TAILIEUCHUNG - Chapter 058. Anemia and Polycythemia (Part 3)

Approach to the Patient: Anemia The evaluation of the patient with anemia requires a careful history and physical examination. Nutritional history related to drugs or alcohol intake and family history of anemia should always be assessed. Certain geographic backgrounds and ethnic origins are associated with an increased likelihood of an inherited disorder of the hemoglobin molecule or intermediary metabolism. Glucose-6-phosphate dehydrogenase (G6PD) deficiency and certain hemoglobinopathies are seen more commonly in those of Middle Eastern or African origin, including African Americans who have a high frequency of G6PD deficiency. Other information that may be useful includes exposure to certain toxic agents. | Chapter 058. Anemia and Polycythemia Part 3 Approach to the Patient Anemia The evaluation of the patient with anemia requires a careful history and physical examination. Nutritional history related to drugs or alcohol intake and family history of anemia should always be assessed. Certain geographic backgrounds and ethnic origins are associated with an increased likelihood of an inherited disorder of the hemoglobin molecule or intermediary metabolism. Glucose-6-phosphate dehydrogenase G6PD deficiency and certain hemoglobinopathies are seen more commonly in those of Middle Eastern or African origin including African Americans who have a high frequency of G6PD deficiency. Other information that may be useful includes exposure to certain toxic agents or drugs and symptoms related to other disorders commonly associated with anemia. These include symptoms and signs such as bleeding fatigue malaise fever weight loss night sweats and other systemic symptoms. Clues to the mechanisms of anemia may be provided on physical examination by findings of infection blood in the stool lymphadenopathy splenomegaly or petechiae. Splenomegaly and lymphadenopathy suggest an underlying lymphoproliferative disease while petechiae suggest platelet dysfunction. Past laboratory measurements may be helpful to determine a time of onset. In the anemic patient physical examination may demonstrate a forceful heartbeat strong peripheral pulses and a systolic flow murmur. The skin and mucous membranes may be pale if the hemoglobin is 80-100 g L 8-10 g dL . This part of the physical examination should focus on areas where vessels are close to the surface such as the mucous membranes nail beds and palmar creases. If the palmar creases are lighter in color than the surrounding skin when the hand is hyperextended the hemoglobin level is usually 80 g L 8 g dL . Laboratory Evaluation Table 58-1 lists the tests used in the initial workup of anemia. A routine complete blood count CBC is required as part of

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