-- History: *** EtoH use, prev bleeds (menstruation, GI), autoimmune dx, nutritional status, vegetarian/vegan, recent meds, bariatric surgery
-- Clinical: *** fatigue, lightheadedness, SOB/DOE, angina, melena, Pica, restless legs
-- Exam: *** pallor, jaundice, glossitis, motor/sens deficits, splenomegaly, brittle nails, hair loss
-- Data: *** MCV, RDW, retic abs and %, smear, iron studies, B12/folate, TSH, bilirubin, LDH, haptoglobin, DAT, coags, UA
-- Etiology/DDx: *** Underproduction (IDA, Chronic Inflammation, ESRD, Folate/B12, Alcohol, Marrow Suppression) vs Destruction/Loss (GI malignancy, Menorrhagia, MAHA, immune-mediated) vs Genetic/Intrinsic (mostly zebras); Anemia AND Thrombocytopenia: Hypersplenism, EtOH, babesiosis, Evans syndrome, B12 deficiency, TMAs (e.g. TTP), HLH, PNH
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- Initial Labs - CBC w/ diff (MCV, RDW), Retic abs count and %, smear
-- Calculate Retic Index (RI) - if <2%, hypoproliferation/underproduction
-- Anemia Labs - iron studies, folate/B12, BMP, LFTs, TSH, CRP; SPEP, EPO, BMBx
-- Hemolysis Labs - LDH, bilirubin, haptoglobin, DAT (Coombs), coags, UA
-- Consider EGD/Colo if c/f GIB
-- Transfuse Hgb <7
-- IDA - tablets 325mg iron sulfate QOD vs IV iron sucrose 300mg QOD x3
-- ESRD - EPO
-- Folate/B12 - replete
PDF coming soon!
Many patients will be anemic in the inpatient setting. Determine if the process is acute and life-threatening, or represents a chronic process, and be mindful of iatrogenic causes. In general, transfuse Hgb >7, but be judicious since blood products are a scarce resource and, like all treatments, have their own risks.