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Overview of Decreased Erythropoiesis

By

Evan M. Braunstein

, MD, PhD, Johns Hopkins University School of Medicine

Last full review/revision Sep 2021| Content last modified Sep 2021
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Anemias due to decreased erythropoiesis (termed hypoproliferative anemias) are recognized by a reticulocyte count that is inappropriately low for the degree of the anemia.

The RBC indices Testing Anemia is a decrease in the number of red blood cells (RBCs—as measured by the red cell count, the hematocrit, or the red cell hemoglobin content). In men, anemia is defined as hemoglobin read more Testing , mainly the mean corpuscular volume (MCV), can narrow the differential diagnosis of deficient erythropoiesis and help determine what further testing is necessary.

Microcytic anemias result from deficient or defective heme or globin synthesis. Microcytic anemias include

Normocytic anemias are characterized by a normal RBC distribution width (RDW) and normochromic indices. The two most common causes are

Macrocytic anemias can be caused by impaired DNA synthesis leading to megaloblastosis, as occurs with

Other causes of macrocytic anemia include

Some patients with hypothyroidism have macrocytic RBC indices, including some without anemia.

Anemias can have variable findings on the peripheral smear Peripheral smear Anemia is a decrease in the number of red blood cells (RBCs—as measured by the red cell count, the hematocrit, or the red cell hemoglobin content). In men, anemia is defined as hemoglobin read more Peripheral smear . The anemia of chronic disease Anemia of Chronic Disease The anemia of chronic disease is a multifactorial anemia. Diagnosis generally requires the presence of a chronic inflammatory condition, such as infection, autoimmune disease, kidney disease... read more may be microcytic or normocytic. Anemias due to myelodysplastic syndromes Myelodysplastic Syndrome (MDS) The myelodysplastic syndrome (MDS) is group of disorders typified by peripheral cytopenia, dysplastic hematopoietic progenitors, a hypercellular or hypocellular bone marrow, and a high risk... read more may be normocytic, macrocytic, or even microcytic. Anemias due to endocrine disorders (such as hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. It is diagnosed by clinical features such as a typical facial appearance, hoarse slow speech, and dry skin and by low levels of thyroid hormones... read more Hypothyroidism ) or elemental deficiencies (eg, copper deficiency Acquired Copper Deficiency Copper is a component of many body proteins; almost all of the body’s copper is bound to copper proteins. Copper deficiency may be acquired or inherited. (See also Overview of Mineral Deficiency... read more , zinc deficiency Zinc Deficiency Zinc (Zn) is contained mainly in bones, teeth, hair, skin, liver, muscle, leukocytes, and testes. Zinc is a component of several hundred enzymes, including many nicotinamide adenine dinucleotide... read more Zinc Deficiency ) can have variable manifestations, including a normocytic or macrocytic anemia.

Treatment of deficient RBC production depends on the cause.

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