Myelophthistic anemia

Background

• Form of normocytic anemia
• Associated with infiltrative disorder or bone marrow in the setting of malignancy--leukemia, lymphoma, granuloma

Clinical Features

• Anemia in patient with h/o malignancy
• Pale skin
• Tachycardia/hypotension in severe cases
• Hepatosplenomegaly as sign of extra medullary hematopoiesis

Differential Diagnosis

• Aplastic anemia
• Myelofibrosis
• Acute blood loss anemia
• Bone marrow suppression
• Anemia of chronic disease
• Hemolytic anemia

Diagnosis

• Requires bone marrow biopsy
• Labs show normocytic anemia with decreased reticulocyte count
• Exam with signs of extra medullary hematopoiesis
• Index of suspicion in setting of malignancy

Management

• Identify anemia as emergent or non-emergent
• Evaluate for superimposed etiologies of anemia (Ie acute blood loss) and target treatment in the ED
• If emergent anemia get IV access, transfuse for signs of end organ damage--AMS, hypotension, chest pain, shortness of breath, decreased UOP
• Will need treatment of underlying malignancy to allow marrow recovery while supporting hemodynamics

Disposition

• Admit for bone marrow biopsy and treatment of underlying disease

See Also

• [Anemia]
• [Transfusions]