Anemia is a common finding, often identified incidentally in asymptomatic patients. It can be a manifestation of a serious underlying disease. Distinguishing among the many disorders that cause anemia, not all of which require treatment, is an important training problem for third-year medical students.
Students should be able to define, describe, and discuss the:
- classification of anemias
- morphological characteristics, pathophysiology and relative prevalence of:
- iron deficiency and other microcytic anemias (i.e., sideroblastic)
- macrocytic anemias
- anemia of chronic disease
- congential disorders
- sickle cell
- hemolytic anemias
- laboratory tests used in evaluating anemia -- normal and abnormal values
- indications, contraindications and complications of blood transfusion
Students should demonstrate specific skills, including:
- History-Taking Skills: Students should be able to obtain, document, and present an age-appropriate medical history, that differentiates among etiologies of disease including:
- constitutional and systemic symptoms:
- weight loss
- GI bleeding
- abdominal pain
- menstrual history
- family history
- past medical history
- Physical Exam Skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease including inspection of:
- lymph nodes
- nervous system
- Differential Diagnosis: Students should be able to:
- generate a list of the most important and most common causes of anemia
- recognize specific history and physical exam findings that suggest a specific etiology of anemia
- Laboratory Interpretation: Students should be able to recommend when to order diagnostic tests and be able to interpret the following laboratory test results:
- hemoglobin and hematocrit
- red cell indices
- reticulocyte count
- iron studies
- serum iron
- serum B12 and folate
- Schilling test
- hemoglobin electrophoresis
- blood smears
- Communication Skills: Students should be able to:
- counsel patients and their families with regard to:
- possible causes of the anemia
- appropriate further evaluation to establish the diagnosis of an underlying disease
- the impact on the family (genetic counseling)
- Basic and Advanced Procedure Skills: Students should be able to:
- interpret a peripheral blood smear.
- assist in performing a bone marrow aspiration.
- Management Skills:Students should be able to develop an evaluation plan to obtain appropriate diagnostic studies useful in establishing a specific diagnosis including:
- GI blood loss
- hemolytic anemia
- pernicious anemia
- chronic disease:
Students should be able to develop a treatment plan for the following:
- iron deficiency anemia
Attitudes and Professional Behaviors
Students should be able to:
- recognize that constitutional symptoms, such as fatigue or malaise, may be caused by depression, rather than any underlying anemia or dietary deficiency.
- appreciate that anemia is not a disease by itself, but rather a common finding that requires further delineation and evaluation to identify the casual disorder and therefore the most appropriate management.
- "Evaluation of Macrocytosis"; Kaferle, J, and Strzoda, CE; American Family Physician, Feb 1, 2009; 79(3); pp 203-208.
- "Evaluation of Microcytosis"; Van Vranken, M; American Family Physician, Nov 1, 2010; 82(9); pp 1117-1122.