Chapter 100: Anemias

Patient Care Process for the Management of Anemia

Collect

• Patient characteristics (e.g., age, race, sex, pregnant)

• Patient history (past medical, dietary habits, activity)

• Symptoms of anemia (fatigue, weakness, chest pain, dizziness, paleness, etc. (see Clinical Presentation Box 100-1)

• Current medications (including over-the-counter and supplements)

• Objective data (see Box 100-1)

  • Blood pressure (BP), heart rate (HR)

  • Labs (CBC, iron studies, vitamin B12, foliate, homocysteine, MMA, etc.)

Assess

• Underlying disease states (blood loss, heart failure, chronic renal disease, HIV, malignancy; see Table 100-6)

• Dietary habits and potential social factors contributing to nutritional deficiencies

• Acuity of symptoms and need for transfusion or hospitalization

• Current medications that may contribute to or worsen anemia or blood loss

• Lab results to determine underlying etiology of anemia for proper treatment selection or attainment of treatment goals

Plan^*

• Dietary interventions for nutritional deficiencies (Tables 100-1, 100-4, 100-5)

• Initiate proper drug therapy treatment based on etiology. This includes correct formulation, strength, dosing, frequency, pertinent drug interactions. (Table 100-2 and 100-3 for iron product selection/drug interactions)

• Monitoring for efficacy and safety (lab and symptom improvement, corrected etiology if possible, adverse effects)

• Patient education (expectations/purpose of treatment, adverse effects, diet, etc.)

• Improved treatment of underlying pathologies if contributing to anemia of chronic disease

Implement^*

• Educate patient on treatment interventions and treatment expectations

• Reinforce adherence to treatment plan for short and long term success

• Schedule patient for follow-up at appropriate intervals

Follow-up: Monitor and Evaluate

• Recheck lab values within 4 weeks after treatment initiation

• Tolerability of medications (e.g., adverse effects)

• Symptom improvement

• If minimal improvement or worsening, evaluate whether etiology of anemia is correct

KEY CONCEPTS

• Anemia is a group of diseases characterized by a decrease in either hemoglobin (Hb) or the volume of red blood cells (RBCs), which results in decreased oxygen-carrying capacity of the blood. Anemia is defined by the World Health Organization (WHO) as Hb less than 13 g/dL (less than 130 g/L; less than 8.07 mmol/L) in men and less than 12 g/dL (less than 120 g/L; less than 7.45 mmol/L) in women.

• Acute-onset anemias are most likely to present with tachycardia, lightheadedness, and dyspnea. Chronic anemia often presents with weakness, fatigue, headache, vertigo, and pallor.

• Iron-deficiency anemia (IDA) is characterized by decreased levels of ferritin (most sensitive marker) and serum iron, as well as decreased transferrin saturation. Hb and hematocrit decrease later. RBC morphology includes hypochromia and microcytosis. Most patients are adequately treated with oral iron therapy, although parenteral iron therapy is necessary in selected patient populations.

• Vitamin B₁₂ deficiency, a macrocytic anemia, can be due to inadequate intake, malabsorption syndromes, and inadequate utilization. Anemia caused by lack of intrinsic factor, ...