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Anemia

Evaluation of anemia

Type	Clinical Features
History	Appetite changes Chronic medical conditions Diet Fever and/or night sweats History of liver disease Medications Signs of bleeding (eg, melena, hematemesis) Weight loss
Physical examination	*Signs of volume depletion from possible blood loss* Dyspnea Fever Postural hypotension Tachycardia *Other possible findings* Pallor in eyes and hands Jaundice Lymphadenopathy Hepatosplenomegaly Tenderness of bones over sternum (eg, myeloma) Rectal exam for blood in stool
Laboratory testing	*CBC with peripheral blood smear* Evaluate indices (MCV, RDW, MCHC) Reticulocyte count and index Low index suggests decreased bone marrow RBC production High index suggests increased bone marrow response to hemolysis or blood loss WBC count Low WBC suggests bone marrow suppression or infiltration Neutrophils Immature cells suggest leukemia Toxic granulations or Dohle bodies associated with sepsis Hypersegmented neutrophils with > 5 lobes suggest macrocytic anemia (eg, B12 or folate deficiency) Red blood cells Fragmented cells suggest DIC Platelets Thrombocytopenia suggests autoimmune etiology, aplastic anemia, hypersplenism, or sepsis Thrombocytosis suggests myeloproliferative disorder, chronic inflammation, or malignancy *Iron studies* Iron Ferritin TIBC Reticulocyte count/index *Evaluation for hemolysis* LDH Bilirubin Decreased haptoglobin *Other possible testing* GI evaluation (eg, endoscopy, colonoscopy) HIV test Liver function tests Electrolytes ESR, CRP Abdominal imaging Bone marrow biopsy in some cases

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