Anemia

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Anemia
Pearl Toy MD
ANEMIA
ESSENTIALS OF DIAGNOSIS
For euvolemic men, hemoglobin concentration100 FL)
Reticulocytosis.
Alcoholism.
Lipid disorders: liver disease, hypothyroidism,hyperlipidemia.
Hypothyroidism.
Folate or vitamin B12 deficiency.
Drugs that interfere with nucleic acid synthesis (eg, zidovudine, cytosine arabinoside, methotrexate).
Abnormal red cell maturation (eg,myelodysplastic syndromes).
BLOOD LOSS
Blood loss is most commonly from the gastrointestinal or genitourinary tract. Iron deficiency implies chronic occult blood loss. Common sources include carcinoma,ulcer, atrophic gastritis, gastritis from drug ingestion, bleeding hemorrhoids, angiodysplasia of the colon, and vaginal bleeding.
ANEMIA OF CHRONIC DISEASE
Anemia of chronic disease is the mostcommon normocytic anemia in the elderly but becomes microcytic in later stages. Chronic diseases include inflammation and cancer. Anemia is also associated with chronic renal insufficiency and liverdisease.
Serum ferritin is normal or elevated in anemia of chronic disease as a result of inflammation or cancer. Subcutaneous erythropoietin is used to treat anemic patients with renal insufficiency orcancer when the Hgb is < 10 g/dL. For cancer patients on chemotherapy with anemic symptoms, subcutaneous erythropoietin 3 times/week (150 U/kg) for a minimum of 4 weeks improves quality of life. Dosageshould be titrated once the Hgb concentration reaches 12 g/dL. If there is no response, no benefit is observed beyond a 6- to 8-week trial.
Rizzo JD et al: Use of epoietin in patients with cancer:evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. Blood 2002;100:2303. [PMID: 12239138]
IRON DEFICIENCY
Iron deficiencyanemia is characterized by small, pale red cells and depleted iron stores. Serum ferritin reflects iron stores, and a level < 10µg/L is diagnostic of iron deficiency. However, serum ferritin levels...
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