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Anemia

  • Criteria

    • Hgb < 11
  • Most common causes

    • iron deficiency, blood loss, hemoglobinopathy, drugs (MTX), folate, B12 deficiency
  • Don't miss

    • aplastic anemia, leukemia, GI bleeding
  • Initial labs

    • FOBT, CBC, iron panel, retic count, folate, B12 levels
  • ROS

    • pika, bleeding, diet, EtOH, steatorrhea, surgical hx, fever, nightsweats
  • Px

    • pallor, tachycardia, concave nails
  • Initial tx

    • type and cross if active bleeding
    • transfuse if hemodynamically unstable or if Hgb < 7
  • Microcytic (MCV < 82)

    • iron deficiency (ferritin < 10, TIBC high)
    • blood loss: GI bleeding, menorrhagia, coagulopathy
    • increased demand: pregnancies, growth
    • decreased intake: infants on cow's milk, malabsorption (steatorrhea), poor diet, anorexia
    • hemoglobinopathy: sickle cell, thalassemia
    • decreased synthesis: lead poisoning, isoniazid, pyrazinamide, sideroblastic anemia
    • hereditary spherocytosis [smear, fragility test, MCHC > 36]
  • Normocytic

    • hemolytic anemia (high retic, high bili, low haptoglobin): G6PD, sulfa drugs
    • MAHA (schistocytes on smear): TTP/HUS, DIC, eclampsia
    • autoimmune hemolysis (positive coombs test): mono, cold agglutinins, malignancy
    • sickle cell disease, thalassemia major
    • spherocytosis
    • malaria, babesia (fever, foreign travel)
    • PNH
    • aplastic anemia (low retic): parvo virus (arthralgia, rash), chloramphenicol, MTX, Fanconi's anemia, MM, leukemia, lymphoma, Gaucher's disease, Niemann-Pick, radiation
    • anemia of chronic disease: chronic infection, HIV, malignancy, autoimmune disease, chronic liver dz
    • renal insufficiency
    • hypothyroidism
    • adrenal insufficiency
    • dilutional effect
  • Macrocytic (MCV > 98)

    • folate or B12 deficiency (folate and B12 levels)
    • poor diet: EtOH, lack of vegetables (low folate), strict vegetarian (low B12), exclusively breast fed (infants)
    • malabsorption (steatorrhea): gastrectomy, ileal resection, pernicious anemia, pancreatic insufficiency, celiac dz, bacterial overgrowth, fish tapeworm
    • antifolates: MTX, TMP, phenytoin
    • increased demand: cancer, pregnancy, hyperthyroidism, hemolysis

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.