Approach To Anemia Flashcards
What is anemia?
Decrease in RBCs mass
What are the 3 causes of anemia ?
Decreased production
Increased destruction (hemolysis)
Loss of RBCs due to blood loss
Some diseases fall into 2 or more categories
When is anemia diagnosed?
When hemoglobin is less than:
13.5 gm/dL in a man
12.0 gm/dL in a woman
Children values vary with age
What to order first to assess anemia ?
CBC with differential Peripheral blood smear Iron studies B12 and folic acid levels LDH and haptoglobin levels
What are the components of a complete blood count?
WBC count: 5-10k RBC count: 4-6M Hemoglobin(Hgb): 12-18g/dL Hematocrit (HCT): 36-52% Platelet count: 140-400k Reticulocyte count: 0.5-1.5% MCV:80-100fL, MCH: 27-31 pg MCHC: 32-36%, MPV:7.4-10.4 fL RDW:11.5-14.5%
What are the causes of microcytic anemia (low MCV)?
Iron deficiency
Lead poisoning
Thalassemia
What are the causes of macrocytic anemia(high MCV)?
Megaloblastic anemia Folate or vitamin B12 deficiency Liver disease Post splenectomy Chemotherapy Hypothyroidism
What are the patterns in microcytic anemia?
Low hemoglobin and hematocrit Low MCV and MCH Often with increased platelet count Usually elevated RDW Clinical correlation with GI or GU blood loss, chronic menstruation
What are the patterns in macrocytic anemia?
Low hemoglobin and hematocrit High MCV, normal or high MCH Often with low platelet count Usually normal RDW Clinical correlation with disease states leading to nutritional deficiency ie malnutrition, alcoholism, parasitic infestation
What are the patterns in acute blood loss anemia?
Low to normal hemoglobin and hematocrit
Normal MCV and MCH
Clinical correlation with whatever organ is spurting blood
What are the patterns in anemia of chronic disease?
Low hemoglobin and hematocrit
Normal MCV and MCH
Clinical correlation with chronic illnesses ie COPD, renal disease, autoimmunity, camcers
What are some diagnostic pearls for anemia workup?
If possible, order all diagnostic tests before any transfusions
Review hematology records to see what is normal for the patient
Careful history and physical: history of previous transfusion, family history of anemia or other blood disorders, medications
What are the typical symptoms of anemia?
Fatigue, weakness, irritability Muscle cramps Headache Dizziness especially with changes in position Chest pain Thirst and anorexia
What are the physical findings in anemia?
Pallor of skin best detected in the palmar crease
Conjunctival pallor
Glossitis
