Hematology
Differential Diagnosis

Differentiating Anemia: Key Labs & Nursing Interventions

Classify anemia rapidly using MCV, iron markers, and targeted nursing care plans for each subtype.

First Branch Point MCV (80–100 fL)
Primary Categories Micro, Normo, Macro
Goal Targeted Nursing Care
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Step 01
Morphologic Approach

The Golden Rule: Check MCV First

Normal MCV 80 – 100 fL
Definition Mean Corpuscular Volume
The Three Diagnostic Branches

• MCV < 80 fL: Microcytic (Small RBCs).
• MCV 80–100 fL: Normocytic (Normal RBC size, reduced count).
• MCV > 100 fL: Macrocytic (Large, megaloblastic RBCs).

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Category 01
MCV < 80 fL

Microcytic: Iron Deficiency & Thalassemia

Serum Ferritin < 15 ng/mL (Low in IDA)
TIBC Elevated in Iron Deficiency
Nursing Care • Iron Therapy

• Give oral iron on an empty stomach with Vitamin C (orange juice).
• Avoid dairy, calcium, and antacids within 2 hours.
• Use Z-track method for IM iron injections.
• Educate patient that dark green or black stools are normal.

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Category 02
MCV 80–100 fL

Normocytic: Hemorrhage & Chronic Disease

Primary Causes Acute Bleeding, CKD, Hemolysis
Reticulocyte Count Normal: 0.5% – 2.0%
Clinical Diagnostic Clue

• High Reticulocytes (>2%): Active bone marrow response (hemorrhage or hemolysis).
• Low Reticulocytes (<0.5%): Marrow hypo-production (CKD, aplastic anemia).
• In CKD: Administer Erythropoietin (Epogen) and monitor BP.

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Category 03
MCV > 100 fL

Macrocytic: Vitamin B12 vs Folate Deficiency

B12 Hallmarks Neurological Signs &plus; Glossitis
Folate Hallmarks No Neurological Deficits
NCLEX Safety Alert

Never treat B12 deficiency with Folic Acid alone! Folate may improve hematologic counts but masks ongoing, irreversible subacute combined degeneration of the spinal cord.

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Clinical Signs
Bedside Assessment

Red Flag Symptoms Every Nurse Must Spot

Cardiovascular Tachycardia, Orthostasis
Integumentary Pallor, Koilonychia (Spoon nails)
Activity Tolerance Exertional Dyspnea, Fatigue
Safety Intervention

Implement fall precautions, assist with ambulation, and cluster nursing activities to conserve patient oxygen and energy reserves.

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Clinical Care Plan
Complete Evidence-Based Guide

Master Anemia Differential Diagnosis

Read the Full Clinical Article

Explore comprehensive lab reference tables, pathophysiology breakdowns, and take our 6-question NCLEX clinical quiz.

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