What history should be collected for a patient suspected of having anemia (iron deficiency or decreased red blood cell count)?

From the Guidelines

When evaluating a patient suspected of anemia, I should collect a comprehensive history that includes several key elements, prioritizing family history, dietary habits, medication history, and history of blood loss, as these are crucial in identifying the underlying cause of anemia, as noted in 1. To collect a comprehensive history, I should ask about symptoms such as fatigue, weakness, shortness of breath, dizziness, palpitations, and pallor, noting their onset, duration, and severity.

• Family history is crucial, particularly regarding hereditary anemias like thalassemia, sickle cell disease, or G6PD deficiency, as well as a history of colorectal carcinoma, as mentioned in 1.
• Dietary habits should be assessed, focusing on intake of iron-rich foods, vitamin B12, and folate, as borderline iron-deficient diets are common, according to 1.
• Medication history is essential, especially NSAIDs, anticoagulants, and chemotherapeutic agents that may cause bleeding or bone marrow suppression, as noted in 1 and 1.
• I should inquire about blood loss through menstrual patterns in women, gastrointestinal bleeding (melena, hematochezia), hematuria, or recent trauma/surgery, as well as a history of blood donation or any other source of blood loss, as mentioned in 1.
• Past medical history of chronic diseases like kidney disease, liver disease, hypothyroidism, autoimmune disorders, or malignancies is relevant as these can contribute to anemia, as noted in 1.
• Recent infections, alcohol consumption, and exposure to toxins or radiation should be documented, as well as travel history, which may reveal exposure to parasitic infections or malaria.
• Previous blood test results and any history of anemia, blood transfusions, or hematologic disorders provide valuable context for current symptoms and help guide appropriate diagnostic testing and management, as mentioned in 1 and 1.

From the Research

History Collection for Suspected Anemia

To collect a comprehensive history for a patient suspected of anemia, the following points should be considered:

• Symptoms:
  • Fatigue
  • Weakness
  • Shortness of breath
  • Restless legs syndrome
  • Pica
  • Dyspnea
  • Lightheadedness
  • Exercise intolerance
  • Worsening heart failure (HF) 2
• Menstrual history:
  • Heavy menstrual bleeding
  • Pregnancy
  • Menstrual irregularities 2, 3
• Dietary history:
  • Inadequate dietary iron intake
  • Restricted diets (e.g., vegan or vegetarian) 2, 4
• Medical history:
  • Chronic kidney disease (CKD)
  • Heart failure (HF)
  • Inflammatory bowel disease (IBD)
  • Cancer
  • Previous gastrointestinal surgeries or conditions (e.g., celiac disease, atrophic gastritis) 2, 5
• Medication history:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Other medications that may cause gastrointestinal bleeding or interfere with iron absorption 2
• Family history:
  • History of anemia or iron deficiency in family members 2
• Social history:
  • Occupation or activities that may increase the risk of iron deficiency (e.g., frequent blood donations)
  • Travel history or exposure to certain infections (e.g., malaria) 2

Physical Examination and Laboratory Evaluation

A thorough physical examination and laboratory evaluation, including a complete blood cell count (CBC) and iron panel, are essential to diagnose and classify anemia 6, 5. The mean corpuscular volume (MCV) and serum ferritin level can help identify the cause of anemia and guide further testing and treatment 6, 5.