Fecal occult blood testing, which should be done in all patients and is positive if GI bleeding is present. Upper GI endoscopy, which should be performed if there is a history of upper GI bleeding or a positive fecal occult blood test.
It may identify sources of an upper GI bleed peptic ulcer disease, gastritis, esophageal varices , hiatus hernia, Meckel diverticulum, or increased gastric pH in achlorhydria. Test and treat for Helicobacter pylori HP in dyspepsia. July [internet publication].
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Immunoglobulin A-tissue transglutaminase IgA-tTG test should be performed in all patients and is positive in celiac disease. Colonoscopy, which should be performed if there is a history of lower GI bleeding or a positive fecal occult blood test. It may reveal malignancy, diverticulosis, ulcerative colitis, or rare causes such as hereditary hemorrhagic telangiectasia; malignancy should be considered in all patients aged over 40 years with symptoms of rectal bleeding or a positive fecal occult blood test. Flow cytometry should be considered if there is a history of passing red urine, or red blood cell RBC results consistent with a hemolytic anemia.
Transvaginal ultrasound, which may reveal causes of menorrhagia including hyperplasia, dysplasia, fibroids, or polyps; malignancy should be considered in patients with menorrhagia who are over 40 years old. Stool microscopy, which may identify hookworm, whipworm, or Schistosoma eggs. This should be performed if clinical features suggest the diagnosis or there is a history of travel to endemic areas. A history of an underlying inflammatory process infection, neoplasms, autoimmune reactions, and injury to tissue from trauma or major surgery is usually present.
A serum erythropoietin level should be considered; the result is usually normal or mildly elevated. Hypothyroidism and vitamin C deficiency may produce a falsely low ferritin level. Plasma ferritin determination as a diagnostic tool. West J Med. The most important cause to exclude is thalassemia. A family history is usually present. The disease is more common in individuals of Mediterranean, Middle Eastern, or Southeast Asian descent. The severity ranges from asymptomatic to severe transfusion-dependent symptoms.
Significant haemoglobinopathies: guidelines for screening and diagnosis. Carrier screening for thalassemia and hemoglobinopathies in Canada.
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J Obstet Gynaecol Can. The examination findings may be normal, or reveal splenomegaly, jaundice, abdominal distension, and icterus. Morphologic changes including skeletal abnormalities, a large head, chipmunk facies, and misaligned teeth are seen in beta-thalassemia intermedia and major. Differentiation of iron deficiency from thalassaemia trait. Discriminant indices for distinguishing thalassemia and iron deficiency in patients with microcytic anemia: a meta-analysis.
Clin Chem Lab Med. An isolated anemia is usually due to pure red cell aplasia, which may be self-limited or persistent. Clinical practice guidelines for evaluation of anemia. Symptoms of bleeding, easy bruising, night sweats, or weight loss suggest hematologic malignancy or aplastic anemia.
Parvovirus infection, infectious mononucleosis, viral hepatitis, malaria, respiratory infections, gastroenteritis, primary atypical pneumonia, and mumps can result in a self-limited pure red cell aplasia, and these should be excluded. Antiepileptic medications phenytoin, carbamazepine, valproate sodium , azathioprine, sulfonamides, isoniazid, and procainamide cause pure red cell aplasia.
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Benzene, penicillamine, and gold can cause aplastic anemia. Chloramphenicol can cause either aplastic anemia or pure red cell aplasia. Chemotherapy causes pancytopenia. Cancer- and chemotherapy-induced anemia. J Natl Compr Canc Netw. A history of immunosuppression or chronic hepatitis suggests persistent pure red cell aplasia. There may be a history or features of chronic kidney disease or hypothyroidism.
Ecchymoses or petechiae due to thrombocytopenia suggest hematologic malignancy, myelodysplastic syndrome, or aplastic anemia.
Lymphadenopathy or fever suggest malignancy or infections e. Splenomegaly may be seen in hematologic malignancies. Clinical features of systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, polyarteritis nodosa, or scleroderma resulting in persistent pure red cell aplasia may be present. Abnormal lung exam if lung cancer is the primary cancer or a breast mass if breast cancer is the primary may be present. A positive Trousseau sign or Chvostek sign in patients with chronic kidney disease indicates hypocalcemia, probably due to associated secondary hyperparathyroidism.
CBC may show an associated cytopenia and characteristic changes specific to a hematological malignancy. A pancytopenia suggests aplastic anemia, or may be due to chemotherapy or radiation therapy. An isolated anemia suggests pure red cell aplasia or anemia due to chronic kidney disease. Bone marrow biopsy is required for the definitive diagnosis of acute leukemia acute lymphocytic leukemia, acute myelogenous leukemia , chronic myelogenous leukemia CML , aplastic anemia, or bone marrow metastases. Antiparvovirus antibodies are positive in parvovirus infection, the most common infectious cause of pure red cell aplasia.
Thick and thin peripheral smear, to exclude malaria if history and clinical findings suggest the diagnosis. Thyroid function tests; thyroid-stimulating hormone TSH is elevated and free thyroxine T4 reduced in hypothyroidism. Antinuclear antibodies, which are positive in systemic lupus erythematosus or scleroderma. Chest x-ray, which may show infiltrates in atypical pneumonia or a smooth mass in thymoma. Erythropoietin levels, which may be inappropriately decreased in patients with chronic kidney disease.
Serum calcium and parathyroid hormone levels should be considered if associated secondary hyperparathyroidism is suspected. These conditions can be caused by microangiopathic hemolytic anemias, autoimmune hemolytic anemia, drugs, infections, inherited conditions, transfusion reactions, or burns. Drugs that can cause hemolysis include penicillin, methyldopa, levodopa, quinidines, cephalosporins, and some NSAIDs.
Cyclosporine, tacrolimus, clopidogrel, oral contraceptive pills, and some chemotherapy drugs may cause hemolytic uremic syndrome.
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Discontinuation of causative medications leads to resolution of the anemia. There may be a history suggestive of microangiopathic disease. Known triggers of disseminated intravascular coagulation DIC include ongoing severe infection, sepsis, malignancy, obstetric emergency, trauma, burns, envenomation, drug overdose, or any cause of endothelial damage. The presence of acute-onset neurologic symptoms, including headache, confusion, focal weakness, seizures, or coma, should prompt suspicion of thrombotic thrombocytopenic purpura TTP.
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Female patients may have associated menorrhagia. Sudden-onset dizziness, headache, mental status changes, loss of sensation or motor strength, chest pain or pressure, dyspnea, or edema in a patient with known hypertension should prompt suspicion of malignant hypertension; a history of renal failure or eclampsia may also be present. An expanding vascular skin lesion in a young infant or child should prompt suspicion of a hemangioma.
A history of prosthetic valve replacement may indicate hemolysis induced by the prosthesis. Infective causes include cytomegalovirus CMV , infectious mononucleosis, toxoplasmosis, and leishmaniasis. Bloody diarrhea should prompt suspicion of Escherichia coli infection and hemolytic uremic syndrome. Patients with inherited hemolytic anemias such as sickle cell anemia, hereditary spherocytosis, or glucosephosphate dehydrogenase G6PD deficiency may have a positive family history.
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Persistent pain in the skeleton, chest, or abdomen; priapism; lower-extremity skin ulcers; or an acute pneumonia-like syndrome suggest sickle cell anemia. There may be a previous history of autoimmune disease e. Note that autoimmune diseases may also cause pure red cell aplasia, in which case the reticulocyte count would be low, with normal lactate dehydrogenase, haptoglobin, and bilirubin levels. Features of microangiopathic disease: there may be purpura or ecchymoses due to bleeding.
Cutaneous reddish-brown or violaceous vascular lesions may indicate hemangioma. Microangiopathic hemolytic anemia. Williams hematology. If you take iron as a liquid instead of as a pill, aim it toward the back of your mouth. This will prevent the liquid from staining your teeth.
You can also brush your teeth after taking the medicine to help prevent staining. What can happen if iron-deficiency anemia is not treated? How can I prevent iron-deficiency anemia? You can help prevent iron-deficiency anemia with the following steps: Treat the cause of blood loss. Talk to your doctor if you have heavy menstrual periods or if you have digestive system problems, such as frequent diarrhea or blood in your stool.