Anemia Differential Diagnosis*
MCV
Normocytic
(MCV 80 - 100 fL)
(RBCs lost, or less RBCs produced)
† WBCs
or Normalwaes
† WBCs
* Low retics
or inappropriately
† High retics
See blood smear.
‡ Low retics or normal
† High retics
(marrow is fine)
†marrow Is tine
Early Fe deficiency
‡ EPO (renal failure)
Malignancy (e.g. MM)
Marrow aplasia, suppression or
infitrration
(pancytopenia).
Spleenomegaly or
Hyperspleenism (primary or secondary
Pregnancy (RBC dilution)
B12/Fol deficiency
RBCs: Normal
RBCs: Spherocytes
or SenIStocVteS
RBCs: Sickle cells,
target cells, howell-jolly bodies
Acute Bleeding
Hemolysis
Autommune or hereditary spherocytosis
Hemoglobinopathy
(HbS, HbE, HbC)
(HbE can be microcytic)
Microangiopathic
homovic anemia:
DOC, TTP, HUS
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Designed by Khudhur M.
• Target cells
• Normal WBCs
Liver Disease (More lipids in RBC
memorane)
khudhur_moh
me@khudhur.com
Macrocytic
(MCV > 100fL
(V DNA synthesis, 4 Cell division)
Rule out Reticulocytosis
Abnormal blood smear
• Oval macrocytes.
• Hyper-segmented
neutroonis.
• + Retics.
• Pancvtopenia.
• Megaloblastic
anemia in marrow
• RBCs in Rouleaux formation (false increase in MCV
que to
agglutination.
Multiple Myeloma
‡ RBC
• + Folate
・ ↑ Homocysteine
(alcoholic?)
Folate deficiency
(malabsorption, increased need)
Normal Blood Smear
Drugs: can mimic B12/
Folate deticiencies.
• Bi-lobed neutrophils.
Myelodysplasia
& Serum B12
•个Hcy
・↑ MMA
• Red tongue
B12 deficiency
(malabsorption, increased need, no proteases, decreased stomach acid, Crohn's/celiac)

Anemia: differential diagnosis