Other associated

Characteristic/Parameter Etiology Mean corpuscular volume Laboratory abnormalities Physical examination Treatment
abnormalities

• Abnormal hemoglobin electrophoresis • Irritability •

• Transfusion support Extramedullary
• Genetic defect with alpha- or beta- • Abnormal high performance liquid chromatography • Growth retardation hematopoiesis
• Microcytic (<80 femtoliter) • Iron chelation
Thalassemia globin production • Elevated ferritin (due to frequent transfusions and • Jaundice • Mental retardation
in most cases • Gene therapy if available
• Absence of alpha or beta-globin chains iron overload) • Hepatomegaly • Myelodysplastic
• Patient education and genetic counseling
• Microcytic hypochromic anemia • Splenomegaly syndrome

• Genetic defect resulting in sickled
hemoglobin
Sickle cell anemia
• Point mutation in beta-globin chain,
converting glutamic acid to valine
• Microcytic (<80 femtoliter)
or normocytic
• Folate supplementation
• Hydroxyurea (to increase
• Abnormal hemoglobin electrophoresis with elevated
• Vaso-occlusion in fetal hemoglobin production
HbSS fraction
peripheral vascular beds • Oxygen supplementation • Extramedullary
• Sickled [red blood cells]] on peripheral blood smear hematopoiesis
• Jaundice from hemolysis • Transfusion support
• Elevated ferritin (due to frequent transfusions and • Pain crises
• Hepatomegaly • Iron chelation
iron overload) • Acute chest syndrome
• Splenomegaly • Gene therapy if available
• Elevated red blood cell mass
• Crizanlizumab (P-selectin inhibitor)
• Patient education and genetic counseling

• Loss of iron from occult bleeding • Low serum iron • Pallor

• Gastrointestinal blood loss • Elevated transferrin • Weakness • Intravenous or oral iron supplementation
Iron deficiency anemia • Microcytic (<80 femtoliter) • Positive occult • Chronic blood loss
• Menstrual blood loss • Low transferrin saturation • Blood transfusions
blood testing (if GI
• Dietary iron deficiency • Low ferritin bleeding)

• Medication-induced
• Indirect hyperbilirubinemia
• Autoimmunity • Removal of offending agent causing hemolysis • HELLP syndrome
• Normocytic (80-100 • Reticulocytosis • Pallor
Hemolytic anemia • Red blood cell membrane defect • Steroids • TTP
femtoliter) • Low haptoglobin • Jaundice
• Red blood cell enzyme defect • Alternative immunosuppression • CLL
• Elevated LDH
• Shear stress from mechanical valves

• Alcoholism • Microcytic (<80 femtoliter) • Removal of offending medication • Myelodysplastic

• Lead poisoning Or • Ringed sideroblasts in bone marrow • Pallor • High-dose vitamin B6 (up to 200mg daily) syndrome
Sideroblastic anemia • Vitamin B6 deficiency • Low vitamin B6 level • Avoidance of splenectomy • Myeloproliferative
• Isoniazid • Normocytic (80-100 • High lead level • Weakness • Symptomatic transfusion support
neoplasm
• Chloramphenicol femtoliter) with iron chelation as needed • Iron overload

• Chronic kidney disease

• Elevated ESR and CRP
• Rheumatologic disease
• Elevated hepcidin • Pallor • Treatment of the underlying
• Cancer • Normocytic (80-100 • Inflammatory bowel
Anemia of chronic disease • Low serum iron cause; erythropoiesis-stimulating agents
• HIV femtoliter)
• •
disease
• Low transferrin Weakness Supportive red blood cell transfusions
• Chronic infection; excess release of IL-
• Elevated ferritin
1 and IL-6

• Pallor
• Epoetin alfa 50-100 units/kg 3 times weekly • Dialysis dependence
• Chronic kidney disease or other renal • Normocytic (80-100 • Weakness
Erythropoietin deficiency • Low erythropoietin level • Darbepoietin 0.45 mcg/kg weekly or 0.75 • Myelodysplastic
dysfunction femtoliter) • Signs of chronic kidney mcg/kg every 2 weeks syndrome
disease

• Pernicious anemia • Numbness

• Low vitamin B12 or folate level
Vitamin B12 or folate • Diphyllobothrium latum infection • Macrocytic (>100 • Weakness • Vitamin B12 1000mcg daily
• Megaloblastic anemia with • Neuropathy
deficiency • Nutritional deficiency femtoliter) • Tingling • Folate 1mg daily
hypersegmented neutrophils
• Crohn's disease of terminal ileum • Paresthesias