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Updated: Dec 15 2021

Anemia Overview

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https://upload.medbullets.com/topic/120222/images/differential for anemia - moises d.jpg
  • Snapshot
    • A 20-year-old woman who is a vegan with a history of heavy menses presents with fatigue. She states that she barely has the energy to do anything anymore. She denies substance abuse and states she gets a good 9 hours of sleep every night. On exam you see a thin young woman who is tired appearing with palor of her conjunctivae on physical exam. Her blood pressure is 95/60 mmHg and pulse is 88/minute.
  • Introduction
    • Defined as low hematocrit and/or hemoglobin relative to normal values
    • Risk factors include
      • neoplasia
      • family history
      • alcoholism
      • GI bleeding
      • vegan diet
      • African-American descent
      • Mediterranean descent
  • Presentation
    • Symptoms
      • weakness
      • fatigue
      • dyspnea on exertion
    • Physical exam
      • pallor
      • tachycardia
      • systolic flow murmor
      • jaundice
      • positive stool guiac
    • May present as angina
  • studies
    • Initially assess
      • hematocrit
      • MCV
      • reticulocyte count
      • peripheral blood smear
    • If microcytic follow with
      • ferritin
      • iron
      • TIBC
    • If macrocytic follow with
      • RBC folate
      • serum B12
    • If normocytic follow with
      • Coombs test
      • iron studies
      • bilirubin
    • Screen for malignancy, haptoglobin levels, and Guiac
  • Differential
      • Microcytic Anemias
      • Findings
      • Low ferritin
      • Low serum Fe
      • High TIBC
      • Thalassemia
      • HbF increased, low MCV, hemolysis
      • Sideroblastic Anemia
      • High ferritin
      • High serum Fe
      • Low TIBC
      • Lead poisoning
      • Low MCV, basophilic stippling, increased free erythrocyte porphyrins
      • Macrocytic Anemia
      • Labs and Miscellaneous
      • B12 / Folate deficiency
      • Increased MCV, increased LDH, decreased haptoglobin
      • Hemolytic Anemia:
      • Mechanical
      • Immunologic
      • Increased reticulocyte count
      • Positive Coombs test
      • Drug exposure
      • History of phenytoin, phenobarbital, or MTX
      • Diamond-Blackfan
      • Congenital "pure RBC anemia" with triphalangeal thumbs and a webbed neck
      • Hypoproliferative Anemia
      • Normocytic
      • Labs and Miscellaneous
      • Hemorrhage
      • Watch CVP, not the Hct
      • Chronic disease
      • High ferritin
      • Low serum Fe
      • Low TIBC
      • Renal failure
      • High ferritin
      • Low serum Fe
      • Low TIBC
      • Infection
      • Osteomyelitis, HIV, Mycoplasma, or EBV
      • Bone marrow disease
      • Leukemia, lymphoma, or myelodysplasia
      • Intrinsic Hemolysis
      • Normocytic
      • Labs and Miscellaneous
      • G6PD
      • Decreased serum haptoglobin
      • Hereditary spherocytosis
      • Decreased serum haptoglobin
      • Extrinsic Hemolysis
      • Normocytic
      • Labs and Miscellaneous
      • Cold agglutinins
      • Osteomyelitis, HIV, Mycoplasma, or EBV
      • Autoimmune
      • Increased LDH, K+ and bilirubin, decreased haptoglobin
      • Mechanical destruction
      • Microangiopathic Hemolytic (TTP, HUS, or DIC)
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