title: How to approach chronic anemia.
abstract: We present herein an approach to diagnosing the cause of chronic anemia based on a patient's history and complete blood cell count (CBC). Four patterns that are encountered frequently in CBCs associated with chronic anemias are considered: (1) anemia with abnormal platelet and/or leukocyte counts, (2) anemia with increased reticulocyte counts, (3) life-long history of chronic anemia, and (4) anemia with inappropriately low reticulocytes. The pathophysiologic bases for some chronic anemias with low reticulocyte production are reviewed in terms of the bone marrow (BM) events that reduce normal rates of erythropoiesis. These events include: apoptosis of erythroid progenitor and precursor cells by intrinsic and extrinsic factors, development of macrocytosis when erythroblast DNA replication is impaired, and development of microcytosis due to heme-regulated eIF2α kinase inhibition of protein synthesis in iron-deficient or thalassemic erythroblasts.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. mark.koury@vanderbilt.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Koury
authors.forename: Melissa
authors.initials: M
authors.lastname: Rhodes
mesh_terms: D000465:Algorithms; D000740:Anemia / Q000175:diagnosis* / Q000628:therapy*; D001772:Blood Cell Count; D001792:Blood Platelets / Q000166:cytology; D001853:Bone Marrow / Q000378:metabolism; D002908:Chronic Disease; D004261:DNA Replication; D004900:Erythroblasts / Q000378:metabolism; D004912:Erythrocytes / Q000166:cytology; D004920:Erythropoiesis; D015852:Eukaryotic Initiation Factor-2 / Q000378:metabolism; D005260:Female; D006405:Hematology / Q000379:methods*; D006801:Humans; D007962:Leukocytes / Q000166:cytology; D008297:Male; D012156:Reticulocytes / Q000166:cytology; D013789:Thalassemia / Q000378:metabolism
chemical_list: D015852:Eukaryotic Initiation Factor-2