Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++Table Graphic Jump Location|Download (.pdf)|PrintDiseaseSymptoms and SignsAnemiaPallor, fatigue, weakness, dizziness, chest pain, weight loss, jaundice, tachypnea and tachycardia, heart murmur, heart failurePolycythemiaIrritability, cyanosis, jaundice, headache, itching, bleeding or easy bruising, dizziness, tinnitus, blurry vision, seizures, strokeNeutropeniaFever, pharyngitis, oral and perianal ulcerations, severe gingivitis, frequent or uncommon infections, cellulitis, lymphadenopathy, bacteremiaThrombocytopeniaPetechiae, ecchymoses, GI hemorrhage, epistaxis, hematuria, heavy menstrual bleeding, excessive bleeding from minor cuts or surgeryCoagulopathyBruising, hemarthrosis, internal bleeding after minor traumaThrombosisPulmonary embolus, DVT, stroke, seizures ++ Definition: Hb, HCT, and/or RBC count <2 SD below age-specific normsMechanism: Hemorrhage, hemolysis, ineffective hematopoiesis ++Table Graphic Jump Location|Download (.pdf)|PrintHemoglobin (g/dL)Packed Cell Volume (%)Mcv (fl)MCH (pg)Age (Y)MeanLower LimitMeanLower LimitMeanLower LimitMeanLower Limit0.5–412.511.03632807228245–1013.011.538338375292511–14♀13.512.039348577292611–14♂14.012.041358577292615–19♀13.512.040348879302715–19♂15.013.043378879302720–44♀13.512.040359080312720–44♂15.513.5453990803127Note: 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. +++ Diagnosis ++ 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). +++ Classification ++eFigure 18-1Graphic Jump LocationView Full Size||Download Slide (.ppt)Morphologic classifi cation of anemia.++eFigure 18-2Graphic Jump LocationView Full Size||Download Slide (.ppt)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 measure of iron availability ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.