Source: Cook K, Ineck BA,
Lyond WL. Anemias. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells
BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8
Accessed June 12, 2012.
- Decreased oxygen-carrying capacity of blood characterized
by a decrease in hemoglobin (Hb) or red blood cells (RBCs)
- World Health Organization (WHO) definition
Hb <13 g/dL (<130 g/L; <8.07 mmol/L)
- Women: Hb <12 g/dL (<120 g/L; <7.45
- Microcytic anemia resulting from iron deficiency or impaired
- Result of long period of negative iron balance
- Excessive blood loss
- Peptic ulcer
- Chronic hemorrhage
- Vaginal bleeding
- Peptic ulcer
- Intestinal parasites
- Aspirin and other NSAIDs
- Excessive RBC destruction
- Inadequate production of mature RBCs; result of nutrient deficiency
- Three phases:
- Iron stores are reduced without
reduced serum iron levels.
- Assess with serum ferritin.
- Iron stores are depleted, resulting in iron deficiency
- Assess with serial CBC measurements; Hb may still be in
- IDA diagnosed: Hb falls to less than normal values.
- Iron deficiency is most common nutritional deficiency.
- Children <2 years
- Adolescent girls
- Adults >65 years
- Severity of symptoms does not always correlate with degree
- Elderly may not tolerate levels of Hb
tolerated by younger patients.
- Patients with cardiac or pulmonary disease may be less tolerant
of mild anemia.
- Rapid onset of anemia, observable in cardiorespiratory
- Hypovolemia (with acute bleeding)
- Chronic onset of anemia
- Symptoms of heart failure
- Sensitivity to cold
- Loss of skin tone
- Manifestations of IDA (Hg ≤9 g/dL [90
g/L; 5.59 mmol/L])
- Smooth tongue
- Reduced salivary flow
- Pica (compulsive eating of nonfood items)
- Pagophagia (compulsive eating of ice)
Means of Confirmation
- CBC (Table 1)
- Focus on Hb, hematocrit
(Hct) and RBC indices
- May initially be normal and then decrease as anemia progresses.
- Reticulocyte index
- Stool sample (for occult blood)
- Serum iron (low with IDA)
- Low with IDA
- Earliest and most sensitive indicator of iron deficiency
- Interpret in conjunction with transferring saturation and
- Transferrin saturation (serum iron divided by TIBC)
- Total iron binding capacity (high with IDA)
Table 1. Normal Hematologic Values |Favorite Table|Download (.pdf)
Table 1. Normal Hematologic Values
Reticulocyte count, absolute (%)
Serum iron (mcg/dL)