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Anemia

  • Clinical Updates in Women's Health Care CU
  • November 2012

ABSTRACT: Anemia is a public health issue that affects individuals across all age groups. The relatively high prevalence of anemia in both pregnant and nonpregnant women of reproductive age and the progressively increasing prevalence of anemia in older women require obstetrician–gynecologists to be well equipped to prevent anemia in susceptible women and to evaluate and treat the patients with common forms of anemia. Although iron deficiency is the most common underlying cause of anemia in women, the development and pathogenesis of anemia are frequently multifactorial, modulated by a combination of inherited, environmental, iatrogenic, and systemic disease-related factors. A comprehensive and systematic approach to the clinical and laboratory evaluation of each anemic patient will allow obstetrician–gynecologists to comfortably establish a diagnosis, administer treatment in uncomplicated cases of isolated anemia, and collaborate with a hematology subspecialist in the treatment of patients who require further evaluation and treatment.

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Figures & Tables

Fig. 1. The globin gene clusters and hemoglobins during development. Genes within the α-like and β-like globin gene clusters go through an orderly switching process during embryonic, fetal, and neonatal development.

Fig. 1. The globin gene clusters and hemoglobins during development. Genes within the α-like and β-like globin gene clusters go through an orderly switching process during embryonic, fetal, and neonatal development.

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Fig. 2. General hierarchical classification of anemia.

Fig. 2. General hierarchical classification of anemia.

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Fig. 3. Approach to the clinical and laboratory evaluation of anemia. Differential diagnostic considerations in anemic patients with low or high reticulocyte counts and microcytic, normocytic, and macrocytic red blood cells are based on mean corpuscular volume. Absolute reticulocyte count less than 75 × 10 3 per microliter or reticulocyte index less than 2 indicates low reticulocyte count. Absolute reticulocyte count greater than 75 × 10 3 per microliter or reticulocyte index more than 2 indicates high reticulocyte count. Peripheral blood smear examination may provide important clues that lead to the underlying diagnosis, such as the presence of immature myeloid cells, blasts, nucleated red blood cells, atypical lymphocytes, and specific red blood cell morphologic abnormalities. Abbreviations: Hb indicates hemoglobin; MCV, mean corpuscular volume.

Fig. 3. Approach to the clinical and laboratory evaluation of anemia. Differential diagnostic considerations in anemic patients with low or high reticulocyte counts and microcytic, normocytic, and macrocytic red blood cells are based on mean corpuscular volume. Absolute reticulocyte count less than 75 × 10 3 per microliter or reticulocyte index less than 2 indicates low reticulocyte count. Absolute reticulocyte count greater than 75 × 10 3 per microliter or reticulocyte index more than 2 indicates high reticulocyte count. Peripheral blood smear examination may provide important clues that lead to the underlying diagnosis, such as the presence of immature myeloid cells, blasts, nucleated red blood cells, atypical lymphocytes, and specific red blood cell morphologic abnormalities. Abbreviations: Hb indicates hemoglobin; MCV, mean corpuscular volume.

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Fig. 4. The evaluation of microcytic, hypochromic anemia. Abbreviation: Hb indicates hemoglobin.

Fig. 4. The evaluation of microcytic, hypochromic anemia. Abbreviation: Hb indicates hemoglobin.

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Fig. 5. The evaluation of macrocytic anemia.

Fig. 5. The evaluation of macrocytic anemia.

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Table 1. Differential Diagnosis of Microcytic, Hypochromic Anemia

Table 1. Differential Diagnosis of Microcytic, Hypochromic Anemia

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Table 2. Commonly Used Oral Agents in the Treatment of Anemia

Table 2. Commonly Used Oral Agents in the Treatment of Anemia

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Table 3. Risk of Contracting Transfusion-Transmitted Infectious Complications

Table 3. Risk of Contracting Transfusion-Transmitted Infectious Complications

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