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Anemia Evaluation
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MCV splits the workup; reticulocyte count clarifies normocytic anemia.
Decision
Outcome
Decision
Anemia confirmed — first stratifier?
✓
MCV
✗
Reticulocyte count first
Decision
MCV category?
✓
Microcytic (<80)
✓
Normocytic (80–100)
✓
Macrocytic (>100)
Outcome
Microcytic: iron deficiency, thalassemia, lead, sideroblastic, ACD (sometimes)
Ferritin: ↓ in IDA, ↑ or normal in ACD/thalassemia. RDW: ↑ in IDA, normal in thalassemia.
Decision
Normocytic — reticulocyte count?
✓
Low → marrow failure (aplastic, CKD), anemia of chronic disease, leukemia
✓
High → hemolysis or hemorrhage
Outcome
Workup: BMP, B12/folate, reticulocyte response after iron replacement; bone marrow if uncertain
Outcome
Hemolysis workup: LDH, haptoglobin, indirect bili, peripheral smear, Coombs
Causes: G6PD, hereditary spherocytosis, autoimmune, microangiopathic, sickle cell.
Outcome
Megaloblastic: B12, folate; non-megaloblastic: alcohol, liver, hypothyroid, MDS, drugs
B12 deficiency: subacute combined degeneration. Folate doesn't cause neuro symptoms.
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