Anemia resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Chetan Lokhande, M.B.B.S [2]

Definition

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

1. Aplastic crisis
2. Sickle cell crisis
3. Severe Hemorrhage

Most Common Causes

Inadequate production

1. Iron deficiency anemia
2. Thalassemia
3. Megaloblastic anemia ( Vit B12 , Folate )
4. Hypothyroid
5. Chronic renal disease
6. Bone marrow suppression
7. Pregnancy

Hemolysis

1. Autoimmune hemolytic anemia
2. Hemoglobinopathies
3. RBC membrane defect
4. Splenic sequestration
5. 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 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

Check peripheral smear

↓ EPO production or improper response to EPO

Maturation defect

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

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

References

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