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Anemia Approach (based on severity not etiology (Paradigm: worse the…

- - - - Symptomatology
        
        Hb > 10
        
        Sx: normal (anemia presents with sx)
        
        Hb 8-9
        
        Sx: malaise, fatigue, PALLOR begins
        
        :pencil2:seen w/ person previously active no longer as active :runner:
        
        Pallor: skin an anterior rim
        
        :warning:space under the eyelid lacks vessels :eye:: Hgb <8
        
        Hb 6-7
        
        DOE, pre syncope
        
        Hb 4-5
        
        :warning:Sx: MI, CVA, HOHF (hi output HF) :<3:
        
        Normal Hb >13
        
        Sx: normal
    - - sicker pt is at baseline
        
        Faster drop in Hb
        
        ∆Hgb
        __
        ∆Time
        
        large ∆, more sx
        
        slow ∆ have time to adapt: e.g. Asx pt w/ Hgb < 3
  - - - small drop in Hb won't feel sx
      - Large drop might feel compensatory increase in CO
        
        Sx: Tachycardia
    - - any drop in Hb causes severe sx
- - - - bone can't make more blood, though it should
- - - - normal Hb
        
        no anemia
        :forbidden: stop (look for something else)
      - :check:(+), low Hgb
        
        Check MCV, and order reticulocyte index
        
        microcytic
        
        most are production anemias
        
        Ferritin test, or iron studies( ferritin, Fe, TIBC, % sat
        
        IDA
        
        ACID
        
        Thalassemia
        
        Sideroblastic
        
        normocytic
        
        usually destruction anemias, w/ exceptions
        
        Hemolysis or hemorrhage
        
        :arrow_up:elev LDH,
        
        :arrow_down_small:dec haptoglobin,
        
        :arrow_up:bilirubin (elevated T bill, Direct bill)?
        
        2 more items...
        
        :warning:exception: normocytic anemias that is production problem
        
        low reticulocyte index
        
        marrow malignancy
        
        leukemia
        
        MDS
        
        CKD
        
        Macrocytic
        
        most are production anemias
        
        Blood smear for hyperhsegmented PMN (≥5 lobes)
        
        :check:(+) megaloblastic
        
        Megaloblastic: impaired DNA synth
        
        3 more items...
        
        :green_cross:(-), non-megaloblastic anemia
        
        liver disease: cirrhosis
        
        Rx
        
        metabolic disorders
        
        ETOH