Anemia Diagnosis and Treatment

Diagnostic Approach

Physical manifestations of anemia may include pallor, tachycardia, and in severe cases, heart failure, according to the Gut guideline 1
Initial evaluation should include a complete blood count (CBC) with hemoglobin, hematocrit, and mean corpuscular volume (MCV), as recommended by Praxis Medical Insights 2, 3
Anemia severity is classified as mild (Hb ≥10 g/dl to ≤11.9 g/dl), moderate (Hb ≥8.0 g/dl to ≤9.9 g/dl), and severe (Hb <8.0 g/dl), according to Praxis Medical Insights 3
Serum ferritin below 15-30 μg/L confirms iron deficiency, though this may be falsely elevated in inflammatory states, as noted by Praxis Medical Insights 2, 3

Oral iron supplementation is first-line therapy for most patients with iron deficiency anemia, with a recommended dosage of 60-120 mg elemental iron daily, according to Praxis Medical Insights 2, 3
Treatment should continue for 2-3 months after hemoglobin normalizes to replenish iron stores, as recommended by Praxis Medical Insights 2
Intravenous iron is indicated for patients with chronic inflammatory conditions, such as CKD, heart failure, IBD, or cancer, according to Praxis Medical Insights 3
Erythropoiesis-stimulating agents (ESAs) may be used for chemotherapy-induced anemia with Hb ≤10 g/dl, but should be avoided for mild to moderate anemia with heart disease due to increased risks, as noted by Praxis Medical Insights 3

Screening for anemia is recommended at the first prenatal visit, with low-dose iron supplementation (30 mg/day) recommended at the first prenatal visit, according to Praxis Medical Insights 2, 3
If anemia develops during pregnancy, increase iron supplementation to 60-120 mg/day, as recommended by Praxis Medical Insights 2, 3

Failure to identify and treat the underlying cause can lead to recurrence of anemia, as noted by Praxis Medical Insights 3
Ferritin is an acute phase reactant that may be falsely elevated in inflammatory states, potentially masking iron deficiency, according to Praxis Medical Insights 3
ESAs carry risks including hypertension, thromboembolism, and potential tumor progression in cancer patients, as noted by Praxis Medical Insights 3
Monitoring is essential, with repeat hemoglobin measurement after 4 weeks of treatment, as recommended by Praxis Medical Insights 3