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Anemia Algoritma

Fatigue, weakness, pallor, dizziness, fainting ORDER CBC with Platelet Count and Automated Differential (including RBC indices and morphology on manual differential) AND Corrected reticulocyte index >=2. No yes Classify by RBC indices Fragmented cells on peripheral smear yes bone marrow disorder (infiltration, aplasia) Lead toxicity Folate, B12 deficiency (see Megalobl

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1K views1 page

Anemia Algoritma

Fatigue, weakness, pallor, dizziness, fainting ORDER CBC with Platelet Count and Automated Differential (including RBC indices and morphology on manual differential) AND Corrected reticulocyte index >=2. No yes Classify by RBC indices Fragmented cells on peripheral smear yes bone marrow disorder (infiltration, aplasia) Lead toxicity Folate, B12 deficiency (see Megalobl

Uploaded by

Amilia Wahyuni
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Anemia Testing

Click here for topics associated with this algorithm INDICATIONS FOR TESTING Fatigue, weakness, pallor, dizziness, fainting
ORDER CBC with Platelet Count and Automated Differential (including RBC indices and morphology on manual differential) Reticulocytes, Percent & Number

Anemia present on CBC (males Hgb < 13g/dL, females Hgb <12g/dL) AND Corrected reticulocyte index 2.5

no

yes

Classify by RBC indices

Fragmented cells on peripheral smear

no Normocytic, normochromic (normal MCV, MCHC) (suggests hypoproliferation) Microcytic, hypochromic (low MCV, MCHC) (suggests maturation defects) Macrocytic (high MCV) (suggests maturation defects) Suspect hemorrhage and acute blood loss

yes

Bone marrow disorder (infiltration, aplasia) Inflammation Autoimmune disease Chronic renal disease Critical illness Chronic endocrine disorders Aplastic anemia, pure red cell aplasia

Iron deficiency Chronic disease Thalassemia (see Hemoglobinopathies topic) Sideroblastic anemia Lead toxicity

Folate, B12 deficiency (see Megaloblastic Anemia Testing Algorithm) Drug effect Excessive alcohol use Hypothyroidism Myelodysplasia (see Myelodysplastic Syndromes Consult topic)

Suggests hemolytic process: Metabolic defect (see, PNH Consult topic) Hemoglobinopathies (eg, sickle cell) (see Hemolytic Anemias Testing Algorithm) Autoimmune destruction Splenic sequestration RBC membrane defect (see Hemolytic Anemias Consult topic) Intravascular hemolysis (see Hemolytic Anemias Consult topic)

Abnormal peripheral smear

ORDER Iron and Iron Binding Capacity Ferritin

no no yes B12, folate studies

Low/normal TIBC Normal/high ferritin Low/normal iron

High TIBC Low iron Low ferritin

Workup based on smear characteristics Abbreviations and Formula

Suggests: Inflammation Chronic disease

Iron deficiency

Bone marrow biopsy may be necessary

MCV = mean cell volume MCHC = mean cell hemoglobin concentration TIBC = total iron binding capacity Reticulocyte correction for anemia:

If no obvious chronic disease present, consider bone marrow biopsy

ReticCount%

Hgb Htc

1 _ Maturation time correction (use 2 for most patients)

2006-2011 ARUP Laboratories. All Rights Reserved. 5/16/2011

www.arupconsult.com

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