Hematological Disorders Paper

Hematological Disorders Paper

The hematologic system performs several functions, including oxygen and nutrient delivery, clearance of toxic byproducts, defense against infection, and hemostasis (Echeverry & Dalton, 2018). Hematological disorders are a constellation of disease states affecting blood and blood-forming organs and affect millions of Americans. For instance, red blood cells, leucocytes, platelets, bone marrow, spleen, and lymph nodes.

These disorders can be genetic or acquired. However, this discussion will explore the need for a splenectomy after a diagnosis of immune thrombocytopenic purpura and the types of anemia based on a case scenario of a 14-year-old girl with abnormal bruises, gingival bleeding while brushing her teeth, prolonged bleeding after venipuncture and a platelet count of 100 000/mm3.

The need for a splenectomy after diagnosis of ITP

Immune thrombocytopenic purpura is a condition marked by isolated thrombocytopenia secondary to the formation of autoantibodies against platelets (Mccance & Huether, 2019). This condition is predominantly primary/idiopathic, although secondary causes are not uncommon. ITP affects more females than men. It follows a viral infection in children and is usually self-limiting. However, in adults, the condition is typically an incidental finding, and most patients progress to chronic ITP. An individual with ITP can be managed conservatively, with medical therapy and rarely with splenectomy.

Splenectomy is usually reserved as a last resort due to complications of asplenia, including recurrent infections, risk of cancer, and thrombosis. Splenectomy is indicated in ITP if the patient has severe bleeding that is unresponsive to any other intervention (Chaturvedi et al., 2018). Additionally, splenectomy should be considered in ITP patients with treatment-resistant thrombocytopenia lasting more than 12 months (Chaturvedi et al., 2018).

Nevertheless, the spleen ought to be confirmed as the principal site of platelet breakdown using radiolabeled thrombocytes before splenectomy. Following splenectomy, the primary site of antibody production and platelet clearance pulled out substantially, increasing platelet levels. Finally, splenectomy provides the greatest durable response of up to 70% compared to other therapies (Chaturvedi et al., 2018).

Different kinds of anemia

Anemia is defined as a reduction in the absolute quantity of circulating red blood cells for age and sex (Turner et al., 2022). It is evidenced by low RBC count, hemoglobin, or hematocrit. Anemia is customarily a manifestation of an underlying disease. Several classifications exist for categorizing anemia, including according to RBC size and morphology, severity, time course, etiology, inheritance, and RBC proliferation.

However, morphological classification into microcytic, normocytic, and macrocytic is the most widely utilized. Anemia is microcytic, normocytic, and macrocytic when the mean corpuscular volume (MCV) is < 80, 80-100, and > 100 fL, respectively (Turner et al., 2022). Microcytic anemia is caused by decreased hemoglobin production. For instance, diminished heme production due to iron deficiency anemia and lead poisoning, and globin chain production due to thalassemia (Chaparro & Suchdev, 2019).

Normocytic anemia results from diminished blood volume or insufficient erythropoiesis, such as hemolytic anemia, blood loss, and anemia of chronic disease. On the other hand, macrocytic anemia result from delayed nucleus maturation relative to cytoplasm due to defective DNA synthesis and repair (Chaparro & Suchdev, 2019). Macrocytic anemia can be megaloblastic as a result of folate and or vitamin B12 deficiency or non-megaloblastic due to liver disease, alcohol use, and multiple myeloma, among others.

Conclusion

ITP follows a viral infection in children, while it is usually an incidental finding in adults. ITP can be managed conservatively, medically, or with splenectomy. Splenectomy should be reserved for refractory cases due to devastating complications of asplenia. Anemia is usually a manifestation of an underlying disease state and can be classified morphologically as microcytic, normocytic, and macrocytic.

References

Chaparro, C. M., & Suchdev, P. S. (2019). Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of the New York Academy of Sciences1450(nyas.14092), 15. https://doi.org/10.1111/nyas.14092

Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood131(11), 1172–1182. https://doi.org/10.1182/blood-2017-09-742353

Echeverry, G., & Dalton, A. (2018). Hematologic disorders. Anesthesiology Clinics36(4), 553–565. https://doi.org/10.1016/j.anclin.2018.07.006

Mccance, K., & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children 8e (8th ed.). Mosby.

Turner, J., Parsi, M., & Badireddy, M. (2022). Anemia. https://pubmed.ncbi.nlm.nih.gov/29763170/