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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Myelophthisic Anemia


Text Only Home | Graphic-Rich Site | Overview | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
284.2 - Myelophthisis; Leukoerythroblastic Anemia; Myelophthisic Anemia

Related Terms

  • Leukoerythroblastic Anemia
  • Leukoerythroblastosis
  • Myelopathic Anemia
  • Secondary Myelofibrosis

Overview

Myelophthisic anemia is a type of bone marrow failure caused by the invasion or replacement of normal bone marrow tissue by abnormal tissue. The reduction of normal bone marrow tissue limits the production of red blood cells and platelets while white blood cell production may be normal or increased. The low number of mature red blood cells reduces the oxygen-carrying capacity of the blood, resulting in severe anemia. Low numbers of platelets can result in bleeding.

Cell lines from the marrow including leukemia, lymphoma, and myeloma may infiltrate the marrow or the marrow may be invaded by metastatic cancer. Cancers that spread to the marrow from another location include breast, prostate, lung, and thyroid. Other causes of bone marrow invasion include fungal infections, rare lipid disorders (e.g., Gaucher's or Niemann-Pick disease), and tumors (granulomas) of tuberculosis.

Incidence and Prevalence: In the US, fewer than 10% of individuals with metastatic cancer develop myelophthisic anemia, and those who do are typically in an advanced stage of cancer; the incidence of myelophthisic anemia is higher in geographic areas where access to medical care is limited (Besa).

Source: Medical Disability Advisor



Diagnosis

History: Symptoms of myelophthisic anemia include fatigue, weakness, dizziness, drowsiness, a vague feeling of discomfort or illness (malaise), chest pain, the sensation of a rapid or intense heartbeat (palpitations), and shortness of breath. There may be fever and evidence of infection. Additional symptoms are usually specific for the underlying disease.

Physical exam: On exam, paleness (pallor) of skin, fingernail beds, and mucous membranes and an increased heart rate (tachycardia) may be present. Bruises and bleeding under the skin (petechiae) may be evident. Additional physical signs reflect the underlying disease.

Tests: A complete blood count (CBC) will show a significant decrease in the number of red blood cells (anemia) and platelets (thrombocytopenia). Microscopic examination of a peripheral blood smear will show red blood cells with a characteristic teardrop shape (poikilocytosis), immature white blood cells, and giant platelets. Aspiration of bone marrow may be unsuccessful due to the fibrotic nature of the invaded marrow tissue. Microscopic examination of a bone marrow biopsy will reveal and identify the invasive tissue. Additional tests may be needed (i.e., tuberculosis or lipid storage disorders) to confirm the diagnosis.

Source: Medical Disability Advisor



Treatment

Treatment is aimed at the underlying disease causing the marrow tissue invasion. When caused by infection (i.e., tuberculosis or fungal), the myelophthisic anemia usually corrects itself once the infection is successfully treated. When this anemia is caused by a malignant process, chemotherapy specific to the type of malignancy is indicated. During treatment of the underlying disease, the individual may need blood transfusions to boost blood counts to safe levels and antibiotics to prevent infection. If the spleen is enlarged, surgical removal (splenectomy) may be necessary. Some individuals with low levels of the hormone erythropoietin (EPO), which stimulates bone marrow to produce blood cells, may benefit from EPO supplementation.

Source: Medical Disability Advisor



Prognosis

The prognosis depends on the underlying cause. When caused by a treatable underlying condition such as a fungal infection or tuberculosis, the anemia is corrected when the underlying condition is treated. In many cases, however, the underlying cause may not respond to treatment. For example, this is the case when the invasive tissue is metastatic cancer, an end stage cancer that is usually fatal.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Hematologist
  • Infectious Disease Internist
  • Oncologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Blood-clotting disorders
  • Immune system disorders

Source: Medical Disability Advisor



Complications

Complications include infection, hemorrhage, tissue damage (hypoxia), and death due to inadequate oxygen levels in the blood. If the platelet count of an individual drops to a dangerously low level, severe, even life-threatening bleeding can occur, particularly inside the brain (intracranial hemorrhage). Splenectomy carries the risk of infection.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors that may influence the length of disability include the severity of the condition, the underlying medical condition causing the anemia, any complications, and the individual's access to medical care and response to treatment.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work responsibilities may need to be sedentary due to weakness and fatigue. Exposure to individuals with infection should be limited. Individuals with significantly decreased platelet counts need a safe work environment to avoid the risk of personal injury that could trigger acute bleeding. Where indicated, protective gear, especially to the head, should be worn. Office work or sedentary work would probably be more appropriate than strenuous work involving heavy lifting or other physical exertion. The appropriate level of care should be obtained quickly in the event of an on-the-job injury. The underlying cause of the condition will dictate further restrictions or accommodations.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have weakness, dizziness, drowsiness, a vague feeling of discomfort or illness (malaise), chest pain, the sensation of a rapid or intense heartbeat (palpitations), and shortness of breath? Fever or evidence of infection?
  • Does individual have a history that points to an underlying disease, such as advanced cancer or tuberculosis?
  • On exam, does individual have paleness (pallor) of skin, fingernail beds, and mucous membranes and an increased heart rate (tachycardia)? Are bruises and bleeding under the skin (petechiae) evident?
  • Was a complete blood count (CBC) done? Did results show a significant decrease in the number of red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia)?
  • Was microscopic examination of a peripheral blood smear done? Did it show an increase in the number of immature red and white blood cells and platelets? Do the red blood cells have a characteristic teardrop shape (poikilocytosis)?
  • Was the underlying condition identified?
  • Were other causes of marrow invasion ruled out?

Regarding treatment:

  • Was the underlying condition treated (i.e., antibiotics or antifungal medications for infection, chemotherapy for malignancy, or surgery for spleen enlargement)? If not, what other treatment options are available?
  • Are blood counts kept at safe levels by regular monitoring and periodic transfusions?

Regarding prognosis:

  • Has the underlying condition responded favorably to treatment? If not, what other treatment options are available?
  • Are efforts concerning individual's environment being made to prevent infection and injury? Does individual have access to emergency medical care?
  • Has individual experienced any complications that may affect recovery?

Source: Medical Disability Advisor



References

Cited

Besa, Emmanuel, Ulrich Woermann, and C. Wullstein. "Myelophthisic Anemia." eMedicine. Eds. Koyamangalath Krishnan, et al. 8 Apr. 2002. Medscape. 20 Oct. 2004 <http//emedicine.com/med/topic1562.htm>.

Source: Medical Disability Advisor