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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Hematology & Oncology : Anemia

  • Check vital signs, hypoxia and bleeding manifestations
  • See tables below and perform labs pertinent to your clinical suspicion
  • Refer to PRBC transfusion guidelines
Low or Normal ReticulocytesHigh Reticulocytes
Hypochromic Microcytic (MCV < 78)
  • iron deficiency
  • thalassemia
  • lead poisoning
  • chronic disease
  • sideroblastic anemia
  • Treated nutritional deficiency
Normochromic Normocytic (80 < MCV < 100)
  • chronic disease
  • liver disease
  • uremia
  • endocrine disorders (hypo/hyperthyroid, Addison's)
  • connective tissue diseases
  • primary marrow abnormalities
  • myelodysplasia
  • infiltration (leukemia, metastates)
  • myelofibrosis
  • aplasia
  • Hemolytic anemia
  • Post hemorrhagic anemia
Macrocytic/Megaloblastic (MCV > 100)
  • Megaloblastic
    • B12 / folate deficiency
    • drugs (MTX, cyclophosphamide,
    • nitrous oxide, arsenic)
  • Macrocytic
    • hypothyroidism
    • hypoplastic marrow, aplasia
    • liver disease
    • alcohol
    • smoking
 



Differentiation of common causes of microcytic anemia:

 Fe Def    Thal Trait   Infectious  
Hbgdecrdecrdecr
MCVdecrdecrnml
RDWincrnmlnml
FEPincrnmlincr
TIBCincrnmlincr
Ferritin   decrnmlnml/incr

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