A 67-year-old male presents with increasing fatigue and is found to be anemic. Physical examination reveals a hard 1-cm nodule in the left lobe of the prostate. The prostatic-specific antigen (PSA) level is found to be elevated. Examination of the peripheral blood reveals an occasional myelocyte. The erythrocytes are mainly normochromic and normocytic, and teardrop RBCs are not found. There are however, about two nucleated red blood cells per 100 white cells. What is the best diagnosis for this patient's anemia?
Myelophthisic anemia results from space-occupying lesions of the bone marrow, such as granulomas or metastatic carcinomas. It is characterized by the presence of leukoerythroblastosis in the peripheral blood. This term refers to finding in the peripheral blood immature white cells, such as myelocytes and metamyelocytes, and immature red blood cells, such as nucleated red blood cells. Metastatic disease in the bone can produce localized bone pain and elevation of alkaline phosphatase that is associated with a normal g-glutamyltransferase (GGT) level. In contrast, microangiopathic hemolytic anemia refers to mechanical destruction (hemolysis) of red cells caused by narrowing within the microvasculature and is seen in patients with prosthetic hea valves or severe calcific aoic stenosis, or in patients having disseminated intravascular coagulopathy, thrombotic thrombocytopenic purpura, or hemolyticuremic syndrome. In addition to microangiopathic HA, other causes of IV mechanical destruction of red cells include march hemoglobinuria and ceain types of infections, such as baonellosis and malaria. Aplastic anemia is a stem cell disorder of the bone marrow that causes a marked decrease in the production of marrow cells that results in extreme marrow hypoplasia. Patients present with symptoms related to pancytopenia (anemia, agranulocytosis, and thrombocytopenia). Because their bone marrow cannot respond normally, patients with aplastic anemia have no increased reticulocytes in the peripheral blood (no polychromasia). Aplastic anemia may be inherited (Fanconi's anemia) or acquired. The most common cause of aplastic anemia is drugs. Other causes include chemicals (benzene and glue sniffing), radiation, and ceain types of infections, such as hepatitis C. There are ceain predisposing conditions, such as PNH, that are associated with an increased risk of developing aplastic anemia. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.
Fanconi's anemia
Microangiopathic hemolytic anemia
Myelophthisic anemia
Autoimmune hemolytic anemia
miscellaneous