Anemia Evaluation

Hematology & Oncology
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Anemia Evaluation
[select name="Q1" value=" |A|B|C"] <-- Select the proper classification.
A: Microcytic (MCV < 80 fL)
B: Normocytic (MCV 80 - 100 fL)
C: Macrocytic (MCV > 100 fL)[conditional field="Q1" condition="(Q1).is('A')"]
[select name="QA1" value=" |A|B"] <-- Select the ferritin level.
A: Low
B: Normal or Elevated[/conditional][conditional field="Q1|QA1" condition="(Q1).is('A')&&(QA1).is('B')"]
[select name="QA2" value=" |A|B"] <-- Select the chronicity of the microcytosis
A: New microcytosis
B: Old microcytosis[/conditional][conditional field="Q1" condition="(Q1).is('B')"]
[select name="QB1" value=" |A|B"] <-- In regard to bleeding
A: History and/or stool evidence of bleeding
B: No history or stool evidence of bleeding[/conditional][conditional field="Q1" condition="(Q1).is('B')"]
[select name="QB2" value=" |A|B|C|D"] <-- In regard to nutritional causes
A: Ferritin is low
B: B12 is low and/or homocysteine is high
C: B12 is low and/or homocysteine is high AND Ferritin is low
D: Ferritin, B12, and homocysteine are normal[/conditional][conditional field="Q1|QB1|QB2|QB3|QB4" condition="(Q1).is('B')&&((QB2).is('B')||(QB2).is('C'))"]
[select name="QB2B" value=" |A|B"] <-- Select the methylmalonic acid (MMA) level
A: Methylmalonic Acid level is high
B: Methylmalonic Acid level is normal[/conditional][conditional field="Q1" condition="(Q1).is('B')"]
[select name="QB3" value=" |A|B"] <-- In regard to renal function
A: Renal insufficiency is present
B: Renal function is normal[/conditional][conditional field="Q1" condition="(Q1).is('B')"]
[select name="QB4" value=" |A|B"] <-- In regard to hemolysis
A: Low serum haptoglobin level is associated with increased LDH, indirect bilirubin, or reticulocyte count.
B: Serum haptoglobin, lactic dehydrogenase, indirect bilirubin, and reticulocyte count are all normal[/conditional][conditional field="Q1|QB1|QB2|QB3|QB4" condition="(Q1).is('B')&&(QB4).is('A')"]
[select name="QB4A" value=" |A|B|C|D"] <-- Select peripheral blood smear finding
A: Peripheral blood smear with spherocytes
B: Peripheral blood smear with schistocytes
C: Other abnormal findings
D: No abnormal findings [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4|QB4A" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('A')"]
[select name="QB4A1" value=" |A|B"] <-- Select Coombs Result
A: Coombs test positive
B: Coombs test negative
[/conditional][conditional
field="Q1|QB1|QB2|QB3|QB4|QB4A|QB4A1" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('A')&&(QB4A1).is('B')"]
[select name="QB4A1B" value=" |A|B"] <-- Select Osmotic Fragility Test Result
A: Osmotic Fragility Test Positive
B: Osmotic Fragility Test Negative
[/conditional][conditional field="Q1|QB1|QB2|QB3|QB4|QB4A" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('B')"]
[select name="QB4AB1" value=" |A|B|C"] <-- Select Other Findings
A: Coagulation testing such as Prothrombin Time (aPT)/INR or Partial Thromboplastin Time (PTT) is Abnormal
B: Prosthetic Heart Valve or Other Valvular Abnormality is Present
C: Coagulation Testing is Normal and Heart Valve Problem is Not Suspected[/conditional][conditional field="Q1" condition="(Q1).is('C')"]
[select name="QC1" value=" |A|B"] <-- Is patient taking any drugs with bone marrow toxicity?
A: Taking a drug such as hydroxyurea, zidovudine, or other marrow toxins [html]<a href="http://www.fpnotebook.com/hemeonc/pharm/MdctnCsOfMcrcytcAnm.htm" target="_blank">see FPNotebook</a>[/html]
B: Not on medication known to have marrow toxicity[/conditional][conditional field="Q1|QC1" condition="(Q1).is('C')&&(QC1).is('B')"]
[select name="QC1B" value=" |A|B"] <-- Serum B12 and Homocysteine Levels
A: B12 is low and/or homocysteine is high
B: B12 and homocysteine are both normal[/conditional][conditional field="Q1|QC1|QC1B" condition="(Q1).is('C')&&(QC1).is('B')&&(QC1B).is('A')"]
[select name="QC1BA" value=" |A|B"] <-- Select the methylmalonic acid (MMA) level
A: Methylmalonic Acid level is high
B: Methylmalonic Acid level is normal[/conditional][conditional field="Q1|QC1|QC1B" condition="(Q1).is('C')&&(QC1).is('B')&&(QC1B).is('B')"]
[select name="QC1BB" value=" |A|B"] <-- Select severity of macrocytosis
A: Marked Macrocytosis (MCV > 110 fL)
B: Mild Macrocytosis (MCV 100 - 110 fL)[/conditional]
----------------------------
INTERPRETATION
----------------------------[conditional field="Q1|QA1" condition="(Q1).is('A')&&(QA1).is('A')"]
Consider IRON DEFICIENCY ANEMIA
Peripheral blood smear clues may include anisocytosis, poikilocytosis, and elliptocytosis.
CBC clues may include increased RDW and thrombocytosis. [/conditional][conditional field="Q1|QA1|QA2" condition="(Q1).is('A')&&(QA1).is('B')&&(QA2).is('A')"]
Consider ANEMIA OF CHRONIC DISEASE
Peripheral blood smear clues may include unremarkable (usually), rouleaux formation, myelophthisis.
CBC clues may include normal RDW.
Usual causes of ANEMIA OF CHRONIC DISEASE may include Temporal arteritis, Rheumatoid arthritis, Chronic inflammation, or Chronic infection.
Unusual causes of ANEMIA OF CHRONIC DISEASE may include Hodgkin lymphoma, Renal cell carcinoma, Castleman disease, or Myelofibrosis. [/conditional][conditional field="Q1|QA1|QA2" condition="(Q1).is('A')&&(QA1).is('B')&&(QA2).is('B')"]
Consider THALASSEMIA
Peripheral blood smear clues may include polychromasia, target cells, and basophilic stippling.
CBC clues may include normal or elevated RBC count and normal or elevated RDW.
Obtain hemoglobin electrophoresis.
Consult hematologist. [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4" condition="(Q1).is('B')&&(QB1).is('A')"]
Consider ANEMIA DUE TO BLOOD LOSS
Peripheral blood smear clues may include polychromasia.
CBC clue is that it is usually unremarkable.
Identify/address causes of blood loss. [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4" condition="(Q1).is('B')&&((QB2).is('A')||(QB2).is('C'))"]
Consider IRON DEFICIENCY ANEMIA
Peripheral blood smear clues may include anisocytosis, poikilocytosis, and elliptocytosis.
CBC clues may include increased RDW and thrombocytosis. [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4|QB2B" condition="(Q1).is('B')&&((QB2).is('B')||(QB2).is('C'))&&(QB2B).is('A')"]
Consider B12 DEFICIENCY ANEMIA
Peripheral blood smear clues may include anisocytosis and dimorphic RBCs.
CBC clues may include increased RDW. [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4|QB2B" condition="(Q1).is('B')&&((QB2).is('B')||(QB2).is('C'))&&(QB2B).is('B')"]
Consider FOLATE DEFICIENCY ANEMIA
Peripheral blood smear clues may include anisocytosis and dimorphic RBCs.
CBC clues may include increased RDW. [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4" condition="(Q1).is('B')&&(QB3).is('A')"]
Consider ANEMIA OF RENAL DISEASE
CBC clues may include normal RDW. [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4|QB4A|QB4A1" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('A')&&(QB4A1).is('A')"]
Consider AUTOIMMUNE HEMOLYTIC ANEMIA
CBC clues may include normal or elevated RDW, thrombocytosis.
Consult hematologist. [/conditional][conditional
field="Q1|QB1|QB2|QB3|QB4|QB4A|QB4A1|QB4AB1" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('A')&&(QB4A1).is('B')&&(QB4A1B).is('A')"]
Consider HEREDITARY SPHEROCYTOSIS
CBC clues may include normal or elevated RDW, thrombocytosis.
Consult hematologist. [/conditional][conditional
field="Q1|QB1|QB2|QB3|QB4|QB4A|QB4A1|QB4AB1" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('A')&&(QB4A1).is('B')&&(QB4A1B).is('B')"]
Consider HEMOLYTIC ANEMIA
Consult hematologist. [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4|QB4A|QB4AB1" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('B')&&(QB4AB1).is('A')"]
Consider DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
Consult hematologist. [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4|QB4A|QB4AB1" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('B')&&(QB4AB1).is('B')"]
Consider VALVULAR HEMOLYSIS
Urinary Hemosiderin Test may be helpful.
Consult specialist to identify/address valvular concerns as appropriate. [/conditional][conditional field="Q1|QB1|QB2|QB3|QB4|QB4A|QB4AB1" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('B')&&(QB4AB1).is('C')"]
Consider THROMBOTIC THROMBOCYTOPENIA/HEMOLYTIC UREMIC SYNDROME
CBC clues may include normal or elevated RDW, thrombocytopenia.
Consult hematologist. [/conditional][conditional
field="Q1|QB1|QB2|QB3|QB4|QB4A" condition="(Q1).is('B')&&(QB4).is('A')&&(QB4A).is('C')"]
Consider HEMOLYTIC ANEMIA
Consult hematologist. [/conditional][conditional field="Q1|QC1" condition="(Q1).is('C')&&(QC1).is('A')"]
Consider DRUG-RELATED MACROCYTIC ANEMIA
Peripheral blood smear clues may include oval macrocytes.
CBC clues may include increased RDW and marked or mild macrocytosis.
Adjust/discontinue medication in collaboration with prescriber if possible/appropriate. [/conditional][conditional field="Q1|QC1|QC1B|QC1BA" condition="(Q1).is('C')&&(QC1).is('B')&&(QC1B).is('A')&&(QC1BA).is('A')"]
Consider B12 DEFICIENCY ANEMIA
Peripheral blood smear clues may include oval macrocytes, hypersegmented neutrophils.
CBC clues may include increased RDW, marked or mild macrocytosis. [/conditional][conditional field="Q1|QC1|QC1B|QC1BA" condition="(Q1).is('C')&&(QC1).is('B')&&(QC1B).is('A')&&(QC1BA).is('B')"]
Consider FOLATE DEFICIENCY ANEMIA
Peripheral blood smear clues may include oval macrocytes, hypersegmented neutrophils.
CBC clues may include increased RDW, marked or mild macrocytosis. [/conditional][conditional field="Q1|QC1|QC1B|QC1BB" condition="(Q1).is('C')&&(QC1).is('B')&&(QC1B).is('B')&&(QC1BB).is('A')"]
Consider MYELODYSPLASTIC SYNDROME or OTHER PRIMARY BONE MARROW DISORDER
Peripheral blood smear clues may include dimorphic RBCs, pseudo Pelger-Huet anomaly cells, oval macrocytes.
CBC clues may include increased RDW.
Consult hematologist. [/conditional][conditional field="Q1|QC1|QC1B|QC1BB" condition="(Q1).is('C')&&(QC1).is('B')&&(QC1B).is('B')&&(QC1BB).is('B')"]
Consider MYELODYSPLASTIC SYNDROME.
Peripheral blood smear clues may include dimorphic RBCs, pseudo Pelger-Huet anomaly cells, oval macrocytes.
CBC clues may include increased RDW.
Consult hematologist.
Note: Other conditions are possible, including LIVER DISEASE, ALCOHOL CONSUMPTION, HYPOTHYROIDISM, and marked reticulocytosis from HEMOLYSIS. [/conditional]
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: <a href="http://www.ncbi.nlm.nih.gov/pubmed/16007898" target="_blank">Tefferi A, Hanson CA, Inwards DJ. How to interpret and pursue an abnormal complete blood cell count in adults. Mayo Clin Proc. 2005 Jul;80(7):923-36.</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/19202968" target="_blank">Kaferle J, Strzoda CE. Evaluation of macrocytosis. Am Fam Physician. 2009 Feb 1;79(3):203-8.</a>[/html][/conditional]
Anemia Evaluation
<-- Select the proper classification.
A: Microcytic (MCV < 80 fL)
B: Normocytic (MCV 80 - 100 fL)
C: Macrocytic (MCV > 100 fL)
----------------------------
INTERPRETATION
----------------------------

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