Algorithmic Approach to Anemia - Differential Diagnosis Framework by MCV



Microcytic (MCV < 80) "TAILS":

 • Thalassemia

 • ACD (inflammation)

 • Iron deficiency

 • Lead poisoning

 • Sideroblastic anemia



Normocytic (MCV 80-100):

 • Non-hemolytic: ACD, Aplastic anemia, CKD

 • Hemolytic:

     - Intrinsic: H. Spherocytosis, G6PD, PK, HbC, HbSS, PNH

     - Extrinsic: Autoimmune, MAHA, Macroangiopathic, Infections



Macrocytic (MCV > 100):

 • Megaloblastic: Folate deficiency, B12 deficiency, Orotic aciduria, Drugs (e.g., hydroxyurea, antifolate)

 • Non-megaloblastic: Liver disease, Alcoholism, Hypothyroidism, Reticulocytosis, MDS



Matthew Ho, MD PhD @MatthewHoMD



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