James J. Bergin, MD, FACP

A 77-year-old woman who had hadanorexia and weakness for 3 monthswas seen after a syncopal episode. Sheappeared pale but alert. Heart rate was110 beats per minute; respiration rate,22 breaths per minute; and blood pressure,170/70 mm Hg. Her hematologicindices were: hemoglobin level, 4.3 g/dL;mean corpuscular volume (MCV), 60fL; mean corpuscular hemoglobin concentration(MCHC), 29 g/dL; red bloodcell count, 1.6 million/μL; white bloodcell count, 7500/μL; and platelet count,452,000/μL.

Anemia is usually detected as an incidentalfinding on a screening completeblood cell (CBC) count. Occasionally,a patient presents with symptoms andsigns that strongly suggest anemia,and a CBC count is ordered. In eithersetting, the next step is to determinethe cause of the anemia.