Anemia Diagnosis and Management

Initial Assessment and Classification

A complete blood count (CBC) with indices is essential to characterize anemia and identify if other cytopenias are present, as recommended by the National Comprehensive Cancer Network 1
The American College of Physicians suggests a detailed history should include duration and onset of symptoms, comorbidities, family history, medication use, and exposure to chemotherapy or radiation 1, 3
Physical examination should look for pallor, jaundice, splenic enlargement, neurologic symptoms, petechiae, heart murmurs, and signs of blood loss, according to the National Comprehensive Cancer Network 1
Common symptoms of anemia include syncope, exercise dyspnea, headache, vertigo, chest pain, fatigue, and abnormal menstruation in females, as reported by the National Comprehensive Cancer Network 1

Serum ferritin is the most powerful test for iron deficiency, with a level of <12 μg/dl being diagnostic, as stated by the Gut journal 3
The National Comprehensive Cancer Network recommends an iron panel, including iron level, total iron binding capacity (TIBC), and transferrin saturation, to diagnose iron deficiency anemia 1
GI investigations, such as upper GI endoscopy and lower GI tract examination, should be considered in all patients with confirmed iron deficiency anemia, unless there is significant non-GI blood loss, as suggested by the Gut journal 3, 4, 5

The Gut journal recommends identifying and treating the underlying cause of iron deficiency anemia, especially GI sources of blood loss, and using iron supplementation (oral or parenteral) depending on severity and tolerance 3, 5
The Annals of Oncology suggests addressing all causes of anemia before considering erythropoiesis-stimulating agents (ESAs) in patients with chemotherapy-induced anemia, and using ESAs with caution due to risks of increased mortality and thromboembolism 7, 10
The Blood journal recommends treatment for genetic disorders of iron metabolism, such as sideroblastic anemia, with pyridoxine, hematopoietic stem cell transplantation, or phlebotomy/chelation therapy as appropriate 8, 9