ANEMIA

Ask the following questions:

1. Is there a history of chronic blood loss? A history of peptic ulcer, ulcerative colitis, or other causes of chronic GI bleeding would indicate the anemia is most likely due to iron deficiency. Likewise, chronic hypermenorrhea or metrorrhagia in women of child-bearing age may lead to iron deficiency anemia.
2. Are there neurologic signs? Paresthesias, loss of vibratory sense, ataxia, and mild dementia should lead one to suspect pernicious anemia.
3. Is there jaundice? Clinical jaundice should arouse the suspicion of a hemolytic anemia, but mild clinical jaundice may be seen in pernicious anemia also. Chronic liver disease, such as alcoholic cirrhosis, is often associated with folate deficiency or sideroblastic anemia.
4. What is the white count? A decreased white count should alert one to the possibility of aplastic anemia, myelofibrosis, or infiltrative diseases of the bone marrow, such as carcinomatosis, Gaucher's disease, or lymphoma. It may also be related to pernicious anemia. An increased white count would suggest leukemia, chronic infections, anemia, or bacteremia.

DIAGNOSTIC WORKUP

The most important thing to do initially is to examine a blood smear for red cell morphology. If the anemia is microcytic, one would consider iron deficiency or chronic blood loss. If it is microcytic, consideration should be given to pernicious anemia or folate deficiency. Further workup should include a chemistry panel, stool for occult blood, liver function tests, reticulocyte count, serum iron and iron-binding capacity, serum B ₁₂ and folic acid, serum haptoglobin, and platelet count. If these studies are inconclusive, a hematologist should be consulted. A hematologist will perform a bone marrow examination for a more definitive diagnosis. Perhaps a liver-spleen scan, CT scan of the abdomen, or therapeutic trial of iron, B ₁₂ , or folic acid is indicated.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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