Practice Efficiency: Evaluating the patient with new anemia

It never fails, you’re looking forward to a long weekend and you receive a new low hemoglobin on a patient. Or it’s a Monday morning and the first lab you look at shows a new low hemoglobin. These always make me stop and take notice as something has to be done. The best thing to have in these circumstances is a standardized checklist of questions to ask the patient. I usually use the module on clinicinfo to send the patient a quick note to contact the office. If I’m not using clinicinfo then I’ll as my secretary to give the patient a quick call and ask the following questions. Now, please know that I am initially assuming that the low hemoglobin is due to blood loss as I need to rule this out first.

The questions I typically ask are as follows:

Preamble: On a recent test your hemoglobin was lower than normal or than expected. Hemoglobin is found inside red blood cells and is important in carrying oxygen to your body. A low hemoglobin may make you feel weak, tired, lightheaded or short of breath. There are many causes for a low hemoglobin. The most common cause is blood loss.

I would ask the patient the following questions:

  1. Recent surgery (this happens more often than you would think)?
  2. Bleeding from the bowels (blood noticed in toilet or on stool)?
  3. Black or tarry looking stool?
  4. Coughing up or vomiting blood?
  5. Severe nosebleeds?
  6. Blood in the urine?
  7. Heavy menstrual periods (women)?
  8. Any new medications?
  9. Any other changes to your health?

If you feel chest pain or heaviness, shortness of breath, or lightheadedness please call 911 or go to the closest emergency department.