eMedicine Specialties > Emergency Medicine > Hematology & Oncology

Anemia, Chronic: Follow-up

Author: Fredrick Melik Abrahamian, DO, FACEP, Associate Professor of Medicine, University of California at Los Angeles School of Medicine; Director of Education for Emergency Medicine Residency Program, Consulting Staff, Department of Emergency Medicine, Olive View-University of California at Los Angeles Medical Center
Coauthor(s): Eric Wilke, MD, Medical Director, Traditions Emergency Medicine, College Station Medical Center
Contributor Information and Disclosures

Updated: Dec 7, 2009

Follow-up

Further Inpatient Care

  • Patients with chronic anemia requiring admission include the following:
    • Patients presenting with hypovolemia, active bleeding, angina, tachypnea, altered mental status, TIA, or exacerbation of CHF
    • Patients who demonstrate a considerable drop in Hgb and hematocrit values when compared to previous values or have new-onset or worsening pancytopenia
    • Patients with an initial Hgb less than 10 g/dL or hematocrit less than 30%
    • Patients who may not comply with follow-up or those in whom the clinician anticipates the need for an extensive workup
  • Patients can be admitted to a ward bed, a monitored bed, or an ICU bed, depending on their condition.

Further Outpatient Care

  • Patients with chronic anemia most often are treated in the outpatient setting. Clear instructions must be given to the patient regarding proper follow-up.
  • Considering the financial situation and outpatient capability to comply with follow-up of these patients is imperative. The key to minimizing complications from chronic anemia is ongoing reassessment and compliance with proposed medical therapy.
  • All efforts should be made to arrange for follow-up. When all avenues for outpatient evaluation fail, patients should be instructed to return to the ED for reassessment in 2-3 weeks.
  • Upon discharge, instruct the patient to watch for signs and symptoms of worsening anemia. The patient should be advised to return to the ED if such symptoms develop.

Transfer

  • Patients with chronic anemia seldom require transfer to another facility for definitive care. Transfers are only acceptable if the patient is hemodynamically stable.

Complications

  • Failure to comply with follow-up and treatment regimens predisposes patients with chronic anemia to complications.
  • The majority of complications arise from chronic or persistent tissue hypoxia.
  • Pediatric patients, elderly patients, and patients who are immunocompromised are at the highest risk for complications, since they have less physiological reserve.

Prognosis

  • Prognosis is dependent on several factors. The underlying medical condition usually dictates the prognosis, but comorbid conditions, the patient's age, and the patient's access to medical care are contributing factors.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify acute blood loss while attributing low Hgb and hematocrit values to a chronic state
  • Failure to recognize anemia as an etiologic factor for patients who present with dyspnea, headache, angina, or altered mental status
  • Failure to recognize anemia as the contributing factor to jaundice (hemolytic anemia) while focusing on other conditions, such as acute hepatitis, that can present with jaundice
  • Failure to recognize the presence of pancytopenia while focusing mainly on anemia
  • Failure to provide appropriate instructions for return
 


More on Anemia, Chronic

Overview: Anemia, Chronic
Differential Diagnoses & Workup: Anemia, Chronic
Treatment & Medication: Anemia, Chronic
Follow-up: Anemia, Chronic
References
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References

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  7. Lux SE, Fruchtman SM, Berk PD. Introduction to anemias: Polycythemia vera and agnogenic myeloid metaplasia. In: Handin RI, Lux SE, Stossel TD, eds. Blood: Principles and Practice of Hematology. Philadelphia, Pa: Williams & Wilkins; 1995:430-5, 1391-2.

  8. Rapaport SI. Diagnosis of anemia. In: Introduction to Hematology. Philadelphia, Pa: Williams & Wilkins; 1987:10-38.

  9. Rhule RL. Anemia. In: Schwarz GR, ed. Principles and Practice of Emergency Medicine. Vol 2. Philadelphia, Pa: Williams & Wilkins; 1992:1966-77.

  10. Tarasiuk A, Abdul-Hai A, Moser A, et al. Sleep disruption and objective sleepiness in children with beta-thalassemia and congenital dyserythropoietic anemia. Arch Pediatr Adolesc Med. May 2003;157(5):463-8. [Medline].

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Further Reading

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Keywords

anemia, chronic anemia, malaise, fatigue, dyspnea, GI bleed, hemolysis, hemorrhage, sickle cell anemia, thalassemia, hemoglobin, Hgb, red blood cell, RBC, decreased production of RBCs, destruction of RBCs, hypochromic microcytic anemia, macrocytic anemia, normocytic anemia, aplastic anemia, myelophthisic anemia, myeloid metaplasia, agnogenic myeloid metaplasia, hemolytic anemia, iron deficiency

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Contributor Information and Disclosures

Author

Fredrick Melik Abrahamian, DO, FACEP, Associate Professor of Medicine, University of California at Los Angeles School of Medicine; Director of Education for Emergency Medicine Residency Program, Consulting Staff, Department of Emergency Medicine, Olive View-University of California at Los Angeles Medical Center
Fredrick Melik Abrahamian, DO, FACEP is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Eric Wilke, MD, Medical Director, Traditions Emergency Medicine, College Station Medical Center
Eric Wilke, MD is a member of the following medical societies: American College of Emergency Physicians and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Roy Alson, MD, PhD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare
Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jeffrey L Arnold, MD, FACEP, Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center
Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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