Diagnostic approach for anemia
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general medicine course 4th year medical course MANAGEMENT IN THE EVENT OF NORMO OR MACROCYTIC ANEMIA Normocytic anemia is defined by a MCV between 80 and 100 fl, it is called macrocytic above 100 in adults. The first complementary etiological assessment must include a control blood count with reticulocyte count, a microscopic reading of the blood smear, a liver, kidney and thyroid assessment and the dosage of vitamins B9 (folates) and B12. The diagnosis of iron deficiency anemia (IDA) or pure inflammatory anemia (IA) is easy. It becomes more delicate in complex situations where the two components coexist because most biological markers are modified by inflammation. The contribution of new biological markers allows for a more precise diagnosis. There are still gray areas in difficult situations in which reasoning must take into account the clinical situation as well as the different parameters with their characteristics and limitations. The aim of this article is to take stock of the markers used in the assessment of iron metabolism disorders during anemia and to propose a practical decision-making algorithm for the diagnostic approach. Anemia is a common pathology in daily practice. The clinical context can be complex, making its diagnosis and management difficult. Iron deficiency anemia or inflammatory anemia, also called anemia of chronic disease (ACD) in English, are the most common causes of non-hereditary anemia.1 The last twenty years have brought a better understanding of iron metabolism, making it possible to refine the indication for invasive digestive explorations. The methods for monitoring the response to iron treatment have also benefited from these advances. Erythropoiesis is a process whose final stage is the circulating erythrocyte. There is no single marker to analyze iron balance abnormalities and their consequences on erythropoiesis. It is therefore necessary to use several measures with their own characteristics to evaluate the different stages of erythropoiesis. The myelogram with Perls staining is certainly a gold standard but is also an invasive test that is less and less used for the diagnosis of iron deficiency anemia. We will not address here the chapter on iron deficiency without anemia or the differential diagnosis of microcytoses in general.
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