Other marrow failure: PRCA and myelophthisis
- Lesion
Sometimes only red cells stop being made, sometimes tumour fills the marrow, and sometimes another failing organ starves the marrow of signals.
What it is
Beyond aplastic anaemia, red cell production fails in several settings. Pure red cell aplasia suppresses only erythroid progenitors: it may be autoimmune, associated with thymoma or LGL leukaemia, drug-related, caused by persistent parvovirus B19 in immunosuppressed people, or congenital (Diamond–Blackfan anaemia, a ribosomal protein disorder). Myelophthisic anaemia results from marrow replacement by metastatic carcinoma, granulomas or fibrosis. Chronic kidney disease lowers erythropoietin; liver disease, hypothyroidism and other endocrine failures also reduce erythropoiesis.
Step by step
- Autoantibodies or T cells (thymoma, LGL leukaemia, autoimmunity) suppress erythroid progenitors selectively.
- Parvovirus B19 enters erythroid progenitors through the P antigen and destroys them until immunity clears it.
- Infiltrating tumour or granulomas distort marrow and release immature cells into blood.
- Damaged kidneys make little erythropoietin, so progenitors are not stimulated.
- Low thyroid hormone and liver failure reduce oxygen demand or alter cell membranes and production.
Marrow failure beyond aplastic anaemia
| Disorder | Mechanism | Clue |
|---|---|---|
| Pure red cell aplasia | Selective loss of erythroid progenitors (immune, parvovirus, congenital) | Anaemia with very low reticulocytes, normal white cells and platelets |
| Myelophthisic anaemia | Marrow replaced by tumour, granulomas or fibrosis | Leukoerythroblastosis, teardrop cells |
| Anaemia of chronic kidney disease | Low erythropoietin, uraemic inhibitors | Normocytic anaemia, low reticulocytes |
| Anaemia of liver disease | Reduced production plus membrane lipid changes, sometimes bleeding or folate lack | Macrocytes and target cells |
| Anaemia of hypothyroidism | Lower oxygen demand and erythropoietin | Mild normocytic or macrocytic anaemia |
Clinical notes
- A sudden fall in haemoglobin with no reticulocytes in a child with sickle cell disease suggests parvovirus B19.
- Myelophthisis in a patient with known cancer often signals bone marrow metastases.
Test yourself
Think of the answer, then tap the question to see it.
Which virus causes transient aplastic crises?
Parvovirus B19, which infects and kills erythroid progenitors.
Which tumour is associated with pure red cell aplasia?
Thymoma (also large granular lymphocytic leukaemia).
What is the main cause of anaemia in chronic kidney disease?
Reduced production of erythropoietin by the damaged kidneys.
Elsewhere in DurgiPedia
Connections
Microorganisms1
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Diamond-Blackfan anemia: MedlinePlus Genetics (MedlinePlus, US National Library of Medicine, 2026); Anemia | MedlinePlus (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.