Anemia

Paolo AquinoPGY-IJanuary 2005VA Hospital

Definition

Anemia is a reduction of hemoglobin or volume of red blood cells from normal limitsVariation due to age, genderDecreased production Increased loss

History

Signs of blood lossOnset- rapid vs. gradualFamily historyExposuresDietHistory of infectionPMH- cancer, renal, endocrine

Physical exam

AppearanceVital signsHEENTHeartAbdominal

Laboratory studies

Hemoglobin and hematocritMean corpuscular volumeReticulocytesPeripheral smear

Microcytic anemia

Most common cause: iron-deficiency anemia

ThalassemiaLead poisoningSideroblastic anemiaAnemia of chronic disease

Normocytic anemia

Marrow hypoplasiaMarrow infiltrationMyelofibrosisRenal insufficiencyAnemia of chronic diseaseMild iron deficiencyMixed microcytic/macrocytic

Approach

History and physicalHemoglobin, hematocritReticulocytes decreased production,

increased lossRemember to correct the retic count for the

anemia

Approach

If reticulocytes low, check MCVLow MCV: check iron studies, examine

peripheral blood smear, hemoglobin electrophoresis

Normal MCV: check iron studies, examine peripheral blood smear, test endocrine function, consider bone marrow aspiration

Peripheral smear

Normal RBC size equal to nucleus of a mature lymphocyte

ShapeSpherocytesSickle cellHelmet cellsTear drop cells

Peripheral smear

ColorHypochromasia

Iron deficiencySideroblastic

HyperchromasiaMegaloblastic anemiaSpherocytosis

Peripheral smear

MorphologyHowell-Jolly bodiesBasophilic stipplingHeinz bodies

Requires supravital stain Cabot ring

Nuclear remnants

Peripheral smear

MorphologyRouleaux formationParasitesNucleated RBCsTarget cells

Summary

Once anemia is establishedCheck reticulocyte count

Correct count for anemia Increased retic count indicates RBC loss-

hemolysis or bleedDecreased retic count indicates decreased

RBC productionCheck MCV

Summary

Decreased reticulocyte countNormocytic

check iron studies, examine peripheral blood smear, test endocrine function, consider bone marrow aspiration

Microcyticcheck iron studies, examine peripheral blood

smear, hemoglobin electrophoresis