Idiopathic Autoimmunity

Predisposing Risk Factors

-Age-Gender-Race-Lifestyle Choices

Precipitating Risk factors

-Treatment with high dose radiation or chemotherapy-Exposure to toxic chemicals-Drug induced(Chloramphenicol)-Autoimmune blood disorders-Pregnancy (Rare)-Genetic

Activation of cytotoxic T cells Mutation in genes responsible for telomere repair complex

Targets own marrow stem cells

Depletion and damage of hematopoietic stem cells

Reduction in bone marrow progenitorsDepression or cessation of activity of all blood producing elements

Deficiency in the repair capacity of

hematopoietic tissue.

Depletion and damage of hematopoietic stem cells

Decreased Normochromic, normocyric RBcs

Pancytopenia

Normocytic Anemia Aplastic Anemia

Clinical manifestations:

Fatigue Shortness of breath with exertion Rapid or irregular heart rate Pale skin Frequent or prolonged infections Unexplained or easy bruising Nosebleeds and bleeding gums Prolonged bleeding from cuts Skin rash Dizziness Headache

Diagnostic tests:

1. Bone marrow aspirate and biopsy: to rule out other causes of pancytopenia (i.e. neoplastic infiltration or significant myelofibrosis).

2. History of iatrogenic exposure to cytotoxic chemotherapy: can cause transient bone marrow suppression

3. X-rays, computed tomography (CT) scans, or ultrasound imaging tests: enlarged lymph nodes (sign of lymphoma), kidneys and bones in arms and hands (abnormal in Fanconi anemia)

4. Chest X-ray: infections5. Liver tests: liver diseases6. Viral studies: viral infections7. Vitamin B12 and folate levels: vitamin deficiency8. Blood tests for paroxysmal nocturnal hemoglobinuria9. Test for antibodies: immune competency

Medications/ Treatment:-Blood transfusions-Immunosuppressant-Bone marrow stimulants-antibiotics, antiviral

Surgical Management:

-Bone marrow transplant

Iron level insufficiency in the body

Impaired/insufficient Hemoglobin synthesis in the red bone marrow

Red Cell release insufficiency

Abnormal Heme Synthesis

Predisposing Risk Factors

-Age-Gender-Race-Lifestyle Choices

Precipitating Risk factors

-Low iron dietary intake-Gynaecologic abnormalities-Chronic bleeding-Pregnancy-Mal absorption Problems

Chronic Bleeding(Due to chronic conditions)

Prolonged/ Over activation of response to initiate Erythropoiesis

Iron store depletion

Formation of Hypochromic, small, non functional RBCs

Iron deficiency anemia

Microcytic Anemia

Clinical Manifestations:

Weakness Loss of appetite Pale lips Sore mouth Pale eyelids Lightheadedness Headache Early symptoms are mild Shortness of breath after exercise Concentration problems Sleeping problems Rapid heartbeat Irregular heartbeat Chest pain Dizziness Impaired cognitive ability Cold skin Fatigue Tiredness Mild early symptoms Pallor Anemia Concave nails Brittle nails Husky voice Tongue inflammation Difficulty swallowing Low levels of iron in blood Low levels of haemoglobin Reduced red blood cell count Pica Persistent urge to consume ice Persistent urge to consume clay Asymptomatic in mild cases Fingernail abnormalities

Laboratory diagnosis

1. Serum ferritin, an iron storage protein, is low

2. Decreased serum iron, increased iron binding capacity, < 16% saturation

3. Microcytosis, hypochromia, anisocytosis, poikilocytosis

4. Increased red cell distribution width(RDW)

5. Decreased absolute reticulocyte count with inadequate response to anemia.

6. Normal WBCs 7. thrombocytosis8. Decreased iron stains in the bone marrow