SIU School of Medicine

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Department of Internal Medicine

Anemia

Rationale

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.

Knowledge

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
    • thalessemias
    • hemolytic anemias
  • laboratory tests used in evaluating anemia -- normal and abnormal values
  • indications, contraindications and complications of blood transfusion

Skills

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:
      • fatigue
      • weight loss
    • GI bleeding
    • abdominal pain
    • medications
    • diet
    • 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:
    • skin
    • eyes
      • sclera
      • conjunctiva
      • fundi
    • mouth
    • heart
    • abdomen
    • rectum
    • 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
      • TIBC
      • ferritin
      • transferrin
    • serum B12 and folate
    • haptoglobin
    • LDH
    • 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:
      • renal
      • thyroid
      • HIV
      • malignancy
      • inflammation
      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.

Resources

  • "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.

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