Summary
Definition
History and exam
Key diagnostic factors
- systemic symptoms of underlying condition
- absent history of bleeding
- physical finding suggesting infection
- physical finding suggesting neoplasm
- physical finding suggesting autoimmune disorder
Other diagnostic factors
- absent history of high alcohol intake
- absent history of exposure to chemicals and radiation
- absent history of drugs known to be associated with risk of anemia
- absent history 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
- chronic disease
Diagnostic tests
1st tests to order
- Hb
- WBC and differential
- platelet count
- mean corpuscular volume (MCV)
- mean corpuscular hemoglobin concentration (MCHC)
- peripheral blood smear
- serum ferritin
- serum iron
- total iron-binding capacity
- transferrin saturation
- absolute reticulocyte count
- serum creatinine
Tests to avoid
- flow cytometry
Tests to consider
- C-reactive protein (CRP)
- erythrocyte sedimentation rate
- serum B12
- serum folate
- thyroid function tests
- LFTs
- indirect and direct bilirubin
- LDH
- erythropoietin
- hemoglobin electrophoresis
- bone marrow biopsy
- soluble transferrin receptor
- ratio of soluble transferrin receptor to log ferritin
Treatment algorithm
mild to moderate anemia (hemoglobin [Hb] 8 to 11 g/dL)
severe (Hb <8 g/dL) or life-threatening (Hb <6.5 g/dL) anemia
Contributors
Authors
Marina Beltrami Moreira, MD
Assistant Professor
The Ohio State University Wexner Medical Center
The Ohio State University College of Medicine
Columbus
OH
Disclosures
MBM has a pending research grant from the Pfizer-NCCN grant program.
Acknowledgements
Dr Marina Beltrami Moreira would like to gratefully acknowledge Dr Eric Kraut, Dr Marium Husain, Dr Alice Ma, Dr Damon Houghton, Dr Marco Giovannini, Dr Pasquale Niscola, Dr Karen D. Serrano, Dr Robert D. Woodson, and Dr Kiranveer Kaur, previous contributors to this topic. EK, MH, AM, DH, MG, PN, KDS, RDW, and KK declare that they have no competing interests.
Peer reviewers
Sean R. Lynch, MD
Professor of Clinical Medicine
Eastern Virginia Medical School
Norfolk
VA
Disclosures
SRL declares that he has no competing interests.
Christopher Pechlaner, MD
Associate Professor of Medicine
Innsbruck Medical University
Innsbruck
Austria
Disclosures
CP declares that he has no competing interests.
Robert Chen, MD
Hematology/Oncology Fellow
Department of Medical Oncology
University of Colorado Health Sciences Center
Denver
CO
Disclosures
RC declares that he has no competing interests.
Brady Stein, MD
Associate Professor of Medicine
Northwestern University
Evanston
IL
Disclosures
BS declares that he has no competing interests.
References
Key articles
KDIGO Anemia Work Group. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012;2(4):279-335.Full text
Bohlius J, Bohlke K, Castelli R, et al. Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update. J Clin Oncol. 2019 Apr 10;37(15):1336-51.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: hematopoietic growth factors [internet publication].Full text
Aapro M, Beguin Y, Bokemeyer C, et al. Management of anaemia and iron deficiency in patients with cancer: ESMO clinical practice guidelines. Ann Oncol. 2018 Oct 1;29(suppl 4):iv271.
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Iron deficiency anemia
- Iron deficiency anemia coexisting with ACD
- Anemia associated with chronic renal disease (erythropoietin deficiency)
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: hematopoietic growth factors
- Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update
More Guidelines
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