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Assess the risk of decompensation of anemic patients (e.g., volume status, the presence of congestive heart failure [CHF], angina, or other disease states) to decide if prompt transfusion or volume replacement is necessary.
Clinical Reasoning Skills, Selectivity
Diagnosis, Treatment
In a patient with anemia, classify the anemia as microcytic, normocytic, or macrocytic by using the MCV (mean corpuscular value) or smear test result, to direct further assessment and treatment.
Clinical Reasoning Skills
Diagnosis, Investigation
In all patients with anemia, determine the iron status before initiating treatment.
Clinical Reasoning Skills
Investigation, Diagnosis
In a patient with iron deficiency, investigate further to find the cause.
Clinical Reasoning Skills
Investigation
Consider and look for anemia in appropriate patients (e.g., those at risk for blood loss [those receiving anticoagulation, elderly patients taking a nonsteroidal anti-inflammatory drug]) or in patients with hemolysis (mechanical valves), whether they are symptomatic or not, and in those with new or worsening symptoms of angina or CHF.
Clinical Reasoning Skills, Selectivity
Hypothesis generation, Investigation
In patients with macrocytic anemia: Consider the possibility of vitamin B12 deficiency.
Clinical Reasoning Skills
Hypothesis generation
In patients with macrocytic anemia: Look for other manifestations of the deficiency (e.g., neurologic symptoms) in order to make the diagnosis of pernicious anemia when it is present.
Clinical Reasoning Skills
History, Physical
As part of well-baby care, consider anemia in high-risk populations (e.g., those living in poverty) or in high-risk patients (e.g., those who are pale or have a low-iron diet or poor weight gain).
Clinical Reasoning Skills, Selectivity
Hypothesis generation
When a patient is discovered to have a slightly low hemoglobin level, look carefully for a cause (e.g., hemoglobinopathies, menorrhagia, occult bleeding, previously undiagnosed chronic disease), as one cannot assume that this is normal for them.
Clinical Reasoning Skills, Selectivity
Hypothesis generation, Diagnosis
In anemic patients with menorrhagia, determine the need to look for other causes of the anemia.
Clinical Reasoning Skills
Hypothesis generation
To generate individual key feature specific field notes, click on the theme link for the desired key feature. To generate field notes for all key features resulting from your search, click on the button at the bottom of the search page.

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