Anemia results from decreased red blood cell production in the bone marrow, increased peripheral destruction, or blood loss. Anemia results in clinical symptoms due to reduced oxygen carrying capacity of blood to peripheral tissues.

Many red cell indices are used to assess anemia. Among them, mean corpuscular volume (MCV) is a measure of the average red blood cell size. Reticulocyte count is the percentage of immature red blood cells and is a measure of red blood cell production by the bone marrow.

Decreased red blood cell production can be from bone marrow disorders or nutritional deficiencies (iron, vitamin B12, folate). Morphologic abnormalities like thalassemia cause ineffective red blood cell formation. Increased destruction occurs in various hemolytic anemias and conditions causing an enlarged spleen. Many chronic diseases cause anemia by various mechanisms.

Many medications cause anemia by immune-mediated hemolysis . The mechanism of psychotropic-induced anemia may be similar, but red blood cell aplasia has also been reported [1]. Anemia thought to result from a medication usually does not need any intervention. Isolated psychotropic-induced anemia is rare and almost never severe enough to warrant any diagnostic workup or stopping the medication. Since anemia associated with psychotropic medications is generally not clinically significant, not much is known about characteristics of the anemia.

Anemia can occasionally be a concern with psychotropic drug treatment when it occurs as part of a pancytopenia. This is discussed in Chapter 30. See the following table for list of psychotropic medications that have been reported to cause anemia [1, 2].