-IBIS-1.5.0-
tx
cardiovascular system
anemia: metabolic dysfunction
diagnoses

definition and etiology

definition:
Reduction in red cell mass from decreased RBCs and/or hemoglobin.

etiology:
There are many factors affecting RBC production:

• hypochromic microcytic anemias
» iron deficiency anemia
» atransferrinemic anemia (iron transport deficiency)
» iron utilization anemia (sideroblastic anemia)
» iron reutilization anemia (anemia of chronic disease)

• normochromic normocytic anemia
» hypoproliferative anemia
» anemia of renal disease
» anemia of endocrine failure (myxedema and hypopituitarism)
» anemia of protein depletion
» hypoplastic (aplastic) anemia
» myelophthisic anemia

• macrocytic anemia
» anemia from B12 deficiency
» anemia from folic acid deficiency
» anemia from copper deficiency
» anemia from ascorbic acid deficiency

signs and symptoms

Anemia is a clinical sign or symptom; its use as a diagnostic term requires an understanding of its mechanism. The clinical expression is tissue hypoxia, and its specific signs represent compensatory responses.

severe anemia can produce:
» weakness
» vertigo
» headache
» tinnitus
» spots before the eyes
» drowsiness
» irritability

and less often:
» amenorrhea
» loss of libido
» gastrointestinal complaints
» jaundice and splenomegaly

finally:
» congestive heart failure
» shock

Lab work is essential for determining extent and cause of the anemia. Basic evaluation requires a CBC with RBC indices, reticulocyte count, platelet count, and cellular morphology. For specific lab values, see: anemia: blood loss

course and prognosis

depends upon etiology

differential diagnosis

Since anemia is a symptom rather than a specific disease entity, it is important to probe the cause. Initial direction may be obtained from thorough history and pertinent physical examination, along with the morphologic evidence gathered from blood work. Determine whether the anemia is from blood loss, decreased production or increased destruction. The differential is systematic, and widely described in standard reference texts, whose flowcharts are an excellent guide to workup prior to consultation with a hematologist.


footnotes