{ "schemaVersion": 2, "eyebrow": "Emergency Medicine", "title": "Acute Anemia", "summary": "Manage acute anemia by first identifying unstable hemorrhage or oxygen-delivery failure, then separating blood loss from hemolysis and impaired production with serial hemoglobin, reticulocyte response, smear, and targeted hemostatic testing. Transfuse to physiologic need while obtaining definitive bleeding control or cause-directed therapy.", "seoDescription": "Point-of-care approach to acute anemia: stabilization, transfusion thresholds, hemorrhage versus hemolysis, reticulocyte interpretation, and escalation.", "clinicalQuestion": "How should physicians stabilize, classify, transfuse, and escalate adults presenting with acute anemia?", "specialty": "Emergency Medicine and Hospital Medicine", "audience": "U.S. physicians and medical trainees", "tags": [ "acute anemia", "hemorrhage", "hemolysis", "red blood cell transfusion", "reticulocyte count", "massive transfusion" ], "keyTakeaways": [ "In active hemorrhage, prioritize hemodynamic stabilization and bleeding control; hemoglobin alone may not reflect the initial severity, and transfusion requirements should follow bleeding rate and clinical context. [10]", "For symptomatic anemia or active bleeding, transfuse RBCs to maintain hemoglobin at least 7 g/dL; use a target at least 8 g/dL in patients with coronary artery disease, particularly acute coronary syndrome. [3]", "An elevated reticulocyte response directs the workup toward hemorrhage or hemolysis, whereas an inappropriately low response favors impaired erythropoiesis; acute blood loss may not produce reticulocytosis for 3 to 4 days. [8][23]", "Order LDH, haptoglobin, indirect bilirubin, and peripheral smear when hemolysis is plausible; a reticulocyte rise alone does not distinguish hemolysis from blood loss. [17]", "Initiate a massive transfusion protocol for life-threatening major hemorrhage requiring rapid replacement of RBCs, plasma, platelets, and sometimes cryoprecipitate. [10]" ], "sections": [ { "id": "stabilize-and-triage", "eyebrow": "First Minutes", "heading": "Identify hemorrhagic instability and restore oxygen delivery", "intro": "Treat active major bleeding as a resuscitation and source-control problem before etiologic refinement.", "paragraphs": [ "In hypotension, ongoing overt bleeding, rapidly worsening symptoms, or anticipated need for rapid blood-product replacement, establish resuscitation, obtain serial CBC and hemostatic measurements, and activate a massive transfusion protocol when major trauma or operative-scale hemorrhage requires prompt replacement of RBCs, fresh frozen plasma, platelets, and sometimes cryoprecipitate. A more liberal RBC approach may be required during ongoing hemorrhage to maintain hemodynamic stability until bleeding is controlled. [10]", "During major bleeding, obtain fibrinogen and platelet count early and replace platelets to maintain a count of at least 50 × 10^9/L and cryoprecipitate to maintain fibrinogen above 100 mg/dL. Patients needing at least 3 units of packed RBCs within 1 hour warrant immediate reassessment for uncontrolled hemorrhage and accelerated hemostatic resuscitation. [3]", "Do not use a single early hemoglobin value to dismiss clinically important acute blood loss. Repeat hemoglobin after initial resuscitation and pair its trend with vital signs, bleeding trajectory, and source-control assessment. [10]" ], "bullets": [ "If brisk gastrointestinal, operative, traumatic, or other external bleeding is present, direct testing and procedural escalation toward localization and control rather than waiting for reticulocyte or iron-study results. [10]", "If acute type 1 myocardial infarction coexists with severe anemia, recognize markedly elevated short-term risk; reported 30-day mortality reaches 30% in this population. [1][2]" ], "subsections": [], "table": { "caption": "Immediate blood-product targets during active bleeding. [3][10]", "columns": [ "Finding or circumstance", "Immediate action", "Target or escalation point" ], "rows": [ [ "Symptomatic anemia or active bleeding", "Transfuse RBCs", "Maintain hemoglobin ≥7 g/dL. [3]" ], [ "Coronary artery disease, especially acute coronary syndrome", "Use a higher RBC target than standard restrictive practice", "Maintain hemoglobin ≥8 g/dL. [3]" ], [ "Thrombocytopenia during active bleeding", "Transfuse platelets", "Maintain platelet count ≥50 × 10^9/L. [3]" ], [ "Hypofibrinogenemia during active bleeding", "Give cryoprecipitate", "Maintain fibrinogen >100 mg/dL. [3]" ], [ "Rapid, life-threatening hemorrhage", "Activate massive transfusion protocol and pursue source control", "Use RBCs, plasma, platelets, and sometimes cryoprecipitate to sustain hemodynamic stability. [10]" ] ] } }, { "id": "initial-classification", "eyebrow": "Diagnostic Branch Point", "heading": "Classify acute anemia by marrow response and cell morphology", "intro": "Use reticulocytes and the peripheral smear to decide whether anemia reflects loss, destruction, or inadequate production.", "paragraphs": [ "Order a CBC with indices, absolute reticulocyte count or reticulocyte index, and peripheral smear in unexplained acute anemia. An increased reticulocyte count supports marrow compensation for RBC destruction or blood loss; an adjusted reticulocyte index of at least 3% is expected with bleeding or hemolysis, whereas a normal or depressed response indicates impaired red-cell formation. [8]", "Interpret a reticulocyte result in relation to timing. After acute blood loss, marrow reticulocytosis has an average 3- to 4-day delay; therefore, a low reticulocyte count early after abrupt hemorrhage does not exclude blood loss. [8]", "Use MCV as a sorting tool, not a final diagnosis. Macrocytosis is generally defined as MCV greater than 100 fL; the combination of macro-ovalocytes and hypersegmented neutrophils supports megaloblastic anemia and directs testing toward vitamin B12 or folate deficiency. A nonmegaloblastic smear with reticulocytosis shifts attention toward hemolysis or hemorrhage, whereas hypothyroidism, liver disease, alcohol exposure, medications, and marrow dysplasia remain important alternatives. [9][23]" ], "bullets": [ "An absolute reticulocyte count below approximately 40,000 to 50,000 cells/mL is compatible with reduced erythropoiesis in erythropoietin-deficiency states; an elevated count should trigger evaluation for blood loss or hemolysis instead. [23]", "Microcytosis with increased red-cell distribution width and erythroid hypochromasia, especially with a nutritional history consistent with low iron intake, supports iron deficiency; reticulocyte hemoglobin content may identify iron-restricted erythropoiesis early. [23]", "Do not attribute macrocytosis automatically to alcohol or nutritional deficiency when anemia is acute or severe; assess smear, reticulocyte response, liver disease, thyroid disease, and possible marrow dysplasia. [9]" ], "subsections": [], "table": { "caption": "Initial branching framework for unexplained acute anemia. [8][9][17][23]", "columns": [ "Pattern", "Key tests or findings", "Interpretation and next action" ], "rows": [ [ "Reticulocyte index ≥3%", "History for overt or occult blood loss; hemolysis panel and smear", "Compensated blood loss or hemolysis is likely; determine whether active bleeding requires source control or hemolysis requires cause-specific treatment. [8][17]" ], [ "Low or inappropriately normal reticulocyte response", "CBC indices, smear, renal context, nutritional testing guided by morphology", "Favor impaired production; assess erythropoietin-deficiency states, iron restriction, vitamin B12 or folate deficiency, drug effect, and marrow disease. [9][23]" ], [ "Macro-ovalocytes and hypersegmented neutrophils", "Vitamin B12 and folate testing", "Megaloblastic anemia is likely. [9][23]" ], [ "Nonmegaloblastic macrocytosis with reticulocytosis", "Hemolysis panel and bleeding assessment", "Hemolysis or hemorrhage becomes more likely than isolated nutrient deficiency. [9]" ], [ "Microcytosis, high RDW, hypochromasia", "Iron-directed evaluation; consider reticulocyte hemoglobin content", "Supports iron deficiency and should prompt evaluation for a bleeding source when clinically appropriate. [23]" ] ] } }, { "id": "hemorrhage-pathway", "eyebrow": "Blood Loss", "heading": "When to prioritize bleeding-source evaluation and procedural control", "intro": "A regenerative pattern does not establish hemolysis; identify occult or overt bleeding before labeling anemia as destructive.", "paragraphs": [ "In a patient with reticulocytosis and no clear external blood loss, reassess for gastrointestinal, gynecologic, postoperative, traumatic, and medication-associated bleeding while reviewing serial hemoglobin values and hemodynamics. Occult bleeding commonly presents through iron-deficiency anemia and/or a positive fecal occult blood test rather than visible hemorrhage. [19][20]", "For acute gastrointestinal bleeding with symptomatic anemia or active hemorrhage, RBC transfusion should maintain hemoglobin at least 7 g/dL; in coronary artery disease or acute coronary syndrome, target at least 8 g/dL. The treatment endpoint is hemostatic control, not normalization of hemoglobin during the initial resuscitation. [3]", "In acute coronary syndrome requiring percutaneous coronary intervention, bleeding risk alters antiplatelet decisions but does not eliminate the need for timely restoration of coronary flow. In patients at high bleeding risk receiving a drug-eluting stent, current American and European ACS guidance allows consideration of shortened dual antiplatelet therapy, as short as 1 month, with a Class IIb recommendation; active bleeding after PCI may require temporary antithrombotic interruption. [1][2]" ], "bullets": [ "Escalate immediately when transfusion needs accelerate, including a requirement for at least 3 RBC units in 1 hour, because this pattern indicates a need for urgent hemorrhage-control reassessment. [3]", "Avoid using a delayed reticulocyte response to exclude abrupt blood loss in the first several days after the event. [8]" ], "subsections": [], "table": { "caption": "Bleeding-focused decisions in acute anemia. [2][3][8][10][19][20]", "columns": [ "Clinical branch", "Actionable discriminator", "Next step" ], "rows": [ [ "Overt active bleeding", "Hemodynamic instability or ongoing blood loss", "Resuscitate, trend hemoglobin, replace hemostatic components to targets, and obtain definitive bleeding control. [3][10]" ], [ "Possible occult blood loss", "Iron-deficiency anemia and/or positive fecal occult blood test", "Evaluate for an occult bleeding source in the appropriate clinical context. [19][20]" ], [ "Recent abrupt hemorrhage with low reticulocytes", "Bleeding duration <3 to 4 days", "Do not exclude blood loss; repeat reticulocyte assessment if needed while managing the suspected source. [8]" ], [ "ACS with severe anemia", "Known or suspected acute type 1 MI", "Use coronary disease transfusion target and coordinate revascularization with bleeding-risk management. [1][2][3]" ] ] } }, { "id": "hemolysis-pathway", "eyebrow": "Red-Cell Destruction", "heading": "Confirm hemolysis before selecting cause-directed treatment", "intro": "Use concordant biochemical and smear evidence, then pursue the immune, mechanical, inherited, or disease-specific branch.", "paragraphs": [ "When blood loss is not evident and reticulocytosis is present, order LDH, haptoglobin, indirect bilirubin, and a peripheral smear. The combination of elevated reticulocytes with abnormalities in LDH, haptoglobin, and indirect bilirubin supports hemolysis, but reticulocytosis alone is shared with blood loss and is insufficient for diagnosis. [17]", "The peripheral smear can provide a decisive etiologic clue and may occasionally be sufficient to identify a specific hemolytic disorder. Examine it promptly rather than treating it as a confirmatory test after extensive serology. [17]", "For suspected hereditary spherocytosis, obtain CBC, smear, reticulocyte count, direct antiglobulin test, and bilirubin; if family history or smear supports the diagnosis, obtain an incubated osmotic fragility test. Family history should specifically ask about anemia, jaundice, gallstones, and splenectomy. [24]" ], "bullets": [ "If hemolysis is suspected in a patient with alcohol-associated hepatitis, recognize Zieve syndrome as the triad of jaundice, hyperlipidemia, and alcoholic steatohepatitis; lipid values may be normal in up to 50% of cases. [14]", "In Zieve syndrome, management described in reported cases includes intravenous hydration, thiamine and folate supplementation, and alcohol-withdrawal management; avoid attributing bilirubin entirely to hepatic injury without accounting for hemolysis. [14]", "For sickle cell disease with acute ischemic stroke, severe acute chest syndrome or hypoxic respiratory failure, or multisystem organ failure, use urgent exchange transfusion rather than treating the hemoglobin value alone. [12]" ], "subsections": [ { "heading": "Sickle cell disease: separate isolated anemia from transfusion emergencies", "paragraphs": [ "In sickle cell disease, a hemoglobin value substantially below the patient’s baseline may justify transfusion depending on clinical context, but first exclude acute bleeding, hemolysis outside the expected baseline pattern, acute chest syndrome, and splenic sequestration because management differs. Exchange transfusion is indicated for acute ischemic stroke, severe acute chest syndrome or any hypoxic respiratory failure, and multisystem organ failure. [12]" ], "bullets": [ "Before surgery requiring general anesthesia for more than 1 hour, ASH guidance suggests preoperative transfusion rather than no transfusion and advises aiming for total hemoglobin above 9 g/dL. [12]" ] } ], "table": { "caption": "Hemolysis-directed diagnostic and escalation actions. [12][14][17][24]", "columns": [ "Suspected branch", "Discriminator", "Action" ], "rows": [ [ "Hemolysis versus hemorrhage", "Reticulocytosis plus LDH, haptoglobin, indirect bilirubin, and smear findings", "Confirm a hemolytic pattern before selecting disease-specific therapy; reticulocytosis alone also occurs with blood loss. [17]" ], [ "Hereditary spherocytosis", "Suggestive smear or family history of anemia, jaundice, gallstones, or splenectomy", "Obtain direct antiglobulin testing and bilirubin; add incubated osmotic fragility testing when suggested by smear or family history. [24]" ], [ "Zieve syndrome", "Jaundice, hyperlipidemia, alcoholic steatohepatitis, and acute hemolysis", "Treat supportively and account for hemolysis when interpreting bilirubin; normal lipids do not exclude the syndrome. [14]" ], [ "Sickle cell transfusion emergency", "Acute ischemic stroke, severe acute chest syndrome or hypoxic respiratory failure, or multisystem organ failure", "Perform exchange transfusion. [12]" ] ] } }, { "id": "underproduction-and-follow-up", "eyebrow": "Nonregenerative Pattern", "heading": "Escalate impaired production when reticulocytes do not match anemia severity", "intro": "An inappropriately low marrow response shifts management away from hemorrhage resuscitation and toward morphology-guided testing.", "paragraphs": [ "With low or inappropriately normal reticulocytes, use MCV and smear morphology to target the workup. Macrocytosis with macro-ovalocytes and hypersegmented neutrophils supports vitamin B12 or folate deficiency, while nonmegaloblastic macrocytosis should prompt review for alcohol or medication toxicity, hypothyroidism, liver disease, and primary marrow dysplasia. [9][23]", "Pancytopenia, nucleated RBCs, macrocytosis with basophilic stippling, or other dysplastic smear findings should raise concern for marrow disease such as myelodysplastic syndrome. In one hematology case of intramedullary hemolysis from myelodysplastic syndrome, the smear showed macrocytosis, basophilic stippling, and rare nucleated RBCs without spherocytes or schistocytes typical of peripheral hemolysis. [18]", "Monitor response after stabilization with serial hemoglobin and repeat reticulocyte assessment when the initial result was obtained within days of suspected blood loss. A rising reticulocyte response supports recovery or ongoing compensation; persistent reticulocytopenia requires continued evaluation for inadequate erythropoiesis rather than empiric attribution to occult bleeding. [8][23]" ], "bullets": [ "Use reticulocyte hemoglobin content as an early supportive marker of iron deficiency when microcytosis or hypochromia has not fully developed. [23]", "Reserve marrow-directed escalation for persistent unexplained cytopenias or dysplastic blood-film features after readily reversible nutritional, renal, hemolytic, and bleeding causes have been considered. [9][18][23]" ], "subsections": [], "table": { "caption": "Findings that favor impaired erythropoiesis over acute blood loss or peripheral hemolysis. [8][9][18][23]", "columns": [ "Finding", "Interpretation", "Next diagnostic direction" ], "rows": [ [ "Normal or depressed reticulocyte index despite anemia", "Inadequate marrow response", "Assess production failure rather than assuming ongoing loss or destruction. [8]" ], [ "Absolute reticulocyte count <40,000 to 50,000 cells/mL in an erythropoietin-deficiency context", "Compatible with decreased RBC production", "Evaluate the production defect; elevated reticulocytes would instead require evaluation for hemolysis or blood loss. [23]" ], [ "Macro-ovalocytes and hypersegmented neutrophils", "Megaloblastic process", "Test for vitamin B12 and folate deficiency. [9][23]" ], [ "Macrocytosis, basophilic stippling, nucleated RBCs, and cytopenias", "Possible marrow dysplasia or intramedullary hemolysis", "Escalate evaluation for myelodysplastic syndrome or another marrow disorder. [18]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Managing Acute Myocardial Infarction in Shock and Anemia", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/full/10.1016/j.jaccas.2025.104814", "authors": "www.jacc.org", "host": "www.jacc.org" }, { "number": 2, "title": "Managing Acute Myocardial Infarction in Shock and Anemia | JACC: Case Reports", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jaccas.2025.104814", "authors": "www.jacc.org", "host": "www.jacc.org" }, { "number": 3, "title": "2020 ACC Expert Consensus Decision Pathway on Management of ...", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2020.04.053", "authors": "www.jacc.org", "host": "www.jacc.org" }, { "number": 4, "title": "Systematic review and meta-analysis of outcome-relevant anemia in ...", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-022-24591-x", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 5, "title": "The Acute Hemolytic Anemias: The Importance of Emergency Diagnosis and Management - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0736467917301555", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 6, "title": "Treatment of Acute Abnormal Uterine Bleeding in Adolescents: What Are Providers Doing in Various Specialties? - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1083318815003733", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 7, "title": "Expert consensus on improving iron deficiency anemia ...", "detail": "obgyn.onlinelibrary.wiley.com", "url": "https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.14804", "authors": "obgyn.onlinelibrary.wiley.com", "host": "obgyn.onlinelibrary.wiley.com" }, { "number": 8, "title": "Reticulocyte Count - an overview | ScienceDirect Topics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/reticulocyte-count", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 9, "title": "A practical approach to the differential diagnosis and evaluation of the adult patient with macrocytic anemia", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0025712516303418", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 10, "title": "Acute Anemia - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/sites/books/NBK537232", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 11, "title": "Acute Anemia - StatPearls - NCBI Bookshelf - NIH", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK537232", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 12, "title": "Society for Maternal-Fetal Medicine Consult Series #68: Sickle cell ...", "detail": "www.ajog.org", "url": "https://www.ajog.org/article/S0002-9378%2823%2900767-6/fulltext", "authors": "www.ajog.org", "host": "www.ajog.org" }, { "number": 13, "title": "Study Details | NCT07422480 | A Study to Compare Elritercept With Epoetin Alfa to Treat Anemia in Adults With Very Low, Low, or Intermediate Risk Myelodysplastic Syndromes (MDS) Who Need Regular Blood Transfusions | ClinicalTrials.gov", "detail": "clinicaltrials.gov", "url": "https://clinicaltrials.gov/study/NCT07422480", "authors": "clinicaltrials.gov", "host": "clinicaltrials.gov" }, { "number": 14, "title": "Hemolysis in Acute Alcoholic Hepatitis: Zieve's Syndrome - 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an overview | ScienceDirect Topics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/nursing-and-health-professions/reticulocyte-hemoglobin-content", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 24, "title": "Erythrocyte Disorder - an overview | ScienceDirect Topics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/erythrocyte-disorder", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Managing Acute Myocardial Infarction in Shock and Anemia", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/full/10.1016/j.jaccas.2025.104814", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Title: Managing Acute Myocardial Infarction in Shock and Anemia\nAuthors: Mehdi Madanchi, Emilie P.Belley-Côté, Arushi Bansal, Silvia Maiorano, and Michael B.Tsangmichael.tsang@medportal.caAuthors Info & Affiliations. Patients presenting with acute type 1 MI and concomitant severe anemia are at a sig", "score": 0.1902425 }, { "number": 2, "title": "Managing Acute Myocardial Infarction in Shock and Anemia | JACC: Case Reports", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jaccas.2025.104814", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Title: Managing Acute Myocardial Infarction in Shock and Anemia | JACC: Case Reports\nPatients presenting with ST-segment elevation myocardial infarction (STEMI) and concurrent anemia or active bleeding present a therapeutic dilemma. Patients presenting with acute type 1 MI and concomitant severe ane", "score": 0.11735977 }, { "number": 3, "title": "2020 ACC Expert Consensus Decision Pathway on Management of ...", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2020.04.053", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Supportive measures should include blood product transfusion when appropriate. Randomized trial data suggest that a restrictive (rather than liberal) transfusion strategy improves survival and reduces the risk of recurrent bleeding in patients presenting with severe acute upper GI bleeding (28). Pat", "score": 0.5829428 }, { "number": 4, "title": "Systematic review and meta-analysis of outcome-relevant anemia in ...", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-022-24591-x", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "RBCT was administered in a third of the cases (mean 32.07%, range 7.8–88.6%), with institutional threshold varying from 7.00 to 10.00 g/dL (mean", "score": 0.3421763 }, { "number": 5, "title": "The Acute Hemolytic Anemias: The Importance of Emergency Diagnosis and Management - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0736467917301555", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Clinical Reviews in Emergency Medicine The Acute Hemolytic Anemias: The Importance of Emergency Diagnosis and Management. Hemolytic anemias are defined by the premature destruction of red blood cells. These anemias have many causes that are mostly due to chronic diseases, but, occasionally, cases ", "score": 0.61112726 }, { "number": 6, "title": "Treatment of Acute Abnormal Uterine Bleeding in Adolescents: What Are Providers Doing in Various Specialties? - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1083318815003733", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Abnormal uterine bleeding in adolescents\n\nSocieties such as ACOG and several hospital systems have proposed algorithms to manage adolescent AUB, both outpatient and in the emergency room, although significant variability and lack of standardization persist in evaluation and management.13,28–31 O", "score": 0.11603103 }, { "number": 7, "title": "Expert consensus on improving iron deficiency anemia ...", "detail": "obgyn.onlinelibrary.wiley.com", "url": "https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.14804", "authors": "obgyn.onlinelibrary.wiley.com", "host": "obgyn.onlinelibrary.wiley.com", "snippet": "Use of intravenous iron before surgery results in reduction in blood transfusions, higher hemoglobin 4 weeks after discharge, replenishment of", "score": 0.081556484 }, { "number": 8, "title": "Reticulocyte Count - an overview | ScienceDirect Topics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/reticulocyte-count", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Chapter\n\n## Pallor and Anemia\n\n### Reticulocyte Count\n\nThe reticulocyte count, reported as a percentage of total RBCs, is essential in categorizing anemia. An elevated reticulocyte count implies a bone marrow response to either increased RBC destruction (hemolysis) or acute or chronic blood loss. In", "score": 0.5313802 }, { "number": 9, "title": "A practical approach to the differential diagnosis and evaluation of the adult patient with macrocytic anemia", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0025712516303418", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "smear is nonmegaloblastic, the reticulocyte count helps differentiate between drug or alcohol toxicity and hemolysis or hemorrhage. Of other possible etiologies, hypothyroidism, liver disease, and primary bone marrow dysplasias (including myelodysplasia and myeloproliferative disorders) are some of ", "score": 0.44434834 }, { "number": 10, "title": "Acute Anemia - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/sites/books/NBK537232", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "This activity discusses the diagnosis, management, and collaborative care of acute anemia, including differentiating etiologies, initiating resuscitation measures, and applying evidence-based guidelines. Additionally, this activity aims to foster effective interprofessional collaboration, including ", "score": 0.4420348 }, { "number": 11, "title": "Acute Anemia - StatPearls - NCBI Bookshelf - NIH", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK537232", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "This activity discusses the diagnosis, management, and collaborative care of acute anemia, including differentiating etiologies, initiating resuscitation measures, and applying evidence-based guidelines. Additionally, this activity aims to foster effective interprofessional collaboration, including ", "score": 0.43972388 }, { "number": 12, "title": "Society for Maternal-Fetal Medicine Consult Series #68: Sickle cell ...", "detail": "www.ajog.org", "url": "https://www.ajog.org/article/S0002-9378%2823%2900767-6/fulltext", "authors": "www.ajog.org", "host": "www.ajog.org", "snippet": "41.\n\nChou, S.T. ∙ Alsawas, M. ∙ Fasano, R.M. ...\n\nAmerican Society of Hematology 2020 guidelines for sickle cell disease: transfusion support\n\n_Blood Adv._ 2020; 4:327-355\n\nCrossref\n\nPubMed\n\nGoogle Scholar\n\n Although transfusion may be considered for those whose hemoglobin level is significantly low", "score": 0.37250575 }, { "number": 13, "title": "Study Details | NCT07422480 | A Study to Compare Elritercept With Epoetin Alfa to Treat Anemia in Adults With Very Low, Low, or Intermediate Risk Myelodysplastic Syndromes (MDS) Who Need Regular Blood Transfusions | ClinicalTrials.gov", "detail": "clinicaltrials.gov", "url": "https://clinicaltrials.gov/study/NCT07422480", "authors": "clinicaltrials.gov", "host": "clinicaltrials.gov", "snippet": "2. Diagnosed to have MDS associated with del(5q) cytogenetic abnormality or MDS unclassifiable according to WHO 2016 classification or secondary MDS.\n3. Known history of diagnosis of acute myeloid leukemia (AML).\n4. Anemia due to any other known cause including but not limited to thalassemia; ", "score": 0.17046688 }, { "number": 14, "title": "Hemolysis in Acute Alcoholic Hepatitis: Zieve's Syndrome - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508957", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "# Hemolysis in Acute Alcoholic Hepatitis: Zieve's Syndrome. Zieve's syndrome has been described in literature, mostly in non-English language case studies, but is largely under-recognized and under-reported. Zieve's syndrome is an uncommonly recognized form of acute hemolytic anemia that manifests a", "score": 0.15201993 }, { "number": 15, "title": "[PDF] The Statistical Analysis Plan for the Myocardial Ischemia and ...", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/07/NCT02981407/SAP_002.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "transfusion strategy receive one unit of packed RBCs following randomization and will receive enough blood to raise the hemoglobin concentration to 10 g/dL or above any time during the index hospitalization that the hemoglobin concentration is detected to be below 10 g/dL. A post transfusion hemoglo", "score": 0.106309816 }, { "number": 16, "title": "Patient blood management during cardiac surgery: Do we have ...", "detail": "www.jtcvs.org", "url": "https://www.jtcvs.org/article/S0022-5223(11)00387-4/fulltext", "authors": "www.jtcvs.org", "host": "www.jtcvs.org", "snippet": "Transfusion of allogeneic blood products during and after cardiac operations is common. When the degree of anemia and the consequent decrease in oxygen delivery", "score": 0.067307346 }, { "number": 17, "title": "Hemolytic Anemia - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK558904?report=reader", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Hemolytic anemia is a class of anemia that is caused by the destruction of red blood cells, increased hemoglobin catabolism, decreased levels of hemoglobin, and an increase in efforts of bone marrow to regenerate products. This activity reviews the evaluation and treatment of hemolytic anemia and hi", "score": 0.4811862 }, { "number": 18, "title": "Hyperbilirubinemia in Myelodysplastic Syndromes | The Hematologist | American Society of Hematology", "detail": "ashpublications.org", "url": "https://ashpublications.org/thehematologist/article/doi/10.1182/hem.V17.3.10386/461805/Hyperbilirubinemia-in-Myelodysplastic-Syndromes", "authors": "ashpublications.org", "host": "ashpublications.org", "snippet": "Title: Hyperbilirubinemia in Myelodysplastic Syndromes | The Hematologist | American Society of Hematology\nPeter Greenberg, Jason Kurzer; Hyperbilirubinemia in Myelodysplastic Syndromes. A 68-year-old man with Gilbert's syndrome was referred for evaluation of fatigue and pancytopenia. Automated bloo", "score": 0.30461073 }, { "number": 19, "title": "AGA Technical Review on the Evaluation and Management of ...", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S0016-5085(00)70430-6/pdf", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org", "snippet": "Occult bleeding typically refers to the initial presenta- tion of a positive fecal occult blood test (FOBT) result and/or iron-deficiency anemia", "score": 0.2624912 }, { "number": 20, "title": "AGA technical review on the evaluation and management of occult ...", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S0016-5085(00)70430-6/fulltext", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org", "snippet": "Occult bleeding typically refers to the initial presentation of a positive fecal occult blood test (FOBT) result and/or iron-deficiency anemia (IDA) without", "score": 0.26228568 }, { "number": 21, "title": "Complications of Massive Transfusion", "detail": "journal.chestnet.org", "url": "https://journal.chestnet.org/article/S0012-3692(10)60037-2/abstract", "authors": "journal.chestnet.org", "host": "journal.chestnet.org", "snippet": "Blood transfusion in trauma, surgery, and critical care has been identified as an independent predictor of multiple organ failure, systemic inflammatory response syndrome, increased infection, and increased mortality in multiple studies. **Laboratory hemostatic abnormalities in massively transfused ", "score": 0.59061456 }, { "number": 22, "title": "[PDF] Prospective multicenter Observational study on Transfusion practice ...", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/73/NCT03815773/Prot_SAP_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "Overload. Anesthesiology 126: 409-418 8. Lavelle JC, Grant ML, Karp JK, (2015) Transfusion-related acute lung injury in an era of TRALI risk mitigation. Immunohematology 31: 155-158 16 9. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellmann A, Nollet G, Peres-Bota D, (2002)", "score": 0.30906594 }, { "number": 23, "title": "Reticulocyte Hemoglobin Content - an overview | ScienceDirect Topics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/nursing-and-health-professions/reticulocyte-hemoglobin-content", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "The reticulocyte count is a useful and inexpensive test to distinguish anemia caused by underproduction of RBCs from that caused by RBC loss or destruction. In the setting of EPO deficiency, RBC production is decreased and most anemic patients would be expected to have a decreased absolute reticuloc", "score": 0.43568602 }, { "number": 24, "title": "Erythrocyte Disorder - an overview | ScienceDirect Topics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/erythrocyte-disorder", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "When presented with a pale cat, the first diagnostic step is to measure the PCV and total plasma protein concentration. If the PCV is normal, the veterinarian should look for other causes of pallor. If the PCV is low, the next step is to determine if the anemia is regenerative or nonregenerative (Fi", "score": 0.41976747 } ], "publishedAt": "2026-09-15T22:25:54.905492+00:00", "updatedAt": "2026-09-15T22:25:54.905492+00:00", "readingMinutes": 6, "slug": "acute-anemia" }