The document discusses the approach to evaluating and diagnosing anemia. It defines anemia as a reduction in hemoglobin or red blood cell volume below normal levels. The evaluation involves taking a thorough history including symptoms, medications, travel, diet and family history. A physical exam evaluates for pallor, jaundice, organomegaly and bruising. Initial labs help classify anemia as macrocytic, microcytic or normocytic. Further testing is then guided by these characteristics to identify potential causes such as nutritional deficiencies, bleeding disorders, infections, liver or bone marrow diseases.

1. APPROACH TO ANEMIA-
Pallor+++
Student- Dr. Swati P.
Guide- Dr. Girish Nanoti

2. Definition of Anemia
• Reduction of Hemoglobin concentration or red blood
cells volume below the range of values occuring in
healthy persons.
• Anemia can be functionally defined as an insufficient
RBC mass to adequately deliver oxygen to peripheral
tissues.

3. History
• Duration of symptoms?
• Onset- insidious/acute?
• Family history- bleeding,
jaundice, gallstones,
splenectomy?
• Travel to- malarious/
infectious areas?
• Drug history?
• Dietary history?
• Surgery done in the past?
• Change in stool habits?
• Adolscent girls- menstrual
history?
• Associated fever?
• Pain in limbs, parasthesia,
difficulty in walking?
• Colour of urine?
• Bruises, ecchymoses and
petechiae?
• Symptoms s/o chronic
disease or infection?

4. PHYSICAL EXAMINATION
• Pallor
• Scleral Icterus
• Sternal tenderness (middle/ lower 1/3rd)
• Palpation of liver, spleen and systemic
lymphadenopathy

5. CLINICAL EFFECTS OF ANEMIA
 General-
• decreased work / exercise tolerance
• shortness of breath
• palpitation
 Cardiopulmonary features-
• Insidious + no cardiopulmonary disease- effective
physiological adjustment.
• Insidious + cardiopulmonary disease- dyspnea, awareness of
vigorous rapid heart action at rest.
• Rapid development of anemia- shortness of breath,
tachycardia, dizziness/faintness (arising from sitting position),
extreme fatigue.

6. Pallor-
• Grades of pallor-
Severe pallor- palmar creases become faint and
pale
Moderate pallor- paleness of mucosa but pink hue
of the palmar crease is maintained.
• Sallow colour- chronic anemia
• Lemon yellow- pernicious anemia
• Definite pallor + mild scleral and cutaneous
icterus- hemolytic anemia
• Marked pallor + petechiae + ecchymosis- bone
marrow failure

7. Initial evaluation of anemia

8. Initial evaluation of anemia
Is anemia associated with other
hematologic abnormalities?

9. Approach to patient with MACROCYTIC anemia

10. Approach to patient with MICROCYTIC anemia

11. Approach to patient with NORMOCYTIC anemia

12. Signs & symptoms and diagnosis
• Anemia
• No lymph nodes
• No hepatosplenomegaly
• No petechiae/ ecchymosis
Nutritional
Pure red cell aplasia
Thalassemia trait
Lead poisoning
Renal disease

13. • Anemia
• With petechiae, lymphadenopathy and
hepatosplenomegaly
Leukemia
Infections
DIC

14. • Anemia
• With hepatosplenomegaly
Thalassemia
Liver disorder

15. • Anemia
• No lymph nodes
• No hepatosplenomegaly
• With petechiae and ecchymosis
Aplastic anemia
Bleeding disorder
Coagulation diorder
ITP
DIC