🩸 Pallor (Paleness) · Anemia · Iron deficiency · Hemolysis · Bone marrow failure

Schwartz Clinical Handbook — Chapter 57 · Microcytic (iron deficiency, thalassemia) · Macrocytic (B12/folate) · Normocytic (hemolysis, aplastic, acute bleed) · Reticulocyte count

Select hemoglobin, MCV, reticulocyte count, smear findings, bleeding history, diet, and systemic symptoms → differentiate iron deficiency, thalassemia trait, hemolytic anemia (G6PD, spherocytosis, AIHA), acute blood loss, megaloblastic anemia, or bone marrow failure (aplastic, leukemia).
⚠️ Red flags: severe pallor, tachycardia, hypotension, heart failure → urgent transfusion. Pancytopenia + fever → sepsis risk in aplastic anemia / leukemia.

📋 Step 1 — CBC indices & clinical clues
📌 Diagnostic impressions
📖 Schwartz Ch 57

Select hemoglobin level, MCV (microcytic, normocytic, macrocytic), reticulocyte count (↑ hemolysis, ↓ marrow failure), smear abnormalities (spherocytes, schistocytes, target cells, bite cells), bleeding history, diet, and family history → differentiate iron deficiency, thalassemia, hemolytic anemia, acute blood loss, B12/folate deficiency, or aplastic anemia.

✔️ Iron deficiency: low MCV, low ferritin, high RDW, hypochromic microcytic.
✔️ Thalassemia trait: low MCV, normal RDW, elevated HbA2.
✔️ Hemolysis: ↑ reticulocytes, ↑ indirect bilirubin, spherocytes (AIHA/HS), bite cells (G6PD).
✔️ Acute bleed: normocytic, normal reticulocytes initially, later ↑.
✔️ Aplastic anemia: pancytopenia, low reticulocytes, hypocellular marrow.
📘 Schwartz pearls (Chapter 57)
• Reticulocyte count: high = hemolysis/bleed; low = marrow failure / nutritional.
• MCV <75 + mild anemia + elevated RBC count → thalassemia trait.
• Iron deficiency: ferritin <15 ng/mL, trial of iron (6 mg/kg/day elemental).
• G6PD: screen 4‑6 weeks after hemolysis (normal during acute episode).
• Perform DAT (Coombs) for suspected autoimmune hemolytic anemia.