Classification
Microcytic (MCV <80): iron deficiency (most common), thalassemia. Normocytic (80-100): blood loss, chronic disease, CKD. Macrocytic (>100): B12, folate. Hemolytic: sickle cell, AIHA, G6PD. Diagnosis: CBC, retic, smear, iron studies.
Common Types
Iron deficiency: microcytic, low ferritin (<30), blood loss. B12 deficiency: macrocytic, neurological symptoms, pernicious anemia. Folate: macrocytic, no neurological symptoms. Aplastic: pancytopenia. Hemolytic: reticulocytosis, elevated bilirubin/LDH, low haptoglobin.
Nursing Management
Iron: oral ferrous sulfate 325 mg (with vitamin C, causes constipation/black stools), IV if intolerant. B12: IM 1000 mcg monthly or high-dose oral. Folate: oral 1 mg/day. Monitor CBC, retic, symptoms. Activity tolerance, fall risk.
Important Notes
- Iron deficiency in male or postmenopausal female warrants GI workup — colonoscopy indicated.
- B12 causes neurological symptoms (paresthesia, ataxia) that folate does not — distinguish carefully.
Clinical Tips
- Oral iron causes black stools — warn patients to avoid unnecessary GI workup.
- B12 shots should be IM, not IV, to avoid allergic reactions.
Summary
Anemia management requires identifying the type, treating the underlying cause, and monitoring for symptom improvement.
