Anemia- RBC production ≠ RBC destruction

Caused by underproduction (malnutrition or bone marrow) or increased destruction (hemolysis or blood loss)

MCV < 80 fL Microcytic MCV 80-99fL MCV > 100fL Macrocytic

Normal (Pernicious Anemia)
Iron Deficiency Thalassemia Anemia of Chronic Folate Deficiency Vitamin B12
Anemia Disease Deficiency
Laboratory Laboratory Laboratory Laboratory Laboratory
Hgb<12g/dL ↓ Hgb<12g/dL ↓ Hgb<12g/dL ↓ Hgb<12g/dL ↓ Hgb<12g/dL ↓
Hct<35% ↓ Hct- 28-40% ↓ Hct<35% ↓ Hct<35% ↓ Hct<35% ↓
Serum Iron<50mg/ml ↓ Serum Iron ↔/↑ Serum Iron<50mg/ml ↓ Serum Iron ↑ Serum Iron ↑
Ferritin<12ug/L ↓ Ferritin<12ug/L ↔ Ferritin<12ug/L ↔/↑ Ferritin<12ug/L ↑ Ferritin ↑
MCV(nl 80-100) ↓ MCV ↓ MCV ↔ MCV ↑ MCV ↑
MCHC(nl27.5-33.2) ↓ MCHC ↓ MCHC(nl27.5-33.2) ↔ MCHC ↔ MCHC ↓
Retic Count ↓ Retic Count ↔/↑ Retic Count ↔/↓ Retic Count ↓ Retic Count ↓
TIBC<250ug/dL ↑ TIBC(nl 250-450ug/dL) ↔ TIBC<250ug/dL ↓ TIBC250-450ug/dL ↔ TIBC250-450ug/dL ↔
RDW ↑ RDW ↔ RDW ↑ RDW ↑ RDW ↑
Bilirubin ↔ Bilirubin ↑ Bilirubin ↔ Bilirubin ↔/↑ Bilirubin ↔/↑
Serum Folate ↓ B12 ↓
High Risk High Risk High Risk High Risk High Risk
Infants, adolescence, Chinese, Vietnamese, Chronic infection, Poor dietary intake, Partial or complete
pregnancy, vegetarians, African Americans, cancer, inflammation, rapid growth gastrectomy, strict
poor, elderly, GI tract Mediterranean descent renal or liver failure (adolescence, vegetarian, severe
disturbances or surgery, pregnancy) Alcoholics, Crohn’s disease, fish
excessive menstrual chronically tapeworm ingestion,
flow, lead poisoning malnourished age 60+
Symptoms Symptoms Symptoms Symptoms Symptoms
Mucous membrane Pallor, splenomegaly, Milder forms of: Glossitis, angular Weak, fatigue, sore
pallor, pale palmar bronzing of skin, Hypoxia, rapid fatigue, cheilitis, anorexia, tongue, glossitis,
creases (Hgb<7) Thalassemia major tachycardia, palpitations, diarrhea, pale or icteric, angular cheilitis,
hypoxia, rapid fatigue, presents with more tachypnea with exertion, fine brittle hair, Pica anorexia, diarrhea,
irritability, tachycardia, severe anemia chest pain, glossitis, premature aging
*mid-systolic or pan- angular stomatitis, Neurologic signs:
systolic murmur, (*reversible with two Peripheral
palpitations, tachypnea weeks of tx) Ice Pica, paresthesia’s, difficulty
with exertion, chest pain, brittle fine hair, with balance, dementia,
glossitis, angular koilonychia (spoon positive Babinski’s and
stomatitis, (*reversible shaped nails) Romberg signs.
with two weeks of tx) Ice Hepatosplenomegaly
Pica, brittle fine hair,
koilonychia (spoon
shaped nails)
Treatment Treatment Treatment Treatment Treatment
Treat underlying cause! No Iron supplements! Treat underlying cause! Supplement with folic Supplement with B12
Ferrous sulfate 325mg If asymptomatic, no tx Provide with iron-rich acid 1mg QD PO. 1000ug QDx1wk;
TID before meals. Take needed. Patient food list, and iron Recheck folate levels in 1000ug Qweek x
with VitC or citrus identification is needed supplements if needed. 2 months, adjust dose if 1month then 1000ug
juices. Continue to prevent treatment High Iron foods: organ needed. Dietary per month for life.
treatment for 6mos after with iron* Thalassemia and lean red meats, egg sources: asparagus, Consider iron
Hgb is normal. If iron major is usually yolks, apricots, raisins, green leafy vegetables, replacement for 1
absorption is a problem referred for transfusion, grapes, shellfish, green red beans, black beans, month because of
use iron dextran and chelating agent leafy vegetables. bananas, fish, liver increased need, recheck
100mg/wk IM. Check prescription. peanut butter, oatmeal levels in 2 months.
retic count @ 1wk; and wheat bran. PT-motor, OT-
check Hgb @ 2wks neuropathy