Myelophthistic anemia
Revision as of 18:00, 3 August 2015 by Kurtucla05 (talk | contribs)
Background
- Form of normocytic anemia
- Associated with 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
- 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 + 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