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

2. 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

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

4. Physical exam
Appearance
Vital signs
HEENT
Heart
Abdominal

5. Laboratory studies Hemoglobin and hematocrit Mean corpuscular volume
Reticulocytes
Peripheral smear

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

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

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

9. 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

10. Peripheral smear
Normal RBC size equal to nucleus of a mature lymphocyte
Shape
Spherocytes
Sickle cell
Helmet cells
Tear drop cells

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

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

13. Peripheral smear Morphology Rouleaux formation Parasites
Nucleated RBCs
Target cells

14. 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

15. 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