Hematology – Anemia SOAP Note with Karima Khamisa, MD

INTRODUCTION Anemia in the in-hospital setting is relatively common. Daily phlebotomy, anemia of inflammation, chronic disease, or GI bleeding complicates the stay of many patients. In the ER, profound anemia can be seen in patients with acute hemorrhage, hemolysis, or malignant disorders such as acute leukemia In the ambulatory care setting, iron deficiency anemia and anemia of chronic disease are common and can be appropriately managed by primary care practitioners. Referral to a hematologist may not be needed in many cases. OVERVIEW Patients with anemia may present with fatigue, pallor, dyspnea, chest pain, syncope, or palpitations. From a laboratory point of view, a complete blood count (CBC) is the easiest way to detect anemia. A CBC is an automated test that measures the number of red cells, platelets and white cells present in the serum. Hemoglobin concentration and not red cell number is used to quantify anemia. In the United States g/dL units are used; in Canada and Europe, g/L are used. The normal range for hemoglobin varies by sex, age, pregnancy status and individual hospitals. The World Health Association has indicated a normal hemoglobin for a male is greater than 130 g/L and for non-pregnant females greater than 120 g/L. CATEGORIZING ANEMIA Standard approaches categorize anemia by cell size (microcytic, normocytic or macrocytic). These categories are as follows: • 0 – 80 fL: microcytic (smaller than normal) • 80 – 100 fL: normocytic • >100fL: macrocytic (larger than normal) A differential diagnosis can be generated easily for microcytic and macrocytic anemias. •For a microcytic anemia – the mnemonic TAILS can be used: • T – Thalassemia • A – Anemia of Chronic Disease • I – Iron Deficiency