Anemia
Evaluation
Description—a specific decrease in the number of circulating erythrocytes (red blood cells [RBCs]), hemoglobin, and hematocrit
Clinical
If anemia has developed rapidly—hypotension is secondary to loss of blood volume.
Tissue and organ hypoxia (fatigue, shortness of breath, ± pica, etc.) are seen in either chronic or acute anemia.
Pallor, hypotension, tachycardia are seen on physical examination.
Epidemiology
♀: 30 of 1,000 of all ages
♂: 6 of 1,000 for younger than 45 years; 18.5 of 1,000 for older than 75 years
Diagnostic algorithm
First, look at hemoglobin
Second, look at reticulocyte count
If elevated, consider
Hemolysis
Acquired
Immune hemolysis (autoimmune, druginduced)
Traumatic. Examples include:
Thrombotic thrombocytopenic purpura (TTP)
Disseminated intravascular coagulation (DIC)
Prosthetic heart valves
Hypersplenism
Infection (eg., malaria, clostridia toxin)
Osmotic damage (eg., fresh water drowning)
Inherited/congenital (eg., G6PD deficiency, thalassemias, hemoglobin S, etc.)
Blood loss (can be acute or chronic)
If not elevated, then check mean corpuscular volume (MCV):
Low MCV
Iron deficiency
Anemia of chronic disease (some cases)
Lead poisoning
Normal MCV
Iron deficiency (mild-moderate)
Anemia of chronic disease (most cases)
Renal insufficiency
Bone marrow aplasia/hypoplasia
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