Differential diagnosis of anemia [Differenzialdiagnose der Anämie]

Erythrocyte parameters, the reticulocyte production index and the morphological assessment of blood smears are necessary and initially sufficient for the pathogenetic classification of anemia. In the next step parameters of the iron status should be evaluated. For the pathogenetic classification of anemia, it is necessary to differentiate between the hypoproliferative anemia, anemia caused by maturation disorders and particular hemolytic and hemorrhagic anemia. Iron deficiency leads to hypoproliferation and also to maturation disorders. Even in malignant diseases, which basically manifest as hypoproliferative anemia when bone marrow is involved, an iron distribution disorder is to be considered in individual cases as long as the malignancy leads to an inflammatory reaction. Anemia, iron and inflammation pose a challenging “ménage à trois”. Furthermore, the differential diagnosis of iron distribution disorders, iron deficiency and thalassemia sites is also important. The pathogenetic classification allows an accurate differential diagnosis of this most frequent worldwide disorder. © 2015, Springer-Verlag Berlin Heidelberg.