An em ia in Adu lt s Diagn osis

- Hb < 13 g/dL in male adults ABBREVIATIONS:

- Hb < 12 g/dL in female adults AST: aspartate aminotransferase
Anemia
- Hb < 11 g/L during first and third trimester
BUN: blood urea nitrogen
- Hb < 10.5 g/dL during second trimester
CKD: chronic kidney disease
CRP: C-reactive protein
Characterize anemia by red cell size f L: femtoliters
(MCV)
Hb: hemoglobin
Check peripheral blood smear
HbCC: hemoglobin C disease
LDH: lactate dehydrogenase
LFTs: liver function tests
M CV: mean corpuscular volume
Microcytic Normocytic Macrocytic
M DS: myelodysplastic syndrome
anemia: anemia: anemia:
MCV <80 fL MCV 80?100 fL MCV >100 fL M M A: methylmalonic acid
PEt h : phosphatidyl ethanol level
SPEP: serum protein electrophoresis
Common causes: TIBC: total iron-binding capacity
- Iron deficiency anemia
TSH: thyroid-stimulating hormone
- Thalassemia
- Anemia of inflammation Check labs based on clinically
Less common causes: suspected diagnoses: Clin ician s' Pr act ice Poin t :
- Lead poisoning - CRP for inflammatory The reticulocyte index is less helpful than
disorders the absolute reticulocyte count; absolute
- Fragmentation syndrome Is reticulocyte
No - BUN and creatinine for CKD reticulocyte count >0.12 × 1012/L is an
- Hyperthyroidism count increased? appropriate response to anemia
- HbCC - Testosterone for
- Sideroblastic anemia hypogonadism
- LFTs for liver disease
- SPEP for paraproteinemias
Yes

Check iron indices: Bleeding or hemolysis:

- Iron
For hemolysis, check
- TIBC
haptoglobin, AST, LDH,
- Ferritin bilirubin
Is Check vitamin
reticulocyte count No B12, folate, MMA,
Are increased? homocysteine
iron indices Manage for iron levels
No
negative? deficiency
Yes

Yes

Bleeding or hemolysis: Is this

For hemolysis, check vitamin B12 or
Consider Hb
haptoglobin, AST, LDH, folate deficiency?
electrophoresis
bilirubin

Yes

No
Treat for vitamin B12 or
folate deficiency

Evaluate based on other

suspected diagnoses:
- LFTs and FibroScan for
cirrhosis
Is peripheral - PEth level
blood smear No - TSH for
megaloblastic? hypothyroidism
- Drug screen (history)
- Check for MDS
- Check for aplastic
Yes anemia

Consider drug-induced
megaloblastic anemia or
copper deficiency

REFERENCES: Hematol Oncol Clin North Am. 2017 Dec;31(6):1045?1060 - Med Clin North Am. 2017 Mar;101(2):263?284 - Hematol Oncol Clin North Am. 2012 Apr;26(2):205 ?230
Version 1.2 | © EBSCO Industries, Inc. All rights reserved.