welcome back to mad medicine in this lecture we're gonna be discussing aplastic anemia if you guys don't know on our YouTube channel youtube.com forward slash Mad medicine you guys can go and watch all of our he Munk videos and a convenient playlist for you guys for step one and while you're there don't forget to Like comment and subscribe to our channel we'll post brand new videos for you guys every single day so show us some support thank you and with that being said let's talk about normocytic anemias these are gonna be classified based off of an EM CV that is normal 80 to 100 that is the hallmark presentation the hallmark definition of enormous acidic anemia is the MCV you are gonna see that normal ii ii me as it subdivided based off of hemolysis so you can have non hemolytic and hemolytic anemias which can be subdivided into intrinsic and extrinsic hemolytic anemias now when it comes to normocytic anemias we are going to be discussing non hemolytic anemia today and the one we're discussing is called aplastic anemia we have already discussed and anemia of chronic disease and our previous lectures to go check that out on the playlist we will discuss anemia chronic kidney disease and we will also discuss iron deficiency early stage but we have discussed late stage in our microcytic anemia lecture so you can go check it out there now one thing to remember is an enormous lytic anemias especially non hemolytic normocytic anemias you are going to have a reticulocyte count is going to be less than 2% the reason why is because in these conditions in the non-human lytic and emails you just have a decrease in red blood cells that is what's happening the red blood cells are not functioning properly but they're not not just that you have a decrease in the production of red blood cells and if you are licensed ELLs in hemolytic anemias your body's gonna realize that you are running out of red blood cells and therefore it is gonna ramp up production of red blood cells leading to an increase in reticulocyte count we're not gonna see that in non-human lytic anemias so when it comes to aplastic anemia specifically you need to understand that this is a severe life-threatening syndrome severe in which patients will produce will have a lack of production of ripe of white blood cells red blood cells and platelets all that has failed you'll see peripheral pancytopenia and you'll see a hyper cellular hypo cellular bone marrow the way I like to remember this is a plastic anemia is just a plastic bone that's what's happening you're gonna have a plastic you're gonna have a a plastic bone marrow it's not gonna be functioning properly just like in a plastic bone you don't even have any bone marrow to begin with so it doesn't really function like it should so I just think about a plastic bone that doesn't work and that makes me understand what's happening this is a very severe condition definitely understand that so with that being said you need to understand that aplastic anemia occurs in all age groups and all genders and there are several different causes which we will talk about but mainly the symptoms you will see are fatigue malaise pallor petechiae mucosal bleeding and infections and that makes sense the fatigue malaise pallor are going to be caused by decrease in red blood cell production the petechiae and mucosal bleeding will be caused because of decrease in platelets and the infections are all going to be caused due to decrease in white blood cells your body can protect itself now the causes of aplastic anemia are gonna include radiation and medications like benzenes chloramphenicol alkylating agents and antimetabolites and that makes sense these agents are going to mainly target rapidly dividing cells and what is a rapidly dividing cell in your body or they're all located in your bone marrow a lot of them are located there and by using these these drugs that target rapidly dividing cells you will also target your bone marrow and it can lead to in a plastic bone marrow and aplastic anemia viral agents like EBV HIV hepatitis also can cause aplastic anemia idiopathic and immune mediated causes can also lead this and this is mainly gonna be a defect in the primary cell stem cells now this can also follow acute hepatitis and this is gonna be the most common cause so the idiopathic or immune mediated are also going to be very common to most common cause and one of the very low causes very rare diseases that you should know about it's called Fanconi anemia Fanconi anemia can also lead to a plastic anemia so let's talk about that really quickly Fanconi anemia is a condition where patients are gonna have defective DNA repair enzymes right that's what's happening the DNA repair is gonna be defective and that's gonna lead to bone marrow failure and it can lead to a plastic and amia many many cases the DNA repair enzymes are the ones that if defective and that leads patients especially vulnerable to DNA strand cross-linking especially in rapidly dividing cells like in the bone now when it comes to presentation these people will present with a very short stature they're gonna have cafe au lait spots which are just hypo pigmented spots on their body they're gonna have thumb and radial deficits as well as increased incidence of childhood tumors like leukemias myelodysplastic syndromes and squamous cell carcinomas cell carcinoma of the head neck and vulva now when it comes to lab findings you should know that these patients are gonna present with an M CV of 80 to 100 because this is a normal city anemia and in an end in in an in a plastic anemia patients will also have a hypo cellular bone marrow which will show anemia it will show leukopenia and thrombocytopenia so i pancytopenia will be present and when it comes to a bone marrow if you do a biopsy you will see a fatty infiltration a hypo cellular bone marrow and the bone marrow tap will be dry because it is not functioning properly now when it comes to treatment if it is caused by medications you want to stop the offending agent if it is caused idiopathic aliy or it is caused by a immune mediated mechanism you want to give immuno suppression for those patients you can also do a bone marrow allograft you can also give red blood cells and platelets to aid in the anemia and the the thrombocytopenia not looking the Nemean tompa sardinia with the bone marrow and platelets and you can also give gm-csf to stimulate bone marrow and bone marrow production of all of these men all of these these types of cells these white blood cell the red blood cells and the platelets now with that being said thank you so much for watching don't forget to Like comment and subscribe follow us on Instagram at Madison and on Twitter at it's mad medicine and you can find these lectures on your favorite podcast or as for free just search mad medicine now will pop up baby