[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Red cells and bleeding disorders](https://durgical.com/en/general-pathology/areas/red-cells/) › Other marrow failure: PRCA and myelophthisis # 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. Updated Nov 12, 2026 ## Key points - Parvovirus B19 infects and kills erythroid progenitors: transient aplastic crisis in haemolytic anaemias, chronic aplasia in immunosuppressed people. - Thymoma-associated red cell aplasia improves after thymectomy in about half of patients. - Myelophthisis: leukoerythroblastosis and teardrop cells; breast, lung and prostate cancer are the common sources. - Anaemia of kidney disease: mainly low erythropoietin; responds to erythropoiesis-stimulating agents. - Liver disease: slightly macrocytic cells and target cells from lipid changes in the membrane. ## 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](https://durgical.com/en/conditions/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](https://durgical.com/en/conditions/chronic-kidney-disease/) | Low erythropoietin, uraemic inhibitors | Normocytic anaemia, low reticulocytes | | [Anaemia of liver disease](https://durgical.com/en/conditions/cirrhosis/) | Reduced production plus membrane lipid changes, sometimes bleeding or folate lack | Macrocytes and target cells | | [Anaemia of hypothyroidism](https://durgical.com/en/conditions/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. ## Memory aid Only reds gone: think thymus or parvovirus. Teardrops and nucleated reds: think something crowding the marrow. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/other-marrow-failure-prca-and-myelophthisis/) [More Pathology questions →](https://durgical.com/en/practice/?f=pathology) ## Elsewhere in DurgiPedia - [Erythropoiesis and erythropoietin](https://durgical.com/en/physiology/erythropoiesis-and-erythropoietin/) ## Connections ## Related 4 - [Diseases of the thymus](https://durgical.com/en/general-pathology/diseases-of-the-thymus/) - [Essential thrombocythaemia and primary myelofibrosis](https://durgical.com/en/general-pathology/essential-thrombocythaemia-and-primary-myelofibrosis/) - [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/) - [Aplastic anaemia](https://durgical.com/en/general-pathology/aplastic-anaemia/) ## Related conditions 7 - [Pure red cell aplasia (incl. Diamond–Blackfan anaemia)](https://durgical.com/en/conditions/pure-red-cell-aplasia/) - [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/) - [Mediastinal masses (thymoma and anterior mediastinal mass)](https://durgical.com/en/conditions/mediastinal-masses/) - [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/) - [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/) - [Breast cancer](https://durgical.com/en/conditions/breast-cancer/) - [Prostate cancer](https://durgical.com/en/conditions/prostate-cancer/) ## Microorganisms 1 - [Parvovirus B19](https://durgical.com/en/microbiology/parvovirus-b19/) [← All of general pathology](https://durgical.com/en/general-pathology/) 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](https://medlineplus.gov/genetics/condition/diamond-blackfan-anemia/) (MedlinePlus, US National Library of Medicine, 2026); [Anemia | MedlinePlus](https://medlineplus.gov/anemia.html) (MedlinePlus, US National Library of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/other-marrow-failure-prca-and-myelophthisis/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/other-marrow-failure-prca-and-myelophthisis/