Symptoms and Signs
Pallor, fatigue, weakness, dizziness, chest pain, weight loss, jaundice, tachypnea and tachycardia, heart murmur, heart failure
Irritability, cyanosis, jaundice, headache, itching, bleeding or easy bruising, dizziness, tinnitus, blurry vision, seizures, stroke
Fever, pharyngitis, oral and perianal ulcerations, severe gingivitis, frequent or uncommon infections, cellulitis, lymphadenopathy, bacteremia
Petechiae, ecchymoses, GI hemorrhage, epistaxis, hematuria, heavy menstrual bleeding, excessive bleeding from minor cuts or surgery
Bruising, hemarthrosis, internal bleeding after minor trauma
Pulmonary embolus, DVT, stroke, seizures
- Definition: Hb, HCT, and/or RBC count <2 SD below age-specific norms
- Mechanism: Hemorrhage, hemolysis, ineffective hematopoiesis
Packed Cell Volume (%)
- History and physical exam: Determine if acute or chronic bleeding, detailed diet history (milk intake, iron supplementation [breastfed neonates], folate, vitamin B12), infection, drugs, chemicals (lead ingestion), FHx (G6PD, thalassemia, splenomegaly, autoimmune d/o, bleeding d/o, jaundice), other chronic medical conditions. Check vitals (HR, BP, RR) and plot growth parameters. Perform a CV exam (systolic ejection murmur, gallop, cardiomegaly). Check for hepatomegaly and splenomegaly and signs of hypothyroidism.
- Initial lab workup: Primary: CBC, reticulocyte, peripheral smear; Secondary (if hemolysis suspected): Bilirubin, LDH, haptoglobin, UA (urobilinogen).
Morphologic classifi cation of anemia.
Differential diagnosis algorithm for normocytic, normochromic anemia.
*Normal reticulocyte values by age: 0-2 days, 3-7%; 3-4 days, 1-3%; 5 days and older, 0.5-1.5%. Normal absolute
reticulocyte values by age: 0-2 days 0.140-0.220 × 106/μL, 3-4 days 0.040-0.110 × 106/μL, 5 days and older
0.020-0.080 × 106/μL. Furthermore, a reticulocyte hemoglobin (RET-He), which provides a ...
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