What is ineffective erythropoiesis?

By William Aird

Refers to the inability to produce adequate number of red blood cells in the presence of increased immature erythroid precursors.

Per Cazzola, M.:

  • In ineffective erythropoiesis, the erythroid marrow is active and expanded (erythroid hyperplasia) but its efficacy in terms of red cell production is impaired and may lead to anemia.
  • Erythroblasts are predominant in the bone marrow, and the M/E ratio is <1:1.
  • Ineffective erythropoiesis is a major pathogenetic mechanism that is responsible for anemia in several inherited and acquired disorders, including:
    • Thalassemia:
      • Transfusion-dependent β-thalassemia (also known as β-thalassemia major) 
      • Nontransfusion-dependent β-thalassemia (also known as β-thalassemia intermedia; including β-thalassemia/Hb E) 
    • Inherited sideroblastic anemias 
    • Congenital dyserythropoietic anemias
    • Megaloblastic anemias 
    • Myelodysplastic syndrome 
  • Patients with ineffective erythropoiesis may have evidence of parenchymal iron overload, which derives from suppression of hepcidin production.