Anemia (Low Blood Count): Causes, Symptoms & Treatment

Anemia = hemoglobin <13 g/dL (men), <12 g/dL (women) or Hct <39%/36%. Not a diagnosis—always seek the cause.

Major Etiologic Categories

Clinical Presentation

• Fatigue, exertional dyspnea, pallor, tachycardia, palpitations
• Severe: angina, syncope, high-output heart failure
• Specific: koilonychia (Fe), glossitis (B12), jaundice (hemolytic), neuro (B12)

Workup Algorithm

1. CBC + indices (MCV, RDW), reticulocyte count
2. Peripheral smear
3. Iron studies (ferritin, Fe, TIBC, %sat)
4. B12, folate if macrocytic
5. Hemolysis panel if reticulocytosis
6. BM biopsy if unclear or pancytopenia

Treatment

Treat the cause. Iron replacement, B12/folate, ESA (CKD), immunosuppression (AIHA), transfusion (symptomatic/severe), marrow transplant (aplastic).

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Mechanism	Key Causes	Typical Labs
Iron deficiency	Blood loss (GI, menstrual), malabsorption, low intake, pregnancy	↓ Ferritin, ↓ Fe, ↑ TIBC, microcytic/hypochromic
B12/folate deficiency	Pernicious anemia, malabsorption, vegan diet, meds (metformin, PPI), alcohol	↑ MCV (macrocytic), hypersegmented neutrophils, ↓ B12/folate
Chronic disease/inflammation	Infections, autoimmune, CKD, cancer	Normocytic/normochromic → microcytic; ↑ ferritin (acute phase), ↓ Fe, ↓ TIBC
Hemolytic	Autoimmune, hereditary (sickle, thalassemia, G6PD), mechanical, drugs	↑ LDH, ↑ indirect bilirubin, ↓ haptoglobin, reticulocytosis
Bone marrow failure	Aplastic anemia, MDS, leukemia, infiltration, chemo/radiation	Pancytopenia, ↓ retics, hypocellular marrow
Blood loss (acute)	Trauma, surgery, postpartum, GI bleed	Normocytic initially; becomes microcytic if chronic