❑ Iron deficiency
❑ Anemia of chronic disease
❑ Thalassemia
❑ Sideroblastic anemia
❑ Lead toxicity

❑ Megaloblastic bone marrow^[8]

❑ Vitamin B12 deficiency
❑ Folate deficiency
❑ Medications (hydroxyurea, zidovudine, methotrexate, chemotherapy agents)

❑ Nonmegaloblastic bone marrow^[7]

❑ Liver disease
❑ Hypothyroidism
❑ Myelodysplastic syndrome
❑ Alcohol abuse

❑ Increased reticulocyte count

❑ Hemorrhage
❑ Blood loss
❑ Hemolytic anemia

❑ Decreased reticulocyte count

❑ Infections
❑ Aplastic anemia
❑ Leukemia
❑ Medications

❑ Pregnancy
❑ Menorrhagia
❑ GI blood loss
❑ GI surgery
❑ Koilonychia
❑ Pica

Thalassemia^[11]

❑ Resident of Mediterranean and Asia
❑ Chipmunk facies
❑ Skeletal deformity
❑ Hepatomegaly
❑ Splenomegaly

Lead poisoning^[12]

❑ House painted with chipped paint
❑ Wrist drop
❑ Foot drop
❑ Burtonian lines
❑ Basophilic stippling

Sideroblastic anemia^[13]

❑ Alcohol abuse
❑ Isoniazid use
❑ Seborrheic dermatitis
❑ Vitamin B6 deficiency

Anemia of chronic disease^[14]

❑ Signs and Symptoms of a chronic disease (SLE, chronic kidney disease, malignancy)

Vitamin B12 deficiency^[15]

❑ Vegan diet
❑ Gastrectomy
❑ Pernicious anemia
❑ Diphyllobothrium latum infection
❑ Crohn’s disease
❑ Neurological deficit
❑ Psychological symptoms

Folate deficiency^[16][17]

❑ Alcoholism
❑ Pregnancy and Lactation
❑ Medications (methotrexate, trimethoprim, phenytoin)
❑ Malnutrition
❑ Old age
❑ Glossitis
❑ Neural tube defects

Liver disease^[18]

❑ Fever
❑ Jaundice
❑ Abdominal pain
❑ Pruritus

Hypothyroidism^[19]

❑ Cold intolerance
❑ Weight gain
❑ Constipation
❑ Goiter
❑ Periorbital edema

Hemolytic anemia^[5]

❑ Family history of anemia
❑ African-American or African race
❑ Fava beans
❑ Medications
❑ Prosthetic heart valve
❑ Jaundice
❑ Hemoglobinuria
❑ Splenomegaly
❑ Gallstones

Hemorrhage or Blood loss^[20]

❑ Hypotension
❑ Tachycardia

Infections^[21]

❑ Travel History
❑ Fever

Aplastic anemia^[22]

❑ History of radiation exposure
❑ Medications (benzene, chloramphenicol, alkylating agents)
❑ Viral infection (EBV, HIV)

Leukemia^[23]

❑ Family history of cancer
❑ Chemotherapy
❑ Exposure to radiation, pesticide, insecticide
❑ Petechiae
❑ Bleeding
❑ Recurrent infections
❑ Weight loss
❑ Anorexia
❑ Hepatosplenomegaly
❑ Lymphadenopathy

❑ Iron studies

❑ Decreased serum ferritin
❑ Decreased serum iron
❑ Increased total iron binding capacity
❑ Increased serum transferrin/ total iron binding capacity
❑ Increased transferrin saturation

❑ Increased RDW
❑ Elevated erythrocyte (RBC) zinc protoporphyrin
❑ Iron stain (prussian blue stain) on bone marrow aspirate

Thalassemia

❑ Elevated lactate dehydrogenase (LDH)
❑ Low haptoglobin
❑ Hyperbilirubinemia
❑ Abnormal bands on hemoglobin electrophoresis
❑ Target cells on peripheral blood smear

Lead poisoning

❑ Basophilic stippling of red blood cells
❑ Elevated venous blood lead levels

Sideroblastic anemia

❑ Iron studies

❑ Increased serum ferritin
❑ Increased serum iron
❑ Decreased total iron binding capacity
❑ Increased transferrin

❑ Prussian Blue stain of RBC in bone marrow, shows ringed sideroblasts
❑ Bone marrow aspiration and biopsy

Anemia of chronic disease

❑ Iron studies

❑ Normal or Increased serum ferritin
❑ Decreased serum iron
❑ Decreased transferrin
❑ Normal or low-normal percent saturation of transferrin

❑ Increased cytokines (e.g., IL-6, interferon-gamma)
❑ Increased acute phase reactants (e.g., fibrinogen, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP))
❑ Rheumatologic assays or Serological tests (e.g., anti-nuclear antibody, rheumatoid factor, anti-CCP, anti-dsDNA)

Vitamin B12 deficiency

❑ Decreased serum B12 levels
❑ Increased serum homocysteine levels
❑ Increased serum methylmalonic acid levels
❑ Anti-IF antibodies
❑ Anti-parietal cell antibodies

❑ Peripheral blood smear

❑ Multisegmented neutrophils
❑ Anisocytosis
❑ Poikilocytosis

Folate deficiency

❑ Decreased serum folate levels
❑ Decreased RBC folate levels
❑ Increased homocysteine levels
❑ Normal methylmalonic acid levels

❑ Peripheral blood smear

❑ Multisegmented neutrophils
❑ Anisocytosis
❑ Poikilocytosis

Liver disease
❑ Liver function tests

❑ Albumin
❑ Total protein
❑ Bilirubin
❑ ALP (alkaline phosphatase), ALT (alanine transaminase), AST (aspartate aminotransferase), and GGT (gamma-glutamyl transpeptidase)
❑ LDH (lactate dehydrogenase)
❑ Prothrombin time

Hypothyroidism

❑ Low serum T3,T4 levels
❑ Low or elevated serum TSH levels

Hemolytic anemia

❑ Elevated total bilirubin
❑ Elevated LDH
❑ Direct antiglobulin test (DAT) (Coomb’s test)
❑ Indirect antiglobulin test (indirect Coombs’ test)
❑ Osmotic fragility test
❑ Urine hemosiderin
❑ Urine hemoglobin
❑ Peripheral blood smear

❑ Schistocytes
❑ Spherocytes
❑ Target cells
❑ Bite cells
❑ Sickle shaped RBC
❑ Degmacytes

Hemorrhages or Bleeding

❑ Complete blood count
❑ Bleeding time
❑ Prothrombin time (PT) and the activated partial thromboplastin time (aPTT)
❑ Coagulation factors
❑ Serum fibrinogen
❑ Serum D-dimer
❑ Ultrasonography

Infections

❑ CBC with differentials
❑ Blood smear for malaria
❑ Blood culture and sensitivity
❑ Gram stain
❑ Urine culture and sensitivity

Aplastic anemia

❑ Pancytopenia
❑ Bone marrow biopsy

❑ Hypocellular bone marrow with increased adipose tissue and decreased hematopoietic cells in the marrow space
❑ Normal maturation of all cell lines

Leukemia

❑ Bone marrow biopsy
❑ Complete blood count

❑ Thrombocytopenia
❑ Leucocytosis or Leucopenia
❑ Absolute basophilia and eosinophilia
❑ Neutrophilia or Neutropenia
Low or elevated leukocyte alkaline phosphatase

Iron deficiency anemia^[24]

❑ Iron supplements
❑ Erythropoietin
❑ Blood transfusion

Thalassemia^[25]

❑ Blood transfusion
❑ Bone marrow transplant
❑ Gene therapy

Lead poisoning^[26]

❑ Chelation therapy

❑ DMSA/Succimer
❑ Ethylenediaminetetraacetic acid (EDTA)
❑ British anti-Lewisite (BAL)/Dimercaprol

Sideroblastic anemia^[27]

❑ Pyridoxine
❑ Thiamine
❑ Folic acid
❑ Iron chelation therapy
❑ Blood transfusion

Anemia of chronic disease^[28]

❑ Iron supplements
❑ Erythropoietin
❑ Blood transfusion
❑ Treat the underlying cause

Vitamin B12 deficiency^[29]

❑ Vitamin B12 supplementation
❑ Folic acid supplementation
❑ Treat the cause of vitamin B12 deficiency

Folate deficiency^[30]

❑ Folic acid supplementation (rule out vitamin B12 deficiency before starting folic acid supplementation)
❑ Vitamin B12 supplementation (if vitamin B12 deficiency is present)
❑ Treat the cause of folate deficiency

Liver disease^[18]

❑ Treat the underlying cause

Hypothyroidism^[31]

❑ Thyroid hormone replacement therapy

Hemolytic anemia^[32]

❑ Blood transfusion
❑ Erythropoietin
❑ Immunosuppression

Bleeding or Hemorrhage^[33]

❑ Emergency bleeding control
❑ Discontinue antiplatelet and anticoagulation therapy
❑ Blood transfusion
❑ Treat the underlying cause

Infection^[21]

❑ Antibiotics
❑ Treat the underlying cause

Aplastic anemia^[34]

❑ Blood transfusion
❑ Hematopoietic stem cell transplantation
❑ Erythropoietin
❑ Granulocyte colony-stimulating factor
❑ Immunosuppressive therapy
❑ Treat the underlying cause

Leukemia^[35]

❑ Blood transfusion
❑ Chemotherapy
❑ Treat the underlying etiology