Case Vignettes

Question 1

Step 1 laboratory analysis

Answer 1

● Realize there is an anemia…Low Hematocrit/Hemoglobin (H/H)
● What form of anemia may have a normal H/H initially?
● If H/H are only mildly decreased, would be best to repeat the lab
before embarking on an extensive evaluation

Question 2

Step 2 laboratory analysis

Answer 2

Look at the Mean Corpuscular Volume (MCV)
○ <80 fL – Microcytic (small cells)
○ 80 - 100 fL – Normocytic
○ >100 fL – Macrocytic (large cells)

Question 3

Step 3 laboratory analysis

Answer 3

Is the Reticulocyte count elevated?
○ Yes? Consider acute blood loss anemia,
hemolytic anemia, or response to
replacement treatment (Iron, Vit B12,
Folate).
■ Go to Step 4
○ No? Consider bone marrow failure, anemia of chronic disease, renal failure, aplastic anemia, leukemia

Question 4

Step 4 Laboratory analysis

Answer 4

(only if an increased reticulocyte count)
Differentiate between acute blood loss, response to therapy, or hemolysis,

Question 5

Step 4a Laboratory analysis

Answer 5

(searching for evidence of hemolysis)
● May see elevated Bilirubin
● Elevated lactate dehydrogenase (LDH)
● Damaged cells on peripheral blood smear
● May see elevated BUN/Creatinine