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Anemia (cont.)

When to Seek Medical Carefor Anemia

Because anemia is typically a clue to another underlying disease, it needs to be fully evaluated by a doctor, and proper testing needs to be undertaken to determine the cause. Therefore, if signs and symptoms of anemia are present, one should contact his or her physician for evaluation.

  • In the elderly and people with chronic medical conditions, such as heart disease or lung disease, the symptoms of anemia may be more significant, and a prompt medical evaluation is prudent.
  • The diagnosis of anemia at home is difficult unless bleeding is obvious. If significant bleeding is clearly evident, as in a severe injury, immediate medical attention is required and one should consider going to the emergency room. Generally, this kind of acute (short onset) anemia is more likely to cause immediate symptoms than chronic (long-lasting) types of anemia.
  • Many individuals with chronic conditions, such as sickle cell anemia, know when they have an attack related to their disease (sickle cell crisis) and opt to seek medical attention promptly.

Anemia Diagnosis

Doctors can easily detect anemia by drawing a blood sample for a complete blood count. Based on the results of the test and thorough evaluation of the patient, the doctor may order more tests to determine the exact cause of anemia. The complete blood count may be done as part of a routine general check-up or based upon the presence of signs and symptoms suggestive of anemia.

Physical examination and medical history also play a crucial role in diagnosing causes of anemia. Some of the important features in medical history cover questions about family history, previous personal history of anemia or other chronic conditions, medications, color of stool and urine, bleeding problems, and occupation and social habits (such as alcohol intake). While performing a complete physical examination, the physician may particularly focus on general appearance (signs of fatigue, paleness), jaundice (yellow skin and eyes), paleness of the nail beds, enlarged spleen (splenomegaly) or liver (hepatomegaly), heart sounds, and lymph nodes.

Because anemia is only a symptom of another disease, doctors will want to determine what condition is causing the anemia. Some people may need many additional tests, and others may need very few. For example, an anemic person with known stomach ulcers typically would not need multiple blood tests, but may need to have his or her stomach visually evaluated and have the ulcers treated. On the other hand, a person with a family history of anemia and without an obvious source of blood loss may need multiple laboratory blood tests and other types of diagnostic evaluation. Doctors also take into consideration the severity of the anemia when deciding what tests to order. When a person has severe anemia, the cause must be determined rapidly so that it can be treated appropriately.

Lab tests for anemia generally include the following:

  • Complete blood count (CBC): Determines the severity and type of anemia (microcytic anemia or small-sized red blood cells, normocytic anemia or normal-sized red blood cells, or macrocytic anemia or large-sized red blood cells) and is typically the first test ordered. Information about other blood cells (white cells and platelets) is also included in the CBC report. Hemoglobin (Hgb) and hematocrit (Hct) measurements in a complete blood count test are commonly used to diagnose anemia. They measure the amount of hemoglobin, which an accurate reflection of red blood cell (RBC) quantity in the blood.
  • Stool hemoglobin test: Tests for blood in the stool may detect bleeding from the stomach or the intestines (stool Guaiac test or stool occult blood test).
  • Peripheral blood smear: Looks at the red blood cells under a microscope to determine the size, shape, number, and appearance as well as evaluate other cells in the blood.
  • Iron level: A serum iron level may tell the doctor whether anemia may be related to iron deficiency or not. This test is usually accompanied by other tests that measure the body's iron storage capacity, such as transferrin level and ferritin level.
  • Transferrin level: Evaluates a protein that transports iron in the body.
  • Ferritin: Evaluates at the total iron available in the body.
  • Folate: A vitamin needed to produce red blood cells, which is low in people with poor eating habits.
  • Vitamin B12: A vitamin needed to produce red blood cells and low in people with poor eating habits or in pernicious anemia.
  • Bilirubin: Useful to determine if the red blood cells are being destroyed within the body which may be a sign of hemolytic anemia.
  • Lead level: Lead toxicity was formerly one of the more common causes of anemia in children.
  • Hemoglobin electrophoresis: Sometimes used when a person has a family history of anemia; this test provides information on sickle cell anemia or thalassemia.
  • Reticulocyte count: A measure of new red blood cells produced by the bone marrow
  • Liver function tests: A common test to determine how the liver is working, which may give a clue to other underlying disease causing anemia.
  • Kidney function test: A test that is very routine and can help determine whether any kidney dysfunction exists. Kidney failure can result in erythropoietin (Epo) deficiency, leading to anemia.
  • Bone marrow biopsy: Evaluates production of red blood cells and may be done when a bone marrow problem is suspected.

Anemia Self-Care at Home

Very little can be done to self-treat anemia and medical treatment is generally needed. It is important to continue to take any medication that is prescribed for other chronic (long-lasting) medical problems. If the reason for anemia is known, then measures to keep it under control are very important. For example, if anemia is caused by a stomach ulcer, then medications such as aspirin or ibuprofen should be avoided, unless otherwise directed by a doctor.

Medically Reviewed by a Doctor on 2/18/2016

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