Chronic Anemia Differential Diagnoses

Updated: Oct 18, 2023
  • Author: Christopher D Braden, DO; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Diagnostic Considerations

Be vigilant for acute blood loss while attributing low hemoglobin and hematocrit values to a chronic state.

Consider anemia as an etiologic factor in patients who present with dyspnea, headache, angina, or altered mental status.

Consider anemia as a contributing factor to jaundice (hemolytic anemia) while focusing on other conditions, such as acute hepatitis, that can present as jaundice.

Be vigilant for the presence of pancytopenia.

It is important to differentiate iron deficiency anemia from thalassemia trait–induced anemia (TTIA). Although both are microcytic hypochromic anemias and share overlapping features, the disease course and treatment are distinct and TTIA can be fatal if untreated. Patients with TTIA usually have a red blood cell (RBC) count > 5 million/μL while patients with iron deficiency anemia have an RBC count < 4 million/μL. [4]

Conditions to consider in the differential diagnosis of anemia, along with those in the next section, include the following:

  • Hemophilia
  • Hemorrhoids
  • Henoch-Schönlein purpura
  • Inflammatory bowel disease
  • Malaria
  • Methemoglobinemia
  • Mononucleosis
  • Mycoplasma pneumonia
  • Cushing syndrome
  • Alcohol and substance abuse
  • Coccidioidomycosis
  • Dengue fever
  • Disseminated intravascular coagulation
  • Dysfunctional uterine bleeding
  • Dysmenorrhea
  • Sarcoidosis
  • Systemic lupus erythematosus

Differential Diagnoses