|
 | Presentation
 | Fatigue, DOE/SOB, lightheadedness, angina, pallor,
glossitis |
|
| History
| Blood loss - look for the
source! |
| Hematochezia/melena |
| Menstrual history |
| FH: sickle cell, thalassemia, G6PD, spherocytosis |
| Drug exposure - hemolysis (PCN, methyldopa,
cephalosporin, sulfa) |
| SH: EtOH, lead exposure, dietary history (vegan),
do they take vitamin/iron supplements? |
|
| PE
| Vitals (hypotension, tachycardia) |
| HEENT: conjunctival pallor, glossitis, lymphadenopathy
+/- |
| CV: usual exam, listen for murmurs |
| Resp: auscultate |
| Abd: HSM, tenderness, masses |
| Rectal: hemoccult |
| Extr: DTRs (B12 deficiency, hypothyroidism) |
| Neuro: peripheral neuropathy |
|
| DDx
| Normocytic
 | Acute blood loss |
| Acute hemolytic anemias (sickle cell, thal, G6PD, PNH) |
| ACD |
|
| Microcytic
| Iron deficiency |
| ACD |
| Lead toxicity |
|
| Macrocytic
| B12/folate deficiency |
| EtOH |
| Drugs |
| Hypothyroidism |
| Erythroid leukemias |
| Anything with increased retics |
|
|
| Laboratory
| CBC w/ diff (peripheral smear) |
| Retic count |
| Iron studies (serum FE, TIBC, ferritin) |
| Haptoglobin / serum free hemoglobin |
| B12 / red cell folate levels |
| Hemoccult (colonoscopy?) |
| BMP, UA |
| TSH |
|
| Treatment
| Treat blood loss and underlying cause |
| If iron deficient, give supplements plus Vit. C. |
| Synthroid if hypothyroid |
| Vitamin supplements if EtOH abuse |
| Get rid of lead paint in house |
|
| Miscellaneous
| Don't give folate without B12. Corrects anemia but
not neuropathy. |
| Give iron with OJ, because vitamin C increases
absorption. |
|
|
