Define anemia and red blood cell rbc indices in pediatric patients learn to categorize anemias based on rbc size and mechanism understand the presentation, workup, and treatment of pediatric anemias will not discuss anemia secondary to blood loss or anemia secondary to malignancy in great detail. Evaluation of anemia merck manuals professional edition. Autoimmune hemolytic anemia autoimmune hemolytic anemia aiha is mediated by autoantibodies and further subdivided according to their maximal binding. Upon identification, we reach the specific diagnosis of anemia. Inspiration, respiratory rate, and respiratory therapy. Its prevalence increases with age, reaching 44 percent in men older than 85 years. Classification of anemia diagnostic approach to anemia. Myelophthisic anemia may be a manifestation of primary myelofibrosis or fibrosis secondary to other conditions table 1. A different approach, relying on the concept of optimal rather than normal hb values, has been derived by longitudinal studies highlighting an association between hb levels and unfavorable outcomes see also the prevalence of anemia in elderly.
Anemia is a decrease in the number of red blood cells rbcsas measured by the hematocrit or red cell hemoglobin content. Approach to anemia normal red cell production erythropoiesis kidney oxygen sensor epo mrna epo blood vessel bone marrow multipotent stem cell erythroid stem cell 34 days peripheral blood rbc survival 100120 days. Microcytic anemia microcytic anemia is defined as anemia with a low mean corpuscular volume mcv, ie. Approach to the iron deficient patient in this attempt to forge a useful algorithm for the management of iron deficiency, it is prudent to have a discussion of the difference between absolute overt iron deficiency and functional iron deficiency. Pdf anemia is a major cause of morbidity and mortality worldwide and can be. Overt iron deficiency 1,2 body iron stores are depleted.
Upmcahn regional cancer center a 54 year old man with many medical comorbidiges including htn, hpl, cad, dm, ra is found to have a hemoglobin of 10. Primary myelofibrosis pmf is a clonal myeloproliferative. Screening for anemia in highrisk infants and toddlers is recommended. Describe a reasonable initial approach to ordering tests and evaluating patients newly diagnosed with anemia. Anemia is more common with advanced age, but not normal and should be worked up. This collection features afp content on anemia and related issues, including blood transfusions, iron deficiency and iron supplementation, macrocytosis, microcytosis, and thalassemia. Values dont account for race, altitude, or other patient factors. However the approach to manage patients with pancytopenia in the current era of genomics is not well defined in the literature and is widely variable in practice. When the anemia comes on quickly, symptoms may include confusion, feeling.
Normocytic anemia is the most frequently encountered type of anemia. Physiologically, anemia is a condition in which reduced hematocrit or hemoglobin levels lead to diminished oxygencarrying capacity that does not optimally meet the metabolic demands of the body. Included are included are pertinent issues related to the history and physical examination, the initial laboratory workup. Iron deficiency is the most common cause of microcytic anemia.
Anemia is defined as a hemoglobin hb level 96 fl or if certain abnormal rbcs or white blood cells wbcs are observed in the blood smear, the investigative. Bleeding is a leading cause of iron deficiency anemia. Immune hemolytic anemia is classified as autoimmune, alloimmune, or druginduced, based on the antigen that stimulates antibody or complementmediated destruction of red blood cells. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information.
Anemia and dm anemia is a common complication of dm and correlates with renal failure rate of anemia is higher in patients with diabetic nephropathy than in non diabetic renal disease with similar levels of renal impairment. A microcytic, hypochromic anemia could be due to a or bthalassemia, hb e disease or trait, iron deficiency anemia, or, more rarely, sideroblastic anemia including lead poisoning or anemia of chronic inflammation see figure 192. Decrease in the number of circulating red blood cells. The first aim is to establish whether the anemia is microcytic, normocytic or macrocytic. B 9, 18, 19 if anemia is consistent with iron deficiency in a child six to 36 months of age with. Is there decreased rbc production, increased loss rbc destruction or rbc loss i.
Use a three part strategy to narrow the differential diagnosis of anemia. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of. Anemia is defined as a hemoglobin hb level anemia is a common problem that is often discovered on routine laboratory tests. In general, the differential diagnosis of anemia can be substantially narrowed by subcategorization into.
This lecture will address the basics of the classification of anemias and tools used in the medical laboratory to assess a patients blood health or presence of anemia. When anemia comes on slowly, the symptoms are often vague and may include feeling tired, weakness, shortness of breath, and a poor ability to exercise. Is the anemia microcytic small red blood cell size. A diagnostic approach to bone marrow evaluation clinical suspicion of myeloproliferative neoplasm chronic myeloid leukemia chronic myeloid leukemia algorithm mpnr myeloproliferative neoplasm mpn, jak2 v617f with reflex to calr and mpl, varies ngshm oncoheme nextgeneration sequencing for myeloid neoplasms. Diagnostic approach to a patient with suspected anaemia as anaemia may manifest in a wide range of disorders, a streamlined diagnostic approach is vital fig.
Anemia also spelled anaemia is a decrease in the total amount of red blood cells rbcs or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. Anemia in elderly no different definition of anemia in elderly elderly patients should undergo standard anemia evaluation nhanes iii study. The medical laboratory scientist must also understand anemias to provide the needed information to physicians. Regardless of the specific algorithm followed in evaluating anemia. His symptoms include general fague and he has no symptoms or family history of blood disease. Heres the flowchart to clinical approach to anemia, however, if you need deep insights, follow our article below. In men, anemia is defined as hemoglobin 2 sd below mean for age, may be due to three general causes. The approach outlined here is based on the abovementioned classification, clinical scenario and full blood count fbc findings. Algorithm depicting diagnostic approach to anaemia. Myelophthisic anemia is a broad and antique term used to describe hypoproliferative anemia resulting from bone marrow fibrosis and infiltration by abnormal tissues. The diagnostic algorithm 1 reflects a contemporary morphological approach to anaemia utilising the reticulocyte response and mean corpuscular volume mcv as the starting point for evaluation. Practical algorithms in anemia diagnosis mayo clinic proceedings. Objectives generate a differential diagnosis for anemia based on the results of a cbc.
No guidance for next steps when algorithm breaks downhypochromia where part of the algorithm not easily assessed without looking at peripheral smear kinetic approach. For example, a study enrolling 17,030 communitydwelling. How to efficiently and accurately work up the anemic patient. Anemia approach for the primary care physician david seastone, do, ph. Who definition for anemia is hemoglobin less than gmdl for men and less than 12gmdl for women. Anemia of chronic disease, the most common normocytic anemia, is. Anemia is defined as the reduction in one or more of. Originally presented on june 4, 2015 in salt lake city, utah. Approach to anemia uclaolive view internal medicine. Regardless of the specific algorithm followed in evaluating anemia, it is essential that easily remediable causes such as nutritional deficiencies, hemolysis, and anemia of renal insufficiency are identified early and treated appropriately. The most common causes of microcytic anemia in children are iron deficiency and thalassemia algorithm 2 17,23.
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