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Disease

Symptoms and Signs

Anemia

Pallor, fatigue, weakness, dizziness, chest pain, weight loss, jaundice, tachypnea and tachycardia, heart murmur, heart failure

Polycythemia

Irritability, cyanosis, jaundice, headache, itching, bleeding or easy bruising, dizziness, tinnitus, blurry vision, seizures, stroke

Neutropenia

Fever, pharyngitis, oral and perianal ulcerations, severe gingivitis, frequent or uncommon infections, cellulitis, lymphadenopathy, bacteremia

Thrombocytopenia

Petechiae, ecchymoses, GI hemorrhage, epistaxis, hematuria, heavy menstrual bleeding, excessive bleeding from minor cuts or surgery

Coagulopathy

Bruising, hemarthrosis, internal bleeding after minor trauma

Thrombosis

Pulmonary embolus, DVT, stroke, seizures

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  • Definition: Hb, HCT, and/or RBC count <2 SD below age-specific norms
  • Mechanism: Hemorrhage, hemolysis, ineffective hematopoiesis

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Hemoglobin (g/dL)

Packed Cell Volume (%)

Mcv (fl)

MCH (pg)

Age (Y)

Mean

Lower Limit

Mean

Lower Limit

Mean

Lower Limit

Mean

Lower Limit

0.5–4

12.5

11.0

36

32

80

72

28

24

5–10

13.0

11.5

38

33

83

75

29

25

11–14♀

13.5

12.0

39

34

85

77

29

26

11–14♂

14.0

12.0

41

35

85

77

29

26

15–19♀

13.5

12.0

40

34

88

79

30

27

15–19♂

15.0

13.0

43

37

88

79

30

27

20–44♀

13.5

12.0

40

35

90

80

31

27

20–44♂

15.5

13.5

45

39

90

80

31

27

Note: Hemoglobin and MCH were obtained by Coulter counter, packed cell volume was obtained by centrifugation, and MCV was obtained from packed cell volume divided by the Coulter red cell count. All date are based on venous blood in caucasians after excluding individuals with laboratory evidence of iron deficiency or inflammatory disease Hemoglobin values are rounded out to the nearest 0.5 g/dL. Red cell indices are calculated from combined data for both sexes because of the relatively minor difference in values.

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Diagnosis

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  • 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).

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Classification

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eFigure 18-1
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Morphologic classifi cation of anemia.

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eFigure 18-2
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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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