Anemia, general approach
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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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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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