Anemia

1
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
• 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
• check iron studies, examine peripheral blood
  smear, test endocrine function, consider bone
  marrow aspiration
• Microcytic
• check iron studies, examine peripheral blood
  smear, hemoglobin electrophoresis