Anemia of prematurity differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Anemia of prematurity}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Anemia_of_prematurity]]
{{CMG}}; {{AE}} {{Asra}}
{{CMG}}; {{AE}} {{Asra}}


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==Differential Diagnosis==
==Differential Diagnosis==
[[Anemia of prematurity]] should be differentiated from [[anemia]] due to increased [[red blood cell]] destruction, increased [[blood loss]], and decreased [[red blood cell]] production. [[Anemia of prematurity]] should also be differentiated from other causes of [[normocytic]] [[normochromic]] anemia.
[[Anemia of prematurity]] should be differentiated from [[anemia]] due to increased [[red blood cell]] destruction, increased [[blood loss]], and decreased [[red blood cell]] production. [[Anemia of prematurity]] should also be differentiated from other causes of [[normocytic]] [[normochromic]] anemia.<ref>{{cite web |url=https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/pediatrics/anemia-of-prematurity/#:~:text=Anemia%20of%20prematurity%20is%20a,cell%20transfusions%20to%20replace%20loss. |title=www.cancertherapyadvisor.com |format= |work= |accessdate=}}</ref>


===Increased RBC destruction===
===Increased RBC destruction===
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==Differentiating Anemia of prematurity from other diseases==
==Differentiating Anemia of prematurity from other diseases==
 
[[Anemia of prematurity]] must be differentiated based on different laboratory findings including [[mean cell volume]] ([[MCV]]), [[reticulocytosis]], and [[hemolysis]].
[[Anemia of prematurity]] must be differentiated based on different laboratory findings including [[mean cell volume]] ([[MCV]]), reticulocytosis, and hemolysis.


'''''To review the differential diagnosis of anemia, see below table.'''''   
'''''To review the differential diagnosis of anemia, see below table.'''''   


'''''To review the differential diagnosis of microcytic anemia, click [[Microcytic anemia#Differentiating Microcytic Anemia from Other Diseases|here]].'''''
'''''To review the differential diagnosis of normocytic anemia, click [[Normocytic anemia#Differentiating Normocytic Anemia from Other Diseases|here]].'''''
'''''To review the differential diagnosis of macrocytic anemia, click [[Macrocytic anemia differential diagnosis|here]].'''''
'''''To review the differential diagnosis of hypochromic anemia, click [[Hypochromic anemia#Differentiating Hypochromic Anemia from Other Diseases|here]].'''''
'''''To review the differential diagnosis of normochromic anemia, click [[Normochromic anemia#Differentiating Normochromic Anemia from Other Diseases|here]].'''''
'''''To review the differential diagnosis of anisochromic anemia, click [[Anisochromic anemia#Differentiating Anisochromic Anemia from Other Diseases|here]].'''''
'''''To review the differential diagnosis of hemolytic anemia, click [[Hemolytic anemia differential diagnosis|here]].'''''
'''''To review the differential diagnosis of anemia with intrinsic hemolysis, click [[Anemia with intrinsic hemolysis#Differentiating Anemia with intrinsic hemolysis from Other Diseases|here]].'''''
'''''To review the differential diagnosis of anemia with extrinsic hemolysis, click [[Anemia with extrinsic hemolysis#Differentiating Anemia with extrinsic hemolysis from Other Diseases|here]].'''''
'''''To review the differential diagnosis of anemia with low reticulocytosis, click [[Anemia with low reticulocytosis#Differentiating Anemia with low reticulocytosis from Other Diseases|here]].'''''
'''''To review the differential diagnosis of anemia with normal reticulocytosis, click [[Anemia with normal reticulocytosis#Differentiating Anemia with normal reticulocytosis from Other Diseases|here]].'''''


'''''To review the differential diagnosis of anemia with high reticulocytosis, click [[Anemia with high reticulocytosis#Differentiating Anemia with high reticulocytosis from Other Diseases|here]].'''''
{|  
{|  
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
Line 102: Line 79:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Transferrin saturation
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Transferrin saturation
|-
|-
! align="center" style="background:#DCDCDC;" |[[Anemia of prematurity]]  
! align="center" style="background:#DCDCDC;" |[[Anemia of prematurity]] <ref>{{cite journal |vauthors=Strauss RG |title=Anaemia of prematurity: pathophysiology and treatment |journal=Blood Rev. |volume=24 |issue=6 |pages=221–5 |date=November 2010 |pmid=20817366 |pmc=2981681 |doi=10.1016/j.blre.2010.08.001 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |  
*[[Preterm|Premature birth]]
*[[Preterm|Premature birth]]
*[[Low birth weight]]
*[[Low birth weight]]
*[[Phlebotomy]]
*[[Phlebotomy]]
*[[NICU]] admission
*[[NICU]] admission
| align="center" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |  
*[[Pale skin|Pallor]]
*[[Pale skin|Pallor]]
*[[Lethargy]]
*[[Lethargy]]
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| align="center" style="background:#F5F5F5;" | Predominant [[red blood cell]] precursors
| align="center" style="background:#F5F5F5;" | Predominant [[red blood cell]] precursors
|-
|-
! align="center" style="background:#DCDCDC;" |[[Iron deficiency anemia]]
! align="center" style="background:#DCDCDC;" |[[Iron deficiency anemia]]<ref name="pmid25946282">{{cite journal |vauthors=Camaschella C |title=Iron-deficiency anemia |journal=N. Engl. J. Med. |volume=372 |issue=19 |pages=1832–43 |date=May 2015 |pmid=25946282 |doi=10.1056/NEJMra1401038 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
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* Central [[pallor]]
* Central [[pallor]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Iron deficiency anemia]] (early phase)
! align="center" style="background:#DCDCDC;" |[[Iron deficiency anemia]] (early phase)<ref name="pmid24972460">{{cite journal |vauthors=De Andrade Cairo RC, Rodrigues Silva L, Carneiro Bustani N, Ferreira Marques CD |title=Iron deficiency anemia in adolescents; a literature review |journal=Nutr Hosp |volume=29 |issue=6 |pages=1240–9 |date=June 2014 |pmid=24972460 |doi=10.3305/nh.2014.29.6.7245 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
Line 191: Line 168:
* Hypochromasia
* Hypochromasia
|-
|-
! align="center" style="background:#DCDCDC;" |[[Lead poisoning]]
! align="center" style="background:#DCDCDC;" |[[Lead poisoning]]<ref name="pmid25220013">{{cite journal |vauthors=Bain BJ |title=Lead poisoning |journal=Am. J. Hematol. |volume=89 |issue=12 |pages=1141 |date=December 2014 |pmid=25220013 |doi=10.1002/ajh.23852 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
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* Basophilic stippling
* Basophilic stippling
|-
|-
! align="center" style="background:#DCDCDC;" |[[Sideroblastic anemia]]
! align="center" style="background:#DCDCDC;" |[[Sideroblastic anemia]]<ref name="pmid25064706">{{cite journal |vauthors=Bottomley SS, Fleming MD |title=Sideroblastic anemia: diagnosis and management |journal=Hematol. Oncol. Clin. North Am. |volume=28 |issue=4 |pages=653–70, v |date=August 2014 |pmid=25064706 |doi=10.1016/j.hoc.2014.04.008 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
* Defect in [[ALA synthase]] gene
* Defect in [[ALA synthase]] gene
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
|-
|-
! align="center" style="background:#DCDCDC;" |[[Anemia of chronic disease]]
! align="center" style="background:#DCDCDC;" |[[Anemia of chronic disease]]<ref name="pmid21239806">{{cite journal |vauthors=Roy CN |title=Anemia of inflammation |journal=Hematology Am Soc Hematol Educ Program |volume=2010 |issue= |pages=276–80 |date=2010 |pmid=21239806 |doi=10.1182/asheducation-2010.1.276 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
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| align="center" style="background:#F5F5F5;" | NA
| align="center" style="background:#F5F5F5;" | NA
|-
|-
! align="center" style="background:#DCDCDC;" |[[Thalassemia]]
! align="center" style="background:#DCDCDC;" |[[Thalassemia]]<ref name="pmid25500521">{{cite journal |vauthors=Zainal NZ, Alauddin H, Ahmad S, Hussin NH |title=α-Thalassemia with Haemoglobin Adana mutation: prenatal diagnosis |journal=Malays J Pathol |volume=36 |issue=3 |pages=207–11 |date=December 2014 |pmid=25500521 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" | '''[[Thalassemia|α-thalassemia]]'''
| align="left" style="background:#F5F5F5;" | '''[[Thalassemia|α-thalassemia]]'''
* '''''α'''''- globin gene deletions
* '''''α'''''- globin gene deletions
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* Anisopoikilocytosis
* Anisopoikilocytosis
|-
|-
! align="center" style="background:#DCDCDC;" |[[Glucose 6 phosphate dehydrogenase deficiency|G6PD deficiency]]
! align="center" style="background:#DCDCDC;" |[[Glucose 6 phosphate dehydrogenase deficiency|G6PD deficiency]]<ref name="pmid24372186">{{cite journal |vauthors=Luzzatto L, Seneca E |title=G6PD deficiency: a classic example of pharmacogenetics with on-going clinical implications |journal=Br. J. Haematol. |volume=164 |issue=4 |pages=469–80 |date=February 2014 |pmid=24372186 |pmc=4153881 |doi=10.1111/bjh.12665 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Defect in [[Glucose-6-phosphate dehydrogenase|G6PD]] enzyme
* Defect in [[Glucose-6-phosphate dehydrogenase|G6PD]] enzyme
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*  
*  
|-
|-
! align="center" style="background:#DCDCDC;" |[[Pyruvate kinase deficiency]]
! align="center" style="background:#DCDCDC;" |[[Pyruvate kinase deficiency]]<ref name="pmid26087744">{{cite journal |vauthors=Grace RF, Zanella A, Neufeld EJ, Morton DH, Eber S, Yaish H, Glader B |title=Erythrocyte pyruvate kinase deficiency: 2015 status report |journal=Am. J. Hematol. |volume=90 |issue=9 |pages=825–30 |date=September 2015 |pmid=26087744 |pmc=5053227 |doi=10.1002/ajh.24088 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
* [[Mutation]] in the ''[[PKLR]]'' and ''[[PKM2|PKM]]'' gene
* [[Mutation]] in the ''[[PKLR]]'' and ''[[PKM2|PKM]]'' gene
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
|-
|-
! align="center" style="background:#DCDCDC;" |[[Sickle-cell disease|Sickle cell anemia]]
! align="center" style="background:#DCDCDC;" |[[Sickle-cell disease|Sickle cell anemia]]<ref name="pmid25431087">{{cite journal |vauthors=Singh PC, Ballas SK |title=Emerging drugs for sickle cell anemia |journal=Expert Opin Emerg Drugs |volume=20 |issue=1 |pages=47–61 |date=March 2015 |pmid=25431087 |doi=10.1517/14728214.2015.985587 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
* Hbs [[point mutation]] causes a single [[Amino acid|amino acid]] replacement in β chain
* Hbs [[point mutation]] causes a single [[Amino acid|amino acid]] replacement in β chain
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* [[Anisocytosis]]
* [[Anisocytosis]]
|-
|-
! align="center" style="background:#DCDCDC;" |HbC disease
! align="center" style="background:#DCDCDC;" |HbC disease<ref name="pmid25335812">{{cite journal |vauthors=Lemonne N, Billaud M, Waltz X, Romana M, Hierso R, Etienne-Julan M, Connes P |title=Rheology of red blood cells in patients with HbC disease |journal=Clin. Hemorheol. Microcirc. |volume=61 |issue=4 |pages=571–7 |date=2016 |pmid=25335812 |doi=10.3233/CH-141906 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
* Glutamic acid–to-lysine [[mutation]] in β-globin
* Glutamic acid–to-lysine [[mutation]] in β-globin
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* [[Target cell|Target cells]]
* [[Target cell|Target cells]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Paroxysmal nocturnal hemoglobinuria]]
! align="center" style="background:#DCDCDC;" |[[Paroxysmal nocturnal hemoglobinuria]]<ref name="pmid1402472">{{cite journal |vauthors=Bunyaratvej A, Butthep P |title=Cytometric analysis of paroxysmal nocturnal hemoglobinuria erythrocytes |journal=J Med Assoc Thai |volume=75 Suppl 1 |issue= |pages=237–42 |date=January 1992 |pmid=1402472 |doi= |url=}}</ref><ref name="pmid25553278">{{cite journal |vauthors=Kahng J, Kim Y, Kim JO, Koh K, Lee JW, Han K |title=A novel marker for screening paroxysmal nocturnal hemoglobinuria using routine complete blood count and cell population data |journal=Ann Lab Med |volume=35 |issue=1 |pages=35–40 |date=January 2015 |pmid=25553278 |pmc=4272963 |doi=10.3343/alm.2015.35.1.35 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
* [[PIGA]] gene mutations
* [[PIGA]] gene mutations
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| align="center" style="background:#F5F5F5;" | NA
| align="center" style="background:#F5F5F5;" | NA
|-
|-
! align="center" style="background:#DCDCDC;" |[[Hereditary spherocytosis]]
! align="center" style="background:#DCDCDC;" |[[Hereditary spherocytosis]]<ref name="pmid23664421">{{cite journal |vauthors=Da Costa L, Galimand J, Fenneteau O, Mohandas N |title=Hereditary spherocytosis, elliptocytosis, and other red cell membrane disorders |journal=Blood Rev. |volume=27 |issue=4 |pages=167–78 |date=July 2013 |pmid=23664421 |doi=10.1016/j.blre.2013.04.003 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
* [[Mutations]] in [[Ankyrin]], [[Band 3]], [[Protein 4.2]], and [[spectrin]]
* [[Mutations]] in [[Ankyrin]], [[Band 3]], [[Protein 4.2]], and [[spectrin]]
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
|-
|-
! align="center" style="background:#DCDCDC;" |[[Microangiopathic hemolytic anemia]]
! align="center" style="background:#DCDCDC;" |[[Microangiopathic hemolytic anemia]]<ref name="pmid26251142">{{cite journal |vauthors=Morishita E |title=[Diagnosis and treatment of microangiopathic hemolytic anemia] |language=Japanese |journal=Rinsho Ketsueki |volume=56 |issue=7 |pages=795–806 |date=July 2015 |pmid=26251142 |doi=10.11406/rinketsu.56.795 |url=}}</ref><ref name="pmid23390027">{{cite journal |vauthors=George JN, Charania RS |title=Evaluation of patients with microangiopathic hemolytic anemia and thrombocytopenia |journal=Semin. Thromb. Hemost. |volume=39 |issue=2 |pages=153–60 |date=March 2013 |pmid=23390027 |doi=10.1055/s-0032-1333538 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" | Associated with
| align="left" style="background:#F5F5F5;" | Associated with
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* Helmet cells
* Helmet cells
|-
|-
! align="center" style="background:#DCDCDC;" |Macroangiopathic hemolytic anemia
! align="center" style="background:#DCDCDC;" |Macroangiopathic hemolytic anemia<ref name="pmid5108522">{{cite journal |vauthors=Westphal RG, Azen EA |title=Macroangiopathic hemolytic anemia due to congenital cardiovascular anomalies |journal=JAMA |volume=216 |issue=9 |pages=1477–8 |date=May 1971 |pmid=5108522 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
* [[Autoimmunity|Autoimmune]]  
* [[Autoimmunity|Autoimmune]]  
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* [[Spherocytosis|Spherocytes]] or [[Red blood cell|schistocytes]]
* [[Spherocytosis|Spherocytes]] or [[Red blood cell|schistocytes]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Autoimmune  hemolytic anemia]]
! align="center" style="background:#DCDCDC;" |[[Autoimmune  hemolytic anemia]]<ref name="pmid26447931">{{cite journal |vauthors=Hill QA |title=Autoimmune hemolytic anemia |journal=Hematology |volume=20 |issue=9 |pages=553–4 |date=October 2015 |pmid=26447931 |doi=10.1179/1024533215Z.000000000401 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" | Associated with:
| align="left" style="background:#F5F5F5;" | Associated with:
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* [[Red blood cell|RBC]] agglutination
* [[Red blood cell|RBC]] agglutination
|-
|-
! align="center" style="background:#DCDCDC;" |[[Aplastic anemia]]
! align="center" style="background:#DCDCDC;" |[[Aplastic anemia]]<ref name="pmid24424170">{{cite journal |vauthors=Dolberg OJ, Levy Y |title=Idiopathic aplastic anemia: diagnosis and classification |journal=Autoimmun Rev |volume=13 |issue=4-5 |pages=569–73 |date=2014 |pmid=24424170 |doi=10.1016/j.autrev.2014.01.014 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |  
| align="left" style="background:#F5F5F5;" |  
* Constitutive expression of Tbet
* Constitutive expression of Tbet
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
|-
|-
! align="center" style="background:#DCDCDC;" |[[Folate deficiency]]
! align="center" style="background:#DCDCDC;" |[[Folate deficiency]]<ref name="pmid25663227">{{cite journal |vauthors=Koike H, Takahashi M, Ohyama K, Hashimoto R, Kawagashira Y, Iijima M, Katsuno M, Doi H, Tanaka F, Sobue G |title=Clinicopathologic features of folate-deficiency neuropathy |journal=Neurology |volume=84 |issue=10 |pages=1026–33 |date=March 2015 |pmid=25663227 |doi=10.1212/WNL.0000000000001343 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Impaired [[DNA]] synthesis
* Impaired [[DNA]] synthesis
Line 761: Line 738:
*  
*  
|-
|-
! align="center" style="background:#DCDCDC;" |[[Vitamin B12 deficiency]]
! align="center" style="background:#DCDCDC;" |[[Vitamin B12 deficiency]]<ref name="pmid25189324">{{cite journal |vauthors=Hunt A, Harrington D, Robinson S |title=Vitamin B12 deficiency |journal=BMJ |volume=349 |issue= |pages=g5226 |date=September 2014 |pmid=25189324 |doi= |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Impaired [[DNA synthesis]]
* Impaired [[DNA synthesis]]
Line 801: Line 778:
* [[Ovalocytosis|Ovalocytes]]
* [[Ovalocytosis|Ovalocytes]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Orotic aciduria]]
! align="center" style="background:#DCDCDC;" |[[Orotic aciduria]]<ref name="pmid25757096">{{cite journal |vauthors=Grohmann K, Lauffer H, Lauenstein P, Hoffmann GF, Seidlitz G |title=Hereditary orotic aciduria with epilepsy and without megaloblastic anemia |journal=Neuropediatrics |volume=46 |issue=2 |pages=123–5 |date=April 2015 |pmid=25757096 |doi=10.1055/s-0035-1547341 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Autosomal recessive]]
* [[Autosomal recessive]]
Line 828: Line 805:
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |NA
|-
|-
! align="center" style="background:#DCDCDC;" |[[Fanconi anemia]]
! align="center" style="background:#DCDCDC;" |[[Fanconi anemia]]<ref name="pmid25455269">{{cite journal |vauthors=Alter BP |title=Fanconi anemia and the development of leukemia |journal=Best Pract Res Clin Haematol |volume=27 |issue=3-4 |pages=214–21 |date=2014 |pmid=25455269 |pmc=4254647 |doi=10.1016/j.beha.2014.10.002 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Autosomal recessive]]
* [[Autosomal recessive]]
Line 878: Line 855:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
|-
|-
! align="center" style="background:#DCDCDC;" |[[Diamond-Blackfan anemia]]
! align="center" style="background:#DCDCDC;" |[[Diamond-Blackfan anemia]]<ref name="pmid24665981">{{cite journal |vauthors=Vlachos A, Blanc L, Lipton JM |title=Diamond Blackfan anemia: a model for the translational approach to understanding human disease |journal=Expert Rev Hematol |volume=7 |issue=3 |pages=359–72 |date=June 2014 |pmid=24665981 |doi=10.1586/17474086.2014.897923 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |Mutations in:
| align="left" style="background:#F5F5F5;" |Mutations in:
* ''RPL5''
* ''RPL5''
Line 918: Line 895:
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |NA
|-
|-
! align="center" style="background:#DCDCDC;" |[[Infection|Infections]]
! align="center" style="background:#DCDCDC;" |[[Infection|Infections]]<ref name="pmid23324217">{{cite journal |vauthors=Bustinduy AL, Parraga IM, Thomas CL, Mungai PL, Mutuku F, Muchiri EM, Kitron U, King CH |title=Impact of polyparasitic infections on anemia and undernutrition among Kenyan children living in a Schistosoma haematobium-endemic area |journal=Am. J. Trop. Med. Hyg. |volume=88 |issue=3 |pages=433–40 |date=March 2013 |pmid=23324217 |pmc=3592521 |doi=10.4269/ajtmh.12-0552 |url=}}</ref>
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" | Associated with
| align="left" style="background:#F5F5F5;" | Associated with
Line 946: Line 923:
* Maltese crosses  
* Maltese crosses  
|-
|-
! align="center" style="background:#DCDCDC;" |[[Chronic renal failure|Chronic kidney disease]]
! align="center" style="background:#DCDCDC;" |[[Chronic renal failure|Chronic kidney disease]]<ref name="pmid26030647">{{cite journal |vauthors=Drawz P, Rahman M |title=Chronic kidney disease |journal=Ann. Intern. Med. |volume=162 |issue=11 |pages=ITC1–16 |date=June 2015 |pmid=26030647 |doi=10.7326/AITC201506020 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |−
| align="center" style="background:#F5F5F5;" |−
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
Line 975: Line 952:
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
|-
|-
! align="center" style="background:#DCDCDC;" |[[Hepato-biliary diseases|Liver disease]]
! align="center" style="background:#DCDCDC;" |[[Hepato-biliary diseases|Liver disease]]<ref name="pmid23953338">{{cite journal |vauthors=Marks PW |title=Hematologic manifestations of liver disease |journal=Semin. Hematol. |volume=50 |issue=3 |pages=216–21 |date=July 2013 |pmid=23953338 |doi=10.1053/j.seminhematol.2013.06.003 |url=}}</ref>
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* [[Macrocyte|Target macrocytes]]
* [[Macrocyte|Target macrocytes]]
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! align="center" style="background:#DCDCDC;" |[[Alcoholism]]
! align="center" style="background:#DCDCDC;" |[[Alcoholism]]<ref name="pmid24588059">{{cite journal |vauthors=Yokoyama A, Yokoyama T, Brooks PJ, Mizukami T, Matsui T, Kimura M, Matsushita S, Higuchi S, Maruyama K |title=Macrocytosis, macrocytic anemia, and genetic polymorphisms of alcohol dehydrogenase-1B and aldehyde dehydrogenase-2 in Japanese alcoholic men |journal=Alcohol. Clin. Exp. Res. |volume=38 |issue=5 |pages=1237–46 |date=May 2014 |pmid=24588059 |doi=10.1111/acer.12372 |url=}}</ref>
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Transferrin saturation
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Transferrin saturation
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specific finding on blood smear
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Latest revision as of 19:24, 24 August 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asra Firdous, M.B.B.S.[2]

Overview

Anemia of prematurity should be differentiated from anemia due to increased red blood cell destruction, increased blood loss, and decreased red blood cell production. It should also be differentiated from other causes of normocytic normochromic anemia.

Differential Diagnosis

Anemia of prematurity should be differentiated from anemia due to increased red blood cell destruction, increased blood loss, and decreased red blood cell production. Anemia of prematurity should also be differentiated from other causes of normocytic normochromic anemia.[1]

Increased RBC destruction

Anemia of prematurity should be differentiated from anemia due to increased red blood cell destruction:

Decrease RBC production

Anemia of prematurity should be differentiated from anemia due to decreased red blood cell production:

Increase blood loss

Anemia of prematurity should be differentiated from anemia due to increased blood loss:

Normocytic Normochromic anemia

Differentiating Anemia of prematurity from other diseases

Anemia of prematurity must be differentiated based on different laboratory findings including mean cell volume (MCV), reticulocytosis, and hemolysis.

To review the differential diagnosis of anemia, see below table.


Disease Genetics Clinical manifestation Lab findings
History Symptoms Signs Hemolysis Intrinsic/

Extrinsic

Hb concentration MCV RDW Reticulocytosis Haptoglobin levels Hepcidin Iron studies Specific finding on blood smear
Serum iron Serum Tfr level Transferrin or TIBC Ferritin Transferrin saturation
Anemia of prematurity [2] Normochromic Normocytic Nl Nl Nl ↓↓↓ Predominant red blood cell precursors
Iron deficiency anemia[3] Hypochromic Microcytic Nl or ↓ Nl Nl ↓↓↓
Iron deficiency anemia (early phase)[4] Normochromic Normocytic Nl Nl
Lead poisoning[5]
  • House painted with chipped paint
Hypochromic Microcytic Nl Nl or ↓ Nl Nl Nl to ↓ Nl Nl Nl to ↓
  • RBCs retain aggregates of rRNA
  • Basophilic stippling
Sideroblastic anemia[6] Hypochromic Microcytic Nl Nl or ↓ Nl Nl Nl Nl to ↓
Disease Genetics History Symptoms Signs Hemolysis Intrinsic/

Extrinsic

Hb concentration MCV RDW Reticulocytosis Haptoglobin levels Hepcidin Serum iron Serum Tfr level IBC Ferritin Transferrin saturation Specific finding on blood smear
Anemia of chronic disease[7] Hypochromic Microcytic Nl Nl or ↓ Nl Nl NA
Thalassemia[8] α-thalassemia
  • α- globin gene deletions
  • Cis deletions
  • Trans deletions

β-thalassemia

α-thalassemia

β-thalassemia

Hypochromic Microcytic Nl
  • Thalassemia trait: Nl or ↓
  • Thalassemia Syndromes: ↑
Nl Nl Nl to ↑ Nl Nl Nl to ↑
G6PD deficiency[9]
  • History of using
+ Intrinsic Normochromic Normocytic ↑ but usually causes resolution within 4-7 days Nl to ↑ Nl
Pyruvate kinase deficiency[10] + Intrinsic Normochromic Normocytic Nl Nl Nl
Disease Genetics History Symptoms Signs Hemolysis Intrinsic/

Extrinsic

Hb concentration MCV RDW Reticulocytosis Haptoglobin levels Hepcidin Serum iron Serum Tfr level IBC Ferritin Transferrin saturation Specific finding on blood smear
Sickle cell anemia[11] + Intrinsic Normochromic Normocytic Nl or moderately ↑ Nl Nl Nl or moderately ↑ Nl
HbC disease[12]
  • Glutamic acid–to-lysine mutation in β-globin
+ Intrinsic Normochromic Normocytic Nl Nl Nl Nl
Paroxysmal nocturnal hemoglobinuria[13][14] + Intrinsic Normochromic Normocytic Nl Nl NA
Hereditary spherocytosis[15] + Intrinsic Normochromic Normocytic Nl Nl Nl
  • Small, round RBCs with less surface area and no central pallor
Disease Genetics History Symptoms Signs Hemolysis Intrinsic/

Extrinsic

Hb concentration MCV RDW Reticulocytosis Haptoglobin levels Hepcidin Serum iron Serum Tfr level IBC Ferritin Transferrin saturation Specific finding on blood smear
Microangiopathic hemolytic anemia[16][17] Associated with + Extrinsic Normochromic Normocytic Nl Nl
  • Helmet cells
Macroangiopathic hemolytic anemia[18] Associated with + Extrinsic Normochromic Normocytic Nl Nl
Autoimmune hemolytic anemia[19] Associated with:
  • Painful, blue fingers and toes with cold weather
+ Extrinsic Normochromic Normocytic Nl Nl
  • RBC agglutination
Aplastic anemia[20]
  • Symptoms based on underlying condition
Normochromic Normocytic Nl Nl Nl
Disease Genetics History Symptoms Signs Hemolysis Intrinsic/

Extrinsic

Hb concentration MCV RDW Reticulocytosis Haptoglobin levels Hepcidin Serum iron Serum Tfr level IBC Ferritin Transferrin saturation Specific finding on blood smear
Folate deficiency[21]
  • Impaired DNA synthesis
Anisochromic Macrocytic Nl Nl
Vitamin B12 deficiency[22] Anisochromic Macrocytic Nl Nl
Orotic aciduria[23]
  • Neurological manifestation
Anisochromic Macrocytic Nl Nl NA
Fanconi anemia[24]
  • Significant for bilateral short thumbs
Anisochromic Macrocytic Nl Nl
Disease Genetics History Symptoms Signs Hemolysis Intrinsic/

Extrinsic

Hb concentration MCV RDW Reticulocytosis Haptoglobin levels Hepcidin Serum iron Serum Tfr level IBC Ferritin Transferrin saturation Specific finding on blood smear
Diamond-Blackfan anemia[25] Mutations in:
  • RPL5
  • RPL11
  • RPL35A
  • RPS7
  • RPS10
  • RPS17
  • RPS19
  • RPS24
  • RPS26
Anisochromic Macrocytic Nl Nl Nl NA
Infections[26] Associated with + Extrinsic Normochromic Normocytic Nl Nl Nl
Chronic kidney disease[27] Normochromic Normocytic Nl/↑ Nl Nl
Liver disease[28]
  • Hepatitis
  • Binge drinking
  • Gall bladder disease
Anisochromic Macrocytic Nl Nl
Alcoholism[29] Anisochromic Macrocytic Nl Nl
Disease Genetics History Symptoms Signs Hemolysis Intrinsic/

Extrinsic

Hb concentration MCV RDW Reticulocytosis Haptoglobin levels Hepcidin Serum iron Serum Tfr level IBC Ferritin Transferrin saturation Specific finding on blood smear

References

  1. "www.cancertherapyadvisor.com".
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  3. Camaschella C (May 2015). "Iron-deficiency anemia". N. Engl. J. Med. 372 (19): 1832–43. doi:10.1056/NEJMra1401038. PMID 25946282.
  4. De Andrade Cairo RC, Rodrigues Silva L, Carneiro Bustani N, Ferreira Marques CD (June 2014). "Iron deficiency anemia in adolescents; a literature review". Nutr Hosp. 29 (6): 1240–9. doi:10.3305/nh.2014.29.6.7245. PMID 24972460.
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  25. Vlachos A, Blanc L, Lipton JM (June 2014). "Diamond Blackfan anemia: a model for the translational approach to understanding human disease". Expert Rev Hematol. 7 (3): 359–72. doi:10.1586/17474086.2014.897923. PMID 24665981.
  26. Bustinduy AL, Parraga IM, Thomas CL, Mungai PL, Mutuku F, Muchiri EM, Kitron U, King CH (March 2013). "Impact of polyparasitic infections on anemia and undernutrition among Kenyan children living in a Schistosoma haematobium-endemic area". Am. J. Trop. Med. Hyg. 88 (3): 433–40. doi:10.4269/ajtmh.12-0552. PMC 3592521. PMID 23324217.
  27. Drawz P, Rahman M (June 2015). "Chronic kidney disease". Ann. Intern. Med. 162 (11): ITC1–16. doi:10.7326/AITC201506020. PMID 26030647.
  28. Marks PW (July 2013). "Hematologic manifestations of liver disease". Semin. Hematol. 50 (3): 216–21. doi:10.1053/j.seminhematol.2013.06.003. PMID 23953338.
  29. Yokoyama A, Yokoyama T, Brooks PJ, Mizukami T, Matsui T, Kimura M, Matsushita S, Higuchi S, Maruyama K (May 2014). "Macrocytosis, macrocytic anemia, and genetic polymorphisms of alcohol dehydrogenase-1B and aldehyde dehydrogenase-2 in Japanese alcoholic men". Alcohol. Clin. Exp. Res. 38 (5): 1237–46. doi:10.1111/acer.12372. PMID 24588059.

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