Anemia Chart


< 80
> 100
Retic Count Retic Count or Normal
LDH, Bilirubin (indirect)
Retic Count
RDW LDH, indirect bilirubin

Smear =Hypersegmented

> 20%
< 20%
Extravascular Intravascular
Iron Deficiency Anemia ACD Sideroblastic Thalasemia (+) Spherocytosis
PND G6PD Sickle Cell Infection B12 def Folate Def. Fanconi Synd


- FeSo4



- Underlying condition

Alcohol, Lead, INH

- Prussian Blue Stain


- Sometimed Vit B6 in ALA def.

"Target Cells"
Asymptomatic anemia

Normal Fe
- Hg Electrophoresis.

- Minor: Reassure
- Major: Transfuse

Coomb's Test - AML, Aplastic anemia
- Missing DAF

- CD 55/59

Cause of Death:
- Large vessel thrombosis (eg: portal vein)

- Steroids

- Heinz Body
- Bite Cells

- Acute infection
Best initial Test: Smear
Most accurate: Electrophoresis

Best initial Tx if Smear (+):
O2, IV fluids, Analgesic
Acute Chest Syndrome
Vision change
Exchange transfusion
Sudden HCT
Absent Retic
*Aplastic crisis
PCR B19 or IgM B19
Folic Acid
Prevent pneumococcal Sepsis Hydroxyuria
(+) Fever ABx
(ixodes tick)
- Peripheral Neuropathy
- Subacute combined

- methylmalonic acid

Initial Test:
- anti-parietal cell Ab
- anti- intrinsic factor Ab

- intake
- Alcoholic
- Psoriasis
- Sickle cell
- Spherocytosis
- Pregnancy
- Methotrexate
- Phenytoin

- Folic Acid (Lucovorin)
- Child, Delayed growth
- Macrocytic anemia
- Progressive bone marrow failure
- Plt count, MCV


Autoimmune Hereditary Spherocytosis
- Hx of autoimminue problem (SLE, RA)
- Mycoplasma pneumo.
- PNC, Quinidine, Methyldopa

- Steroids
- Recurr: Splenectomy
(+) Osmotic fragility
- BIG Spleen
- Spectrin

- Splenectomy
Folic Acid supplement during aplastic crisis


Lab findings

Chronic Disease Sideroblastic
Hemoc- hromatosis Pregnancy/ OCP use
Serum Fe     -
Transferrin or TIBC -    
Ferritin     -
% transferrin Sat. (serum Fe/TIBC) ↓↓ -       ↑↑
Methylmalonic Acid       -    
Treatment FeSO4   B6 Folate B12    

Classification of Anemia

Classification of Anemia
Mechanism Example
Loss of red blood cells by hemorrhage Acute GI bleeding
Increased destruction Sickle cell disease
Drug-induced autoimmune hemolytic anemia
Impaired production Nutritional deficiency anemia (iron, folate)
Aplastic or myelodysplastic anemia
Dilutional Rapid IV crystalloid infusion


Normal MCV

High MCV

Laboratory Tests

Laboratory Tests in the Evaluation of Anemia
Test Interpretation Clinical Correlation
MCV Measure of the average red blood cell size. Decreased MCV (microcytosis) is seen in chronic iron deficiency, thalassemia, anemia of chronic disease, lead poisoning.
  Increased MCV (macrocytosis) can be due to vitamin B12or folate deficiency, alcohol abuse, liver disease, reticulocytosis, and some medications (see Diagnosis section).
Mean corpuscular hemoglobin Measure of the amount of hemoglobin in average red blood cell.
Red cell distribution width Measures the size variability of the RBC population. In early deficiency anemia (iron, vitamin B12, or folate), may be increased before the mean corpuscular volume becomes abnormal.
MCHC Measure of hemoglobin concentration in average RBC. Low MCHC can be seen in iron deficiency anemia, defects in porphyrin synthesis and hemolytic anemia.
Ferritin Ferritin is a protein in the body that binds to iron. Serum levels serve as an indication of the amount of iron stored in the body. Low serum ferritin is associated with iron deficiency anemia and helps differentiate this anemia from other causes.
Reticulocyte count These RBCs of intermediate maturity are a marker of production by the bone marrow. Decreased reticulocyte count reflects impaired RBC production.
Increased counts are a marker of accelerated RBC production.
Peripheral blood smear Allows visualization of the RBC morphology. May guide to new diagnosis of diseases such as sickle cell disease.
Allows evaluation for abnormal cell shapes. Aids in the diagnosis of entities such as hemolytic anemia.
Allows examination of the white blood cells and platelets. May guide the diagnosis of other diseases that cause anemia.
Direct and indirect Coombs test Direct Coombs test is used to detect antibodies on RBCs. Direct Coombs test is positive in autoimmune hemolytic anemia, transfusion reactions, and some drug-induced hemolytic anemia.
Indirect Coombs test is used to detect antibodies in the sera. Indirect Coombs test is routinely used in compatibility testing before transfusion.


Anemia Type Treatment (Adult Doses)
Iron deficiency anemia Elemental iron, 200 to 300 mg/d (e.g., ferrous sulfate, 325 mg, three to four tablets taken on an empty stomach over the course of day); reticulocyte count should increase within 4–7 d and peak at 10 d; sustained treatment after correction of anemia is usually necessary to replenish iron stores.
Cyanocobalamin (vitamin B12) deficiency anemia Cyanocobalamin, 1000 mcg IM per week for 8 wk and every month thereafter; reticulocyte count should increase within 4 d and peak at 7 d. Oral replacement with 2000 mcg/d may be as effective.
Folate deficiency anemia Folate, 1 mg PO per day (doses up to 5 mg may be needed for patients with malabsorption); reticulocyte count should increase within 4 d with normalization of hemoglobin level in 1–2 mo.
Sideroblastic anemia Evaluate for reversible causes, including alcohol or other drug toxicity, or toxin exposure. Discontinue any offending agents.
Treatment is mainly supportive, consisting primarily of blood transfusions to maintain the hemoglobin level.
A trial of pyridoxine at pharmacologic doses (500 mg PO daily) may be helpful, with response most commonly seen in cases resulting from ethanol abuse or the use of pyridoxine antagonists.
Some patients with hereditary, X-linked sideroblastic anemia also respond to pyridoxine.
Improvement with pyridoxine is rare for sideroblastic anemia of other etiologies.
Aplastic anemia Supportive care, including transfusion if appropriate.
Referral for further workup.
Anemia of chronic disease Supportive care, including transfusion if appropriate. Referral for further workup and evaluation for underlying disease.

Disposition and Follow-Up

  • Any patient with anemia from ongoing blood loss should be admitted to the hospital for further evaluation and treatment.
  • Patients with isolated anemia that is chronic or newly diagnosed and not related to blood loss do not necessarily require admission if they are asymptomatic, hemodynamically stable, have minimal comorbid disease, and close follow-up can be arranged.
  • Patients newly diagnosed with anemia who also have abnormalities in the white blood cell or platelet count should have hematologic consultation and probable admission.

FirstAid Step1 2013 edition
Tintinalli Emergency Medicine 7th ed