Understanding Anemia Overview

Anemia

• Anemia is not a disease, but a sign/symptom of an underlying disorder
• Defined as a reduction in red blood cell (RBC) count, hemoglobin concentration, or hematocrit
• Categories based on etiology:
  • Hypo-proliferative (RBC production disorders):
    • Iron-deficiency anemia
    • Vitamin B12 deficiency
    • Renal failure
    • Marrow failure
  • Non-hypo-proliferative (RBC destruction disorders):
    • Hemoglobin-related: Sickle cell anemia, thalassemia
  • Anemia from blood loss: Acute or chronic
• Clinical presentation:
  • Gradual onset symptoms appear when hemoglobin < 7.5 g/dL
  • Initial symptoms: fatigue, malaise, headache, dyspnea, irritability, mild exercise intolerance
  • Severe symptoms: reduced exercise capacity, resting tachycardia, dyspnea requiring supplemental oxygen
• Physical exam findings:
  • Wide pulse pressure, midsystolic or pansystolic murmur
  • Brittle/spoon-shaped nails, glossitis, angular cheilitis
  • Pale palmar creases
• Diagnostics:
  • Complete blood count (CBC) with differential (especially mean corpuscular volume, MCV)
  • Red blood cell (RBC) morphology
  • Reticulocyte count
  • Peripheral blood smear
  • Hemoglobin electrophoresis
  • Serum ferritin, serum iron, total iron-binding capacity (TIBC), transferrin saturation percentage, vitamin B12/folate levels

Blood Coagulation Disorders

• Coagulation is the process transforming blood from a fluid to a gel, stopping blood loss
• Deficiencies in coagulants or anticoagulants can cause bleeding (coagulopathy) or clotting (thrombosis)
• Disorders can be inherited or acquired
• Inherited disorders: Von Willebrand disease, hemophilia A, hemophilia B
• Acquired disorders: Medications (e.g., aspirin, NSAIDs, anticoagulants), organ dysfunction (e.g., liver disease, cancer)
• Clinical presentation:
  • Hereditary bleeding disorders: lifelong history of easy bruising, prolonged bleeding with cuts, surgery, or trauma
  • Acquired disorders: may appear later in life without history of abnormal bleeding, recent onset of increased bruising, bleeding with trauma, nosebleeds, change in platelet count/clotting test results
  • Physical exam: bruises, petechiae, gingival bleeding, epistaxis (nosebleeds), hematomas, blood clots (lower extremity edema, dyspnea, hypoxia)
• Diagnostics:
  • Platelet count
  • Platelet function analysis
  • Peripheral blood smear
  • Prothrombin time (PT) or activated partial thromboplastin time (aPTT)
  • D-dimer
  • Venous ultrasound
  • Contrast-enhanced CT chest (preferred), or ventilation/perfusion scans (for patients unable to have CT contrast, allergy, or renal contraindication)
• Management:
  • Case-dependent based on underlying etiology, hematologist consultation recommended