Myelophthistic anemia

Background

• Form of normocytic anemia
• Infiltrative disorder of bone marrow in the setting of malignancy--invasive tumor, leukemia, lymphoma, granuloma

Clinical Features

• Most pts begin to be symptomatic at ~7gm/dL
• Weakness, fatigue, lethargy, DOE, palpitations
• Skin, nail bed, mucosal pallor
• Widened pulse pressure
• Tachycardia/hypotension in severe cases
• Hepatosplenomegaly as sign of extra medullary hematopoiesis

Differential Diagnosis

Anemia

RBC Loss

• Hemorrhage

RBC consumption (Destruction/hemolytic)

• Hereditary
• Acquired
• Microangiopathic Hemolytic Anemia (MAHA)
• Autoimmune hemolytic anemia

Impaired Production (Hypochromic/microcytic)

• Iron deficiency
• Anemia of chronic disease
• Thalassemia
• Sideroblastic anemia

Aplastic/myelodysplastic (normocytic)

• Marrow failure
• Chemicals (e.g. ETOH)
• Radiation
• Infection (HIV, parvo)

Megaloblastic (macrocytic)

• Vitamin B12/folate deficiency
• Drugs (chemo)
• HIV

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 + anemia

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