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Anemia evaluation requires a systematic approach combining clinical presentation, laboratory findings, and careful interpretation of blood markers. This article outlines key considerations for primary care physicians to determine anemia type and cause, while providing clear guidance on when specialist referral becomes necessary.
Key Points:
- Utilize three primary diagnostic tools for initial evaluation: clinical presentation, mean corpuscular volume (MCV), and complete blood count (CBC) with reticulocyte count. Consider these factors simultaneously due to anemia’s typically multifactorial nature
- Classify anemia based on corrected reticulocyte count (CRC): hypoproliferative (decreased CRC) indicates conditions like iron/B12 deficiency or bone marrow disorders, while hyperproliferative (increased CRC) suggests hemolysis or recovery from bleeding
- Apply MCV-based classification in stable outpatients: microcytic (iron deficiency, chronic disease), normocytic (early nutrient deficiency, kidney disease), or macrocytic (B12/folate deficiency, myelodysplasia)
- Look for specific markers in hemolysis cases: elevated CRC and LDH, undetectable haptoglobin, and indirect hyperbilirubinemia
- Consider specialist referral for: severe iron deficiency anemia requiring IV iron, pregnancy-related IDA, hemolytic anemia, suspected myelodysplasia, presence of blood cell abnormalities, or uncertain etiology
“Evaluation of anemia can be approached based on the clinical presentation, mean corpuscular volume (MCV), and the CBC and reticulocyte count.”
– Prakash Vishnu MD, FACP, Associate Professor of Hematology & Oncology, University of Washington in Seattle
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