Red cells in the marrow can be reduced in many ways: eg. by marrow damage (ie. aplasia, infiltration by other tumors, drug induced damage), decreased stimulation (ie. renal disease, certain endocrine disorders), lack of certain nutrients (ie. iron deficiency anaemia , folate deficiency anaemia), some hereditary disorders (ie. thalassemia, sickle cell anaemia, G6PD deficiency, sideroblastic anaemia), etc.
Similarly, acute destruction or loss can likewise reduce the number of red cells in the bloodstream. Since the spleen is the major filter of the red cells, any inappropriate increase in splenic function will result in unusually high destruction of the red cells. Increased splenic function (or hypersplenism) may be caused by a primary splenic disease or secondary to the complications of other disease states. Other major mechanisms for red cell destruction will include infective causes (eg malaria), self-destructive causes (eg autoimmune hemolytic anaemia), hereditary disorders (eg paroxysmal nocturnal hemoglobinuria), and physical agents (eg burns). Furthermore, in any situations where there is significant bleeding, the number of red cells can also decrease accordingly.
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