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A. Intoduction
Myelophthisic anemia is a common finding in patients with carcinoma.
It is most often a hypoproliferative anemia classified as the anemia of
chronic inflammation (chronic disease). In some patients the degree of
anemia correlates with the tumor burden. In others, however, there is no
good correlation between tumor burden and the degree of anemia.
Myelophthisic anemia is caused by space occupying disorders of the
bone marrow. The bone marrow becomes infiltrated with fibrotic,
granulomatous or neoplastic cells. It is also the infiltration of abnormal cells
into the bone marrow and subsequent destruction and replacement of the
normal hematopoietic cells. It is a form of bone marrow failure that results
from the destruction of bone marrow precursor cells and their stroma, which
nurture these cells to maturation and differentiation. It is a type of bone
marrow failure caused by the invasion or replacement of normal bone
marrow tissue by abnormal tissue.
B. Etiology and Morphology
Three main causes of Myelophthisic Anemia:
1) metastatic cancer (most common)
2) infiltrative process (granulomatous diseases)
3) spent phase of myeloproliferative disorders
Other causes of this anemia are the following:
c) Schuller-Christian disease
Agnogenic myeloid metaplasia
Myelofibrosis
Leukemia
In terms of morphology of the cell of a person with this anemia, is
usually normocytic (MCV = 80-100) and normochromic (27-33 pg) which
results to the normal size and hemoglobin content of the cell.
C. Pathogenesis
Marrow fibrosis causes abnormal release of nucleated erythroid precursors
and immature granulocytic. Production of cytokines such as fibroblast growth factor
by the abnormal hematopoietic cell clone (particularly by megakaryocytes) leads to
replacement of the hematopoietic tissue of the bone marrow by connective tissue
via collagen fibrosis. The decrease in hematopoietic tissue impairs the patient's
ability to generate new blood cells, resulting in progressive pancytopenia, a
shortage of all blood cell types. However, the proliferation of fibroblasts and
deposition of collagen is a secondary phenomenon, and the fibroblasts themselves
are not part of the abnormal cell clone.
D. Definitive Signs and symptoms
Person with Myelophthisic anemia experiences the following signs and symptoms:
Fatigue
Malaise
Tachycardia
Chest pain
Shortness of breath
Splenomegaly
Bruising and bleeding under the skin (petechiae)
Paleness (pallor) of skin and fingernail beds
Treatment:
G. Case Study
A 66-year-old man presents with history of back and chest pain, fatigue and
experiences the sensation of a rapid or intense heartbeat. Examination of his
peripheral blood smear reveals the abnormal presence of nucleated red blood cells,
immature white blood cells, myelocytes and immature granulocytes.
His CBC result:
Hb = 9.3 g/dL
Hct = 27.4%
MCV = 88fL
MCH =28 pg
Reticulocyte count = 1.8%
Sources:
4. Gupta, A., Nayak, R,. Rai, S,. Essentials in Hematology and Clinical
Pathology.
MT 2a : Hematology 1
Myelophthisic Anemia