EVALUATION OF ANEMIA
PATIENT HISTORY
What medicines are you taking? (including vitamins, alcohol, aspirin, anti-cancer)
What kind of work do you do? (chemical exposure)
Has a family member had anemia or a splenectomy?
Blood loss: heavy menses, pregnancy, GI ulcers?
CLINICAL EXAM
Pallor, bruising, hemorrhage (optic fundus), poor wound healing
Headache, dizzy, tinnitus
Cardiac enlargement, tachycardia
Neuromuscular problems
Epithelial changes, sore tongue, nails pitted, ridges, or spoon shaped
GI problems, nausea, flatulence, anorexia
Decreased libido
LAB TESTS
CBC, Hct, MCV, MCH, MCHC, Hgb electrophoresis (Sickle cell and Thalassemia)
Blood smear (size, shape, color, maturity, nucleated, inclusions)
Bilirubin (conj, unconj), Haptoglobin electrophoresis
Ferritin concentration, TIBC, serum iron
Reticulocyte count
Bone Marrow biopsy (iron stores), stain with Prussian Blue (only if necessary)
ESTABLISH MECHANISM
1) Blood loss
2) Decreased production
3) Increased hemolysis
DETERMINE SPECIFIC CAUSE
1) Nutritional deficiency
2) Hemoglobinopathy
3) Hemolysis
DRUGS THAT CAUSE ANEMIA
Chloramphenicol
Phenylbutasone
Pheytoin
Alcohol
DRUGS THAT CAUSE HEMOLYSIS
Sulfonamides
Apirin
AZT