Anemia, general approach
Etiology
Macrocytic (MCV >100)
- Megaloblastic anemia: folic acid or Vitamin B12 deficiency
- Liver disease (target cells)
- Alcoholism
- Reticulocytosis
- Hypothyroidism
- Myelodysplastic syndrome
- Antiretrovirals, eg, AZT
Microcytic (MCV < 80)
- Iron deficiency
- Thalassemia
- Anemia of chronic disease
- Sideroblastic anemia
- Lead poisoning
Normocytic (MCV 80-100)
- Low reticulocyte count
- Iron deficiency (especially early)
- Anemia of chronic disease
- Chronic renal disease (low erythropoietin)
- Hypothyroidism, adrenal insufficiency, or hypopituitarism
- Primary bone marrow disorder
- Aplastic anemia
- Malignancy, eg, multiple myeloma, leukemia, metastases
- Myelofibrosis
- Myelodysplastic syndrome
- Infection, eg, parvovirus B19 (causes red cell hypoplasia or aplastic anemia)
- High reticulocyte count
- Blood loss
- Hemolysis
- Coombs positive (immune): autoimmune, drugs, infection, lymphoproliferative disease, Rh or ABO incompatibility
- Coombs negative: intrinsic red cell disease
- Abnormal hemoglobin: sickle cell disease, thalassemia, methemoglobinemia
- Membrane defect: hereditary spherocytosis, hereditary elliptocytosis, paroxysmal nocturnal hemoglobinuria
- Enzyme defect: G6PD deficiency, pyruvate kinase deficiency
- Coombs negative: extrinsic disease
- Microangiopathic hemolytic anemia, eg, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, prosthetic valve hemolysis
- Splenic sequestration
- Infection: malaria, Clostridium, Borrelia
- Burns
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Last updated: December 1, 2014
Citation
Zeiger, Roni F.. "Anemia, General Approach." Diagnosaurus, 4th ed., McGraw-Hill Education, 2014. Emergency Central, emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114639/all/Anemia_general_approach.
Zeiger RFR. Anemia, general approach. Diagnosaurus. McGraw-Hill Education; 2014. https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114639/all/Anemia_general_approach. Accessed November 14, 2024.
Zeiger, R. F. (2014). Anemia, general approach. In Diagnosaurus (4th ed.). McGraw-Hill Education. https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114639/all/Anemia_general_approach
Zeiger RFR. Anemia, General Approach [Internet]. In: Diagnosaurus. McGraw-Hill Education; 2014. [cited 2024 November 14]. Available from: https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114639/all/Anemia_general_approach.
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