Paolo Aquino PGY-I January 2005 VA Hospital Anemia Paolo Aquino PGY-I January 2005 VA Hospital

Definition Anemia is a reduction of hemoglobin or volume of red blood cells from normal limits Variation due to age, gender Decreased production Increased loss

History Signs of blood loss Onset- rapid vs. gradual Family history Exposures Diet History of infection PMH- cancer, renal, endocrine

Physical exam Appearance Vital signs HEENT Heart Abdominal

Laboratory studies Hemoglobin and hematocrit Mean corpuscular volume Reticulocytes Peripheral smear

Microcytic anemia Most common cause: iron-deficiency anemia Thalassemia Lead poisoning Sideroblastic anemia Anemia of chronic disease

Normocytic anemia Marrow hypoplasia Marrow infiltration Myelofibrosis Renal insufficiency Anemia of chronic disease Mild iron deficiency Mixed microcytic/macrocytic

Approach History and physical Hemoglobin, hematocrit Reticulocytes decreased production, increased loss Remember to correct the retic count for the anemia

Approach If reticulocytes low, check MCV Low 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 Shape Spherocytes Sickle cell Helmet cells Tear drop cells

Peripheral smear Color Hypochromasia Hyperchromasia Iron deficiency Sideroblastic Hyperchromasia Megaloblastic anemia Spherocytosis

Peripheral smear Morphology Howell-Jolly bodies Basophilic stippling Heinz bodies Requires supravital stain Cabot ring Nuclear remnants

Peripheral smear Morphology Rouleaux formation Parasites Nucleated RBCs Target cells

Summary Once anemia is established Check reticulocyte count Correct count for anemia Increased retic count indicates RBC loss- hemolysis or bleed Decreased retic count indicates decreased RBC production Check MCV

Summary Decreased reticulocyte count Normocytic Microcytic check iron studies, examine peripheral blood smear, test endocrine function, consider bone marrow aspiration Microcytic check iron studies, examine peripheral blood smear, hemoglobin electrophoresis