5F5F5;" |Mutations in: | | align="left" style="background:#F5F5F5;" |Mutations in: | ||
* ''RPL5'' | * ''RPL5'' | ||
Line 918: | Line 895: | ||
| align="center" style="background:#F5F5F5;" |NA | | align="center" style="background:#F5F5F5;" |NA | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Infection|Infections]] | ! 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="center" style="background:#F5F5F5;" | − | ||
| align="left" style="background:#F5F5F5;" | Associated with | | align="left" style="background:#F5F5F5;" | Associated with | ||
Line 946: | Line 923: | ||
* Maltese crosses | * Maltese crosses | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Chronic renal failure|Chronic kidney disease]] | ! 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="center" style="background:#F5F5F5;" |− | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
Line 975: | Line 952: | ||
| align="center" style="background:#F5F5F5;" |Nl | | align="center" style="background:#F5F5F5;" |Nl | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Hepato-biliary diseases|Liver disease]] | ! align="center" style="background:#DCDCDC;" |[[Hepato-biliary diseases|Liver disease]]<ref name="pmid23953338">{{cite journal |vauthors=Marks PW |title=Hematologic manifestations of liver disease |journal=Semin. Hematol. |volume=50 |issue=3 |pages=216–21 |date=July 2013 |pmid=23953338 |doi=10.1053/j.seminhematol.2013.06.003 |url=}}</ref> | ||
| align="center" style="background:#F5F5F5;" |− | | align="center" style="background:#F5F5F5;" |− | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
Line 1,008: | Line 985: | ||
* [[Macrocyte|Target macrocytes]] | * [[Macrocyte|Target macrocytes]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Alcoholism]] | ! align="center" style="background:#DCDCDC;" |[[Alcoholism]]<ref name="pmid24588059">{{cite journal |vauthors=Yokoyama A, Yokoyama T, Brooks PJ, Mizukami T, Matsui T, Kimura M, Matsushita S, Higuchi S, Maruyama K |title=Macrocytosis, macrocytic anemia, and genetic polymorphisms of alcohol dehydrogenase-1B and aldehyde dehydrogenase-2 in Japanese alcoholic men |journal=Alcohol. Clin. Exp. Res. |volume=38 |issue=5 |pages=1237–46 |date=May 2014 |pmid=24588059 |doi=10.1111/acer.12372 |url=}}</ref> | ||
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Latest revision as of 19:24, 24 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asra Firdous, M.B.B.S.[2]
Overview
Anemia of prematurity should be differentiated from anemia due to increased red blood cell destruction, increased blood loss, and decreased red blood cell production. It should also be differentiated from other causes of normocytic normochromic anemia.
Differential Diagnosis
Anemia of prematurity should be differentiated from anemia due to increased red blood cell destruction, increased blood loss, and decreased red blood cell production. Anemia of prematurity should also be differentiated from other causes of normocytic normochromic anemia.[1]
Increased RBC destruction
Anemia of prematurity should be differentiated from anemia due to increased red blood cell destruction:
- Hemolytic anemias
- Congenital fetal infections
- Sepsis
- Disseminated intravascular coagulation
Decrease RBC production
Anemia of prematurity should be differentiated from anemia due to decreased red blood cell production:
- Congenital fetal infections
- Diamond-Blackfan anemia
- Aplastic anemia
- Bone marrow infiltration
- Drug-induced anemia
- Iron deficiency
- Folate and Vitamin B12 deficiency
- Vitamin E deficiency
Increase blood loss
Anemia of prematurity should be differentiated from anemia due to increased blood loss:
Normocytic Normochromic anemia
Differentiating Anemia of prematurity from other diseases
Anemia of prematurity must be differentiated based on different laboratory findings including mean cell volume (MCV), reticulocytosis, and hemolysis.
To review the differential diagnosis of anemia, see below table.
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 | ||||||||||||||
Anemia of prematurity [2] | − |
|
|
− | − | Normochromic | Normocytic | Nl | ↓ | Nl | Nl | ↓ | ↑ | ↑ | ↓ | ↓↓↓ | Predominant red blood cell precursors | |
Iron deficiency anemia[3] | − |
|
− | − | Hypochromic | Microcytic | ↑ | Nl or ↓ | Nl | Nl | ↓ | ↑ | ↑ | ↓ | ↓↓↓ |
| ||
Iron deficiency anemia (early phase)[4] | − |
|
− | − | Normochromic | Normocytic | ↑ | ↓ | Nl | Nl | ↓ | ↑ | ↑ | ↓ | ↓ |
| ||
Lead poisoning[5] | − |
|
|
|
− | − | Hypochromic | Microcytic | Nl | Nl or ↓ | Nl | Nl | Nl to ↓ | Nl | Nl | Nl to ↓ | − | |
Sideroblastic anemia[6] |
|
|
|
|
− | − | Hypochromic | Microcytic | Nl | Nl or ↓ | Nl | Nl | ↑ | Nl | Nl to ↓ | ↑ | − |
|
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 |
Anemia of chronic disease[7] | − | − | − | − | Hypochromic | Microcytic | Nl | Nl or ↓ | Nl | ↑ | ↓ | Nl | ↓ | ↑ | − | NA | ||
Thalassemia[8] | α-thalassemia
|
|
α-thalassemia
|
− | − | Hypochromic | Microcytic | Nl |
|
Nl | Nl | Nl to ↑ | Nl | Nl | ↑ | Nl to ↑ |
| |
G6PD deficiency[9] |
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ but usually causes resolution within 4-7 days | ↓ | ↓ | Nl to ↑ | Nl | ↑ | ↑ | ↑ |
| |||
Pyruvate kinase deficiency[10] |
|
|
|
+ | 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[11] |
|
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl or moderately ↑ | Nl | Nl | Nl or moderately ↑ | ↓ | Nl |
| ||
HbC disease[12] |
|
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | Nl | Nl | Nl | ↓ | − |
| ||
Paroxysmal nocturnal hemoglobinuria[13][14] |
|
|
|
|
+ | Intrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↓ | Nl | ↑ | ↓ | − | NA |
Hereditary spherocytosis[15] |
|
|
+ | 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[16][17] | − | Associated with |
|
+ | Extrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↓ | Nl | − | ↑ | − |
| |
Macroangiopathic hemolytic anemia[18] | Associated with | + | Extrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↓ | Nl | − | − | − | ||||
Autoimmune hemolytic anemia[19] | − | Associated with: |
|
|
+ | Extrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | ↓ | Nl | − | − | − |
|
Aplastic anemia[20] |
|
|
|
− | − | 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 |
Folate deficiency[21] |
|
|
|
|
− | − | Anisochromic | Macrocytic | ↑ | ↓ | Nl | Nl | ↑ | ↑ | ↓ | ↑ | ↑ |
|
Vitamin B12 deficiency[22] |
|
|
|
− | − | Anisochromic | Macrocytic | ↑ | ↓ | Nl | Nl | ↑ | ↑ | ↓ | ↑ | ↑ | ||
Orotic aciduria[23] |
|
|
|
|
− | − | Anisochromic | Macrocytic | ↑ | ↓ | Nl | Nl | ↑ | ↑ | ↓ | ↑ | ↑ | NA |
Fanconi anemia[24] |
|
|
|
− | − | Anisochromic | Macrocytic | ↑ | ↓ | 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 |
Diamond-Blackfan anemia[25] | Mutations in:
|
|
|
|
− | − | Anisochromic | Macrocytic | Nl | ↓ | Nl | Nl | ↑ | ↑ | ↓ | ↑ | ↑ | NA |
Infections[26] | − | Associated with | + | Extrinsic | Normochromic | Normocytic | ↑ | ↑ | ↓ | Nl | Nl | Nl | − | − | − |
| ||
Chronic kidney disease[27] | − | − | − | Normochromic | Normocytic | ↑ | Nl/↑ | Nl | ↑ | ↓ | − | ↓ | ↑ | ↓ | Nl | |||
Liver disease[28] | − |
|
|
− | − | Anisochromic | Macrocytic | ↑ | ↑ | Nl | Nl | ↑ | ↑ | ↓ | ↑ | ↑ | ||
Alcoholism[29] | − |
|
− | − | Anisochromic | Macrocytic | ↑ | ↑ | 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
- ↑ "www.cancertherapyadvisor.com".
- ↑ Strauss RG (November 2010). "Anaemia of prematurity: pathophysiology and treatment". Blood Rev. 24 (6): 221–5. doi:10.1016/j.blre.2010.08.001. PMC 2981681. PMID 20817366.
- ↑ Camaschella C (May 2015). "Iron-deficiency anemia". N. Engl. J. Med. 372 (19): 1832–43. doi:10.1056/NEJMra1401038. PMID 25946282.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Koike H, Takahashi M, Ohyama K, Hashimoto R, Kawagashira Y, Iijima M, Katsuno M, Doi H, Tanaka F, Sobue G (March 2015). "Clinicopathologic features of folate-deficiency neuropathy". Neurology. 84 (10): 1026–33. doi:10.1212/WNL.0000000000001343. PMID 25663227.
- ↑ Hunt A, Harrington D, Robinson S (September 2014). "Vitamin B12 deficiency". BMJ. 349: g5226. PMID 25189324.
- ↑ Grohmann K, Lauffer H, Lauenstein P, Hoffmann GF, Seidlitz G (April 2015). "Hereditary orotic aciduria with epilepsy and without megaloblastic anemia". Neuropediatrics. 46 (2): 123–5. doi:10.1055/s-0035-1547341. PMID 25757096.
- ↑ Alter BP (2014). "Fanconi anemia and the development of leukemia". Best Pract Res Clin Haematol. 27 (3–4): 214–21. doi:10.1016/j.beha.2014.10.002. PMC 4254647. PMID 25455269.
- ↑ Vlachos A, Blanc L, Lipton JM (June 2014). "Diamond Blackfan anemia: a model for the translational approach to understanding human disease". Expert Rev Hematol. 7 (3): 359–72. doi:10.1586/17474086.2014.897923. PMID 24665981.
- ↑ 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.
- ↑ Marks PW (July 2013). "Hematologic manifestations of liver disease". Semin. Hematol. 50 (3): 216–21. doi:10.1053/j.seminhematol.2013.06.003. PMID 23953338.
- ↑ Yokoyama A, Yokoyama T, Brooks PJ, Mizukami T, Matsui T, Kimura M, Matsushita S, Higuchi S, Maruyama K (May 2014). "Macrocytosis, macrocytic anemia, and genetic polymorphisms of alcohol dehydrogenase-1B and aldehyde dehydrogenase-2 in Japanese alcoholic men". Alcohol. Clin. Exp. Res. 38 (5): 1237–46. doi:10.1111/acer.12372. PMID 24588059.