Anemia represents a common problem encountered in daily clinical practice world wide. Hence, a structured approach to evaluating anemia is highly relevant in primary care. Multichannel automated analyzers have revolutionized the work of performing complete blood counts (CBCs). However, when interpreting results, clinicians must be aware of limitations encountered with these technologies, which can yield spurious red blood cell (RBC) values in certain clinical circumstances. Automated analyzers identify subpopulations of RBCs that are unexpectedly small or large or have unexpectedly low or high hemoglobin concentrations, thereby signifying aberrant RBC morphologies for review on peripheral blood smear. Results of various blood chemistries help to refine or confirm diagnostic considerations suggested by the CBC, reticulocyte count, and peripheral blood smear. While tempo of anemia development may strongly support bleeding or hemolysis as the cause of anemia, kinetic changes in RBC mass, even due to these mechanisms, are often more subtle, suggesting possible underproduction causes of anemia. Abnormalities in white blood cell (WBC) counts, platelet counts, and WBC differentials may suggest disorders of trilineage hematopoiesis, although multiple competing factors may coexist, with certain factors affecting RBCs independent of those affecting WBCs and/or platelets. To focus diagnostic considerations, clinicians should consider anemia etiologies categorized by RBC size (mean cell volume, MCV) and morphology (e.g., spherocytes, bite cells, schistocytes, target cells, tear drops). These categories include the microcytic, normocytic, and macrocytic anemias. I will briefly review each of these categories and provide case presentations with multiple choice questions that illustrate specific points.

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

COST: $40.00 for the average learner. Participants living in emerging nations receive a 50% discount or can register for free. See our International Pricing Page for details.

OVERALL LEARNING OBJECTIVES:

1. To develop a structured approach to evaluating anemia
2. To focus diagnostic considerations by considering anemia etiologies categorized by red blood cell size (mean cell volume, MCV) and morphlogy (e.g., spherocytes, bite cells, schistocytes, target cells, tear drops)

CLINICAL LEARNING OBJECTIVES:

1. To review diagnosis and management of commonly encountered causes of anemia, specifically iron deficiency, vitamin B12 deficiency, and underproduction of erythropoietin in chronic renal failure
2. To review diagnosis and management of commonly encountered causes of hemolytic anemia, including oxidative hemolysis, immunohemolytic anemia, thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) and disseminated intravascular coagulation (DIC)

METHOD OF PARTICIPATION:

Registrants participate in the learning process by answering interactive multiple choice questions that are dispersed throughout the case presentation. You must answer a question correctly in order to continue through the course. If you answer a question incorrectly, you will be prompted to try again.

In order to earn credit, physicians must complete the entire educational activity before the termination date (see above). Non-physicians may register for the course but are not eligible for AMA PRA Category 1 Credits™. Instead, non-physicians will earn a certificate of participation after successfully completing the course before its termination date.

COMBINATION OF MEDIA USED:

This internet enduring material is a case-based, interactive presentation comprised mainly of text, interactive questions, and images. A variety of media, including video clips, audio clips, and Flash animation, may be presented. Links to any necessary plugins are provided when necessary, but no plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.

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REED E. DREWS, MD Course Co-Director

Dr. Drews is Director of the Hematology-Oncology Fellowship Program at BIDMC. He has worked on the study of genetic instability in neoplasms and is an active member of the Cutaneous Oncology and Hematologic Malignancy Programs in the Beth Israel Deaconess Cancer Center, with a special interest in CD30-positive lymphoproliferative disorders of the skin. He is a highly sought after teacher and an active clinician. In 2003, 2005, and 2007, he was a nominee for the Harvard Medical School Faculty Prize for Excellence in Teaching (Years 3 & 4). In 2005, he became a Fellow of the American College of Physicians, serving as a member of the ACP’s Scientific Program Subcommittee for the 2007, 2009 and 20011 Annual Sessions. DISCLOSURE: Reported no relevant financial relationships with commercial entities

ELIZABETH C. RILEY, MD Course Co-Director

Elizabeth C. Riley MD is an Assistant Professor of Medicine in the Division of Medical Oncology and Hematology at the University of Louisville in Louisville, Kentucky. She is a graduate of Duke University and received her medical degree from the University of Louisville. Dr Riley completed her post graduate internship and residency in internal medicine at Beth Israel Deaconess Medical Center, Harvard Medical School where she served as Chief Medical Resident. She also completed her fellowship in hematology and oncology at Beth Israel Deaconess Medical Center, Harvard Medical School. She is a member of the American Society of Clinical Oncology, the American Society of Hematology and the American College of Physicians. She currently serves on the Advisor Council of the Kentucky Chapter of the American College of Physicians. She is board certified in internal medicine, hematology and medical oncology. Dr. Riley practices at the James Graham Brown Cancer Center in Louisville, Kentucky specializing in breast cancer and hematology. DISCLOSURE: Reported no relevant financial relationships with commercial entities

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JAMES LEVINE, MD Reviewer

Dr. Levine is an Assistant Professor of Medicine at Beth Israel Deaconess Medical Center in Boston, MA. DISCLOSURE: Mutual Funds that probably invest in biotech and pharmacy companies

JEFFREY ZWICKER, MD Reviewer

Dr. Jeffrey Zwicker is in Instructor in Medicine at the Beth Israel Deaconess Medical Center in Boston, MA. DISCLOSURE: Reported no relevant financial relationships with commercial entities

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SANJIV CHOPRA, MD Planner

Dr. Sanjiv Chopra is Professor of Medicine and Faculty Dean for Continuing Medical Education at Harvard Medical School and Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston. In his role as Faculty Dean for Continuing Education, Dr. Chopra provides oversight and leadership of the Department and oversees the academic development of our programs. Dr. Chopra is an experienced clinician, researcher, and educator. In his research roles, he has served both as a principal investigator as well as co-investigator. He has more than 120 publications and five books to his credit, addressing topics in disease states, patient care, and leadership. Dr. Chopra’s teaching experience is extensive, and he has won numerous teaching awards for his work with medical students, residents and physicians. Currently, he directs and speaks at 10 multiday CME courses, nine of which are through HMS. For his full bio, please click here. DISCLOSURE: Reported no relevant financial relationships with commercial entities.

ANDI LONG, EDM Planner

Andi Long directs the Department of Continuing Education’s Distance Learning group, which offers a variety of online continuing medical education programs to health care professionals around the world. Andi develops strategies for new pilot programs and systematically rolls out new distance learning initiatives and has a leadership role in IT planning and other online processes for HMS DCE. She oversees the day-to-day operations of each distance learning activity and ensures ACCME compliance across all enduring programs. She has had the privilege of working with hundreds of Harvard Medical School Faculty members to develop high-quality, engaging online programs that physicians in more than 170 countries have taken part in. Andi earned her Ed.M. in Technology, Innovation, and Education from Harvard Graduate School of Education and graduated from Bridgewater State College, summa cum laude, with a degree in English. Her professional interests focus on teaching and learning with new technologies and online course development. DISCLOSURE: Reported no relevant financial relationships with commercial entities.

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NUMBER OF CREDITS: 2 

The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

Within 2 weeks of completing the course, you will receive your certificate via email.

Click the image to view a sample of the certificate

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