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 login to view 7 more bullets Presentation Symptoms login to view 3 more bullets Physical exam login to view 5 more bullets May present as angina studies Initially assess login to view 4 more bullets If microcytic follow with login to view 3 more bullets If macrocytic follow with login to view 2 more bullets If normocytic follow with login to view 3 more bullets Screen for malignancy, haptoglobin levels, and Guiac Differential Microcytic Anemias Findings Iron deficiency 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)