ABCs
- Check vitals → rule out shock or active bleeding
- Repeat urgent CBC and compare with baseline
- Ensure the sample is collected in an EDTA tube
HPI & examination
- Symptoms: Chest tightness, SOB, fatigue
- Bleeding
- Melena, hematemesis
- PR bleeding
- Heavy menses
- Hematuria
- Appearance
- Pallor, jaundice
- Dark urine, pale stool
- Bleeding tendency
- Purpura, mucosal bleeding
- Ecchymoses, joint bleeds
- Focused exam
- Pallor, jaundice
- Ecchymosis/purpura/hematomas
- Bedside checks
- PR exam → melena / fresh blood
- Foley → hematuria
- Background
- Known anemia
- GI / liver / renal / thyroid disease
- Medications → Antiplatelets, anticoagulants, NSAIDs
Common causes
| Category | Common Causes |
|---|---|
| Acute blood loss | GI bleed (most common), postoperative bleeding, trauma, hematuria, epistaxis |
| Iatrogenic | Frequent phlebotomy procedures |
| Dilutional | IV fluids, resuscitation, transfusion |
| Reduced production | Anemia of inflammation, nutritional deficiency (iron, B12, folate), drug-induced marrow suppression |
| Hemolysis | Drug-induced (e.g., β-lactams, methyldopa), mechanical (valves, DIC, TTP) |
| Bone marrow failure | Aplastic anemia, myelodysplasia, hematologic malignancy |
Management
- If hypotensive → Give IV fluids (Normal saline)
- If no active bleeding
- Cross-match and reserve 2 PRBCs
- Target: Hb >7 g/dL & Hb >8 g/dL (if CVD)
- Suspected GI bleed
- Start IV PPI: 80 mg stat → 40 mg IV BID or infusion 8 mg/hr
- Before Transfusion
- Send anemia + hemolysis workup
- Ask about prior transfusion reactions
- Investigations:
- Anemia panel: CBC, blood film, iron profile, B12, folate
- Hemolysis: Reticulocyte count, DAT, LDH, haptoglobin, LFT
- Bleeding source: PR exam, urine R/M
- Monitoring:
- Monitor stool for melena / occult blood
- Monitor urine for hematuria
- Repeat CBC after transfusion
Studying for R1? The IM Rapid Review covers this in the same format — see the sample chapter.
Last reviewed · May 2026