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The word anemia derives from an ancient Greek word anaimia, meaning “lack of blood.” Anemia, like a fever, is not a diagnosis but a presentation of an underlying disease. Multiple diseases can present as anemia due to various mechanisms. Anemia affects a significant number of people worldwide (more so in the developing world), resulting in a considerable increase in the cost of medical care. Anemia can be defined as a reduction in hemoglobin (less than 13.5 g/dL in men; less than 12.0 g/dL in women) or hematocrit (less than 41.0% in men; less than 36.0% in women) or red blood cell (RBC) count. The terms hemoglobin and hematocrit are more commonly used than RBC count in day-to-day clinical practice. There are different lower limits of normal range based on ethnicity, gender,  and age. Anemia causes decreased oxygen-carrying capacity of the blood leading to tissue hypoxia. Grading of Anemia, according to the National Cancer Institute, is as follows: Mild: Hemoglobin 10.0 g/dL to lower limit of normal Moderate: Hemoglobin 8.0 to 10.0 g/dL Severe: Hemoglobin 6.5 to 7.9 g/dL[1] Life-threatening: Hemoglobin less than 6.5 g/dL Anemia classified into acute anemia and chronic anemia. Acute anemia is predominantly due to acute blood loss or acute hemolysis. Chronic anemia is more common and is secondary to multiple causes.

Initial Work-Up Complete blood count: Hemoglobin, HCT, MCV, reticulocyte count index Comprehensive metabolic panel: Renal and liver function tests Iron studies which include serum iron, TIBC (total iron binding capacity) and ferritin Serum vitamin B12, folic acid, and thyroid-stimulating hormone (TSH) Stool for occult blood Differentiation of Microcytic Anemias Based on Iron Studies Iron deficiency anemia: Low serum iron, high TIBC, and low ferritin. Anemia of chronic disease: Low serum iron, low TIBC, and high ferritin. Sideroblastic anemia: High serum iron, normal TIBC, and high ferritin. Thalassemia: Normal serum iron, normal TIBC and normal ferritin. Peripheral smear, hemoglobin electrophoresis, and bone marrow examination if needed. Further testing would include esophagogastroduodenoscopy (EGD) and colonoscopy if gastrointestinal (GI) bleeding is suspected and imaging studies if malignancy suspected.