Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • systemic symptoms of underlying condition
  • absent hx of bleeding
  • physical finding suggesting infection
  • physical finding suggesting neoplasm
  • physical finding suggesting autoimmune disorder

Other diagnostic factors

  • absent hx of high alcohol intake
  • absent hx of exposure to chemicals and radiation
  • absent hx of drugs known to be associated with risk of anaemia
  • absent hx of poor nutrition
  • decreased exercise tolerance
  • shortness of breath with exercise
  • fatigue
  • pallor

Risk factors

  • autoimmune disorders
  • malignancy
  • acute or chronic infection
  • critical illness, major trauma, or major surgery with delayed recovery

Diagnostic investigations

1st investigations to order

  • Hb
  • WBC and differential
  • platelet count
  • MCV
  • MCHC
  • peripheral blood smear
  • serum ferritin
  • serum iron
  • TIBC
  • transferrin saturation
  • absolute reticulocyte count
  • serum creatinine
  • LDH
Full details

Investigations to consider

  • CRP
  • ESR
  • serum B12
  • serum folate
  • TFTs
  • LFTs
  • indirect and direct bilirubin
  • erythropoietin
  • quantitative haemoglobin A2 analysis
  • bone marrow biopsy
Full details

Emerging tests

  • soluble transferrin receptor
  • ratio of soluble transferrin receptor to log ferritin
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor

Hemophilia and Thrombosis Center

University of North Carolina

Chapel Hill

NC

Disclosures

AM declares that she has no competing interests.

Hematology Fellow

University of North Carolina

Chapel Hill

NC

Disclosures

DH declares that he has no competing interests.

Dr Alice Ma and Dr Damon Houghton would like to gratefully acknowledge Dr Marco Giovannini, Dr Pasquale Niscola, Dr Karen D. Serrano, and Dr Robert D. Woodson, previous contributors to this monograph. MG, PN, KDS, and RDW declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Clinical Medicine

Eastern Virginia Medical School

Norfolk

VA

Disclosures

SRL declares that he has no competing interests.

Associate Professor of Medicine

Innsbruck Medical University

Innsbruck

Austria

Disclosures

CP declares that he has no competing interests.

Hematology/Oncology Fellow

Department of Medical Oncology

University of Colorado Health Sciences Center

Denver

CO

Disclosures

RC declares that he has no competing interests.

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