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506 Part VI: The Erythrocyte Chapter 34: Clinical Manifestations and Classification of Erythrocyte Disorders 507

TABLE 34–1. Classification of Anemia
I. Absolute anemia (decreased red cell volume) c. Functional impairment of erythroid and other progeni-
A. Decreased red cell production tors from nutritional and other causes
(1) Megaloblastic anemias (Chap. 41)
1. Acquired
a. Pluripotential hematopoietic stem cell failure (a) Selective malabsorption of vitamin B
12
(Imerslund-Gräsbeck disease)
(1) Autoimmune (Aplastic anemia) (Chap. 35) (b) Congenital intrinsic factor deficiency
(a) Radiation-induced
(c) Transcobalamin II deficiency
(b) Drugs and chemicals (chloramphenicol, (d) Inborn errors of cobalamin metabolism (meth-
benzene, etc.) ylmalonic aciduria, homocystinuria, etc.)
(c) Viruses (non–A-G hepatitis, Epstein-Barr
virus, etc.) (e) Inborn errors of folate metabolism (congenital
folate malabsorption, dihydrofolate deficiency,
(d) Idiopathic methyltransferase deficiency, etc.)
(2) Anemia of leukemia and of myelodysplastic syn- (2) Inborn purine and pyrimidine metabolism defects
dromes (Chaps. 87, 88, and 91) (Lesch-Nyhan syndrome, hereditary orotic aciduria,
(3) Anemia associated with marrow infiltration (Chap. 45) etc.)
(4) Postchemotherapy (Chap. 22) (3) Disorders of iron metabolism (Chap. 42)
b. Erythroid progenitor cell failure (a) Hereditary atransferrinemia
(1) Pure red cell aplasia (parvovirus B19 infection, (b) Hypochromic anemia caused by divalent metal
drugs, associated with thymoma, autoantibodies, transporter (DMT)-1 mutation
etc. [Chap. 36]) (4) Hereditary sideroblastic anemia (Chap. 59)
(2) Endocrine disorders (Chap. 38) (5) Thalassemias (Chap. 48)
(3) Acquired sideroblastic anemia (drugs, copper defi- B. Increased red cell destruction
ciency, etc. [Chaps. 59 and 87]) 1. Acquired
c. Functional impairment of erythroid and other progeni- a. Mechanical
tors from nutritional and other causes
(1) Megaloblastic anemias (Chap. 41) (1) Macroangiopathic (march hemoglobinuria, artifi-
cial heart valves [Chap. 51])
(a) Vitamin B deficiency
12 (2) Microangiopathic (disseminated intravascular
(b) Folate deficiency coagulation [DIC]; thrombotic thrombocytopenic
(c) Acute megaloblastic anemia because of nitrous purpura [TTP]; vasculitis [Chaps. 51, 122, and 129])
oxide (N O) (3) Parasites and microorganisms (malaria, bartonellosis,
2
(d) Drug-induced megaloblastic anemia (peme- babesiosis, Clostridium perfringens, etc. [Chap. 53])
trexed, methotrexate, phenytoin toxicity, etc.) b. Antibody mediated
(2) Iron-deficiency anemia (Chap. 42) (1) Warm-type autoimmune hemolytic anemia (Chap. 54)
(3) Anemia resulting from other nutritional deficiencies (2) Cryopathic syndromes (cold agglutinin disease,
(Chap. 44) paroxysmal cold hemoglobinuria, cryoglobuline-
(4) Anemia of chronic disease and inflammation mia [Chap. 54])
(Chap. 37) (3) Transfusion reactions (immediate and delayed
(5) Anemia of renal failure (Chap. 37) [Chaps. 54 and 136])
(6) Anemia caused by chemical agents (lead toxicity c. Hypersplenism (Chap. 56)
[Chap. 52]) d. Red cell membrane disorders (Chap. 46)
(7) Acquired thalassemias (seen in some clonal (1) Spur cell hemolysis
hematopoietic disorders [Chaps. 48 and 83]) (2) Acquired acanthocytosis and acquired stomatocy-
(8) Erythropoietin antibodies (Chap. 36) tosis, etc.
2. Hereditary e. Chemical injury and complex chemicals (arsenic, cop-
a. Pluripotential hematopoietic stem cell failure (Chap. 35) per, chlorate, spider, scorpion, and snake venoms, etc.
(1) Fanconi anemia [Chap. 52])
(2) Shwachman syndrome f. Physical injury (heat, oxygen, radiation [Chap. 52])
(3) Dyskeratosis congenita 2. Hereditary
a. Hemoglobinopathies (Chap. 49)
b. Erythroid progenitor cell failure
(1) Diamond-Blackfan syndrome (Chap. 35) (1) Sickle cell disease
(2) Congenital dyserythropoietic syndromes (Chap. 39) (2) Unstable hemoglobins

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