Anemia resident survival guide: Difference between revisions
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==Do's== | ==Do's== | ||
*1.Before evaluating for anemia ask | *1.Before evaluating for anemia, ask about the following: | ||
** | **Any medical condition that could be associated | ||
** | **Duration of anemia | ||
** | **Ethnicity and race | ||
** | **Any medication use | ||
** | **Occupational history | ||
*2. | *2.Determine if there is anything that shows evidence of: | ||
** | **Decreased red cell production | ||
** | **Increased red cell destruction | ||
** | **Bleeding | ||
** | **Bone marrow suppression | ||
** | **Nutritional deficiency | ||
*3.Do a detailed physical examination and keep a high level of suspicion | *3.Do a detailed physical examination and keep a high level of suspicion | ||
==References== | ==References== | ||
Revision as of 17:41, 21 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Chetan Lokhande, M.B.B.S [2]
Overview
Anemia is defined as a decrease in oxygen-carrying capacity of the blood . It is measured in unit volume concentrations of hemoglobin (Hb), red blood cell volume (MCV), red blood cell number (RBC count).
Causes
Life Threatening Causes
- Aplastic crisis
- Sickle cell crisis
- Severe Hemorrhage
Most Common Causes
Inadequate production
- Iron deficiency anemia
- Thalassemia
- Megaloblastic anemia ( Vit B12 , Folate )
- Hypothyroid
- Chronic renal disease
- Bone marrow suppression
- Pregnancy
Hemolysis
- Autoimmune hemolytic anemia
- Hemoglobinopathies
- RBC membrane defect
- Splenic sequestration
- Sickle cell anemia
Management
| INDICATIONS FOR TESTING Fatigue, weakness, pallor, dizziness, fainting | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Check routine Labs, CBC , smear and reticulocyte count and index | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diagnosed as anemia if Hgb in males < 13g / dl and in females if Hgb < 12g / dl[1][2][3] Check whether corrected reticulocyte index ≥ 2.5 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| If No Check RBC indices | If Yes then | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Normal MCV / MCHC Normocytic Normochromic | Low MCV / MCHC Microcytic Hypochromic | High MCV Macrocytic[4][5] | Check peripheral smear | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ↓ EPO production or improper response to EPO[6][7] | Maturation defect[8] | Maturation defect | Fragmented cells on peripheral smear | No fragmented cells on peripheral smear | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| *Bone marrow disorder Inflammation *Autoimmune disease *Chronic renal disease *Critical illness *Chronic endocrine disorders *Aplastic anemia *Pure red cell aplasia | *Iron deficiency *Chronic disease *Thalassemia (Hemoglobinopathies) *Sideroblastic anemia *Lead toxicity | *Folate, B12 deficiency (Megaloblastic Anemia) * Drug effect *Excessive alcohol use *Hypothyroidism | Suggests hemolytic process *Metabolic defect *Hemoglobinopathies (eg, sickle cell) *Autoimmune destruction *Splenic sequestration *RBC membrane defect *Intravascular hemolysis See Hemolytic Anemia | Suspect hemorrhage and acute blood loss[9] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Abnormal peripheral smear | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| If yes then work up based on smear bone marrow biopsy may be necessary | If no | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ORDER Iron and Iron Binding Capacity and Ferritin check B12, Folate levels | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Start Vit B12,Folate If low | Low / normal TIBC Normal / high ferritin Low / normal iron | High TIBC Low iron Low ferritin | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Inflammation / Chronic Disease Consider Biopsy in this case | Iron Deficiency anemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abbreviations and Formula
MCV = mean cell volume MCHC = mean cell hemoglobin concentration TIBC = total iron binding capacity
Reticulocyte correction for anemia:
Retic Count % x Hgb / Htc x Maturation time correction
Do's
- 1.Before evaluating for anemia, ask about the following:
- Any medical condition that could be associated
- Duration of anemia
- Ethnicity and race
- Any medication use
- Occupational history
- 2.Determine if there is anything that shows evidence of:
- Decreased red cell production
- Increased red cell destruction
- Bleeding
- Bone marrow suppression
- Nutritional deficiency
- 3.Do a detailed physical examination and keep a high level of suspicion
References
- ↑ "Nutritional anaemias. Report of a WHO scientific group". World Health Organ Tech Rep Ser. 405: 5–37. 1968. PMID 4975372.
- ↑ Rodgers, GM.; Becker, PS.; Bennett, CL.; Cella, D.; Chanan-Khan, A.; Chesney, C.; Cleeland, C.; Coccia, PF.; Djulbegovic, B. (2008). "Cancer- and chemotherapy-induced anemia". J Natl Compr Canc Netw. 6 (6): 536–64. PMID 18597709. Unknown parameter
|month=ignored (help) - ↑ Beutler, E.; Waalen, J. (2006). "The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration?". Blood. 107 (5): 1747–50. doi:10.1182/blood-2005-07-3046. PMID 16189263. Unknown parameter
|month=ignored (help) - ↑ Davenport, J. (1996). "Macrocytic anemia". Am Fam Physician. 53 (1): 155–62. PMID 8546042. Unknown parameter
|month=ignored (help) - ↑ Inelmen, EM.; D'Alessio, M.; Gatto, MR.; Baggio, MB.; Jimenez, G.; Bizzotto, MG.; Enzi, G. (1994). "Descriptive analysis of the prevalence of anemia in a randomly selected sample of elderly people living at home: some results of an Italian multicentric study". Aging (Milano). 6 (2): 81–9. PMID 7918735. Unknown parameter
|month=ignored (help) - ↑ Gomes, ME.; Deinum, J.; Timmers, HJ.; Lenders, JW. (2003). "Occam's razor; anaemia and orthostatic hypotension". Lancet. 362 (9392): 1282. doi:10.1016/S0140-6736(03)14572-2. PMID 14575973. Unknown parameter
|month=ignored (help) - ↑ Perera, R.; Isola, L.; Kaufmann, H. (1995). "Effect of recombinant erythropoietin on anemia and orthostatic hypotension in primary autonomic failure". Clin Auton Res. 5 (4): 211–3. PMID 8520216. Unknown parameter
|month=ignored (help) - ↑ Camaschella, C. (2013). "How I manage patients with atypical microcytic anaemia". Br J Haematol. 160 (1): 12–24. doi:10.1111/bjh.12081. PMID 23057559. Unknown parameter
|month=ignored (help) - ↑ Salisbury, AC.; Reid, KJ.; Alexander, KP.; Masoudi, FA.; Lai, SM.; Chan, PS.; Bach, RG.; Wang, TY.; Spertus, JA. (2011). "Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction". Arch Intern Med. 171 (18): 1646–53. doi:10.1001/archinternmed.2011.361. PMID 21824940. Unknown parameter
|month=ignored (help)