Anemia: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*Microcytic Anemia | *Microcytic Anemia (<81 fL) | ||
**RDW high | **RDW high | ||
***Ferritin low: Iron deficiency anemia | ***Ferritin low: Iron deficiency anemia | ||
| Line 38: | Line 38: | ||
***RBC count low: Anemia chronic disease, hypothyroidism, Vitamin C deficiency | ***RBC count low: Anemia chronic disease, hypothyroidism, Vitamin C deficiency | ||
***RBC count nl or high: Thalassemia | ***RBC count nl or high: Thalassemia | ||
*Normocytic Anemia | |||
*Normocytic Anemia ((81-100 fL) | |||
**Retic count nl | **Retic count nl | ||
***RDW normal: Anemia chronic disease, anemia of renal insufficiency | ***RDW normal: Anemia chronic disease, anemia of renal insufficiency | ||
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***Coombs Positive: Autoimmune cause | ***Coombs Positive: Autoimmune cause | ||
***Coombs negative: G6PD, SCD, spherocytosis, microangiopathic hemolysis | ***Coombs negative: G6PD, SCD, spherocytosis, microangiopathic hemolysis | ||
*Macrocytic Anemia | |||
*Macrocytic Anemia (MCV>100 fL) | |||
**RDW high: Vit B12 or folate deficiency | **RDW high: Vit B12 or folate deficiency | ||
**RDW nl: ETOH abuse, liver disease, hypothyroidism, drug induced, myelodysplasia | **RDW nl: ETOH abuse, liver disease, hypothyroidism, drug induced, myelodysplasia | ||
==Treatment== | ==Treatment== | ||
Revision as of 01:43, 14 November 2013
Background
- Affects 1/3 of the world's population
- Most common causes are uterine and GI bleeding
- Pathophysiology
- 4 mechanisms:
- 1. Loss of RBCs by hemorrhage (e.g. GI bleed)
- 2. Increased destruction (SCD, hemolytic anemia)
- 3. Impaired production (iron/folate/B12 deficiency, aplastic/myelodysplastic anemia)
- 4. Dilutional (rapid IVF infusion)
- 4 mechanisms:
Clinical Features
- Most pts begin to be symptomatic at ~7gm/dL
- Weakness, fatigue, lethargy, DOE, palpitations
- Skin, nail bed, mucosal pallor
- Widened pulse pressure
- Jaundice, hepatosplenomegaly (hemolysis)
- Peripheral neuropathy (B12 deficiency)
DDX
- Hemorrhage
- Destruction (hemolytic)
- Hereditary
- Acquired
- Impaired Production
- Hypochromic (microcytic)
- Iron deficiency, anemia chronic disease, thalassemia, sideroblastic anemia
- Aplastic/myelodysplastic (normocytic)
- Marrow failure, chemicals (ETOH), radiation, infection (HIV, parvo), RF
- Megaloblastic (macrocytic)
- Vit B12/folate deficiency, drugs (chemo), HIV
- Hypochromic (microcytic)
Diagnosis
- Microcytic Anemia (<81 fL)
- RDW high
- Ferritin low: Iron deficiency anemia
- Ferritin normal: Anemia chronic disease or sideroblastic anemia (e.g. lead poisoning)
- RDW normal
- RBC count low: Anemia chronic disease, hypothyroidism, Vitamin C deficiency
- RBC count nl or high: Thalassemia
- RDW high
- Normocytic Anemia ((81-100 fL)
- Retic count nl
- RDW normal: Anemia chronic disease, anemia of renal insufficiency
- RDW high: Iron, Vit B12, or folate deficiency
- Retic count high
- Coombs Positive: Autoimmune cause
- Coombs negative: G6PD, SCD, spherocytosis, microangiopathic hemolysis
- Retic count nl
- Macrocytic Anemia (MCV>100 fL)
- RDW high: Vit B12 or folate deficiency
- RDW nl: ETOH abuse, liver disease, hypothyroidism, drug induced, myelodysplasia
Treatment
- Transfusions
- Consider if pt is symptomatic, hemodynamically unstable, hypoxic, or acidotic
- Most pts w/ Hb <6 will benefit from transfusion; most pts w/ Hb >10 will not
- Always draw labs necessary for diagnosis prior to transfusing
See Also
Source
Tintinalli