Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting symptoms and context
Symptom phenotype
Fatigue
Weakness
Dyspnea
Reduced exercise tolerance
Dizziness
Presyncope
Syncope
Chest pain
Palpitations
OPQRST
Onset
Time course
Abrupt versus gradual
Triggering event
Provocation and palliation
Exertion related
Positional
Relief with rest
Response to fluids
Quality
Lightheadedness
Dyspnea character
Chest discomfort character
Region and radiation
Chest discomfort location
Radiation pattern
Severity
Functional limitation
Near syncope frequency
Syncope duration
Timing
Constant versus intermittent
Progressive versus stable
Nocturnal symptoms
Bleeding history
Overt bleeding
Hematemesis
Melena
Hematochezia
Hematuria
Epistaxis
Heavy uterine bleeding
Occult bleeding signals
Dark stools without visible blood
Unexplained iron deficiency
Unintentional weight loss
Prior baseline and trajectory
Baseline status
Prior hemoglobin if known
Prior iron deficiency history
Baseline exercise tolerance
Course
Prior similar episodes
Recent infections or inflammation
Recent surgeries or procedures
Alarm Features
Immediate life threats
Hemodynamic instability
Systolic blood pressure less than 90 mmHg
Shock index greater than 1
Altered mental status
Cool clammy skin
Active major bleeding
Ongoing hematemesis
Ongoing hematochezia
Postpartum hemorrhage concern
Myocardial ischemia or demand ischemia
Chest pain with ischemic features
New ischemic ECG changes
Rising troponin pattern
High risk neurologic events
Syncope with exertion
Syncope with injury
Focal neurologic deficit
High risk thresholds and escalation triggers
Severe anemia markers
Hemoglobin less than 70 g/L with symptoms
Hemoglobin less than 60 g/L regardless of symptoms
Rapid hemoglobin fall
Decompensation patterns
Persistent tachycardia despite fluids
Hypoxia or increased work of breathing
Heart failure signs
Special populations
Pregnancy with bleeding or syncope
Known coronary artery disease with symptoms
Anticoagulated patient with bleeding concern
Immediate actions
Time critical stabilization
If unstable, resuscitation bay
If active major bleeding, activate massive hemorrhage protocol per local protocol dependent
If ischemic symptoms, ECG within 10 minutes
Medications
Medication reconciliation focus
Bleeding and platelet effect medications
Anticoagulants
Antiplatelets
NSAIDs
Bone marrow suppression and hemolysis triggers
Chemotherapy agents
Antiretrovirals
Trimethoprim sulfamethoxazole
Dapsone
Nitrofurantoin
Nutrient absorption interference
Proton pump inhibitors
Metformin
Bile acid sequestrants
Recent medication changes
New start within 4 weeks
Dose escalation within 4 weeks
Transfusion and reversal relevant
Anticoagulant details
Last dose timing
Indication and thrombosis risk
Transfusion history
Prior reactions
Alloimmunization history
Diet
Intake patterns relevant to anemia
Iron intake pattern
Low meat intake
Vegetarian or vegan diet
Pica
B12 and folate intake pattern
Low animal products
Alcohol use pattern
Malabsorption clues
Chronic diarrhea
Post bariatric surgery diet pattern
Exposure patterns
Alcohol exposure
Heavy use
Recent binge
Toxins and heavy metals
Lead exposure risk
Occupational exposure
Review of Systems
Cardiopulmonary
Perfusion and oxygenation symptoms
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea
Chest pain
Palpitations
Bleeding and hematologic
Bleeding and bruising
Easy bruising
Gum bleeding
Epistaxis
Menorrhagia
Hemolysis symptoms
Dark urine
Jaundice
Back or abdominal pain
Constitutional and malignancy signals
Systemic symptoms
Fever
Night sweats
Weight loss
Infection risk signals
Recurrent infections
Oral ulcers
Gastrointestinal
GI bleeding and inflammation
Melena
Hematochezia
Abdominal pain
Dyspepsia
Change in bowel habits
Neurologic
Hypoperfusion symptoms
Syncope
Presyncope
Headache
B12 related neuro symptoms
Paresthesias
Gait instability
Collateral History and Family History
Collateral source and reliability
Source
Family member
Caregiver
Facility staff
Reliability factors
Baseline cognition
Language barriers
Family and inherited conditions
Hematologic disorders
Thalassemia
Sickle cell disease (D57.0)
G6PD deficiency
Bleeding disorders
von Willebrand disease (D68.0)
Hemophilia (D66)
Early cardiovascular disease
Premature coronary disease
Sudden cardiac death
Exposure and household context
Infectious exposures
Sick contacts
Recent travel
Safety and support
Ability to return if worse
Medication access reliability
Risk Factors
Bleeding risk
GI bleeding risk
Prior peptic ulcer disease
Liver disease and portal hypertension
Prior GI bleed
Gynecologic bleeding risk
Uterine fibroids
Postpartum period
Iatrogenic and procedural risk
Recent surgery
Recent endoscopy with intervention
Production failure risk
Nutritional deficiency risk
Low iron intake
Bariatric surgery
Celiac disease
Bone marrow disorder risk
Prior chemotherapy
Radiation exposure
Unexplained cytopenias
Hemolysis risk
Autoimmune risk
Autoimmune disease history
Lymphoproliferative disease history
Mechanical risk
Prosthetic valve
LVAD
Thrombosis risk if transfusing or treating
Venous thromboembolism risk
Cancer
Recent immobilization
Cardiac risk
Coronary artery disease
Heart failure
Differential Diagnosis
Life threatening
Acute hemorrhage
Upper GI bleed
Lower GI bleed
Ruptured ectopic pregnancy (O00.9)
Trauma related hemorrhage
Retroperitoneal bleed
Hemolytic crisis
Autoimmune hemolytic anemia (D59.1)
G6PD related hemolysis (D55.0)
Thrombotic microangiopathy (D59.3)
Cardiorespiratory decompensation from anemia
Acute coronary syndrome (I21.9)
Acute heart failure (I50.9)
Common
Iron deficiency anemia (D50.9)
Chronic occult GI blood loss
Heavy uterine bleeding
Low dietary intake
Anemia of chronic disease (D63.8)
Chronic infection
Inflammatory disease
Chronic kidney disease (N18.9)
B12 deficiency (D51.9)
Pernicious anemia
Malabsorption
Folate deficiency (D52.9)
Alcohol related
Malnutrition
Less common and mimics
Bone marrow failure
Aplastic anemia (D61.9)
Myelodysplastic syndrome (D46.9)
Hemoglobinopathy
Thalassemia trait (D56.3)
Sickle cell disease (D57.1)
Endocrine and systemic mimics
Hypothyroidism (E03.9)
Depression and sleep disorders
Distinguishing clues
Microcytosis
Iron deficiency pattern
Thalassemia trait pattern
Macrocytosis
B12 or folate deficiency pattern
Liver disease pattern
Hypothyroidism pattern
Hemolysis pattern
Elevated LDH
Low haptoglobin
Indirect hyperbilirubinemia
Past Medical History
Relevant chronic conditions
Cardiopulmonary disease
Coronary artery disease
Heart failure
COPD (J44.9)
Renal and hepatic disease
Chronic kidney disease (N18.9)
Cirrhosis (K74.60)
Malignancy and inflammatory disease
Active cancer
Rheumatologic disease
Prior bleeding and transfusion
Bleeding history
Prior GI bleed
Prior heavy uterine bleeding
Transfusion history
Prior transfusions
Prior transfusion reaction
Procedures and devices
GI procedures
Prior endoscopy findings
Colonoscopy timing
Cardiac devices
Prosthetic valve
LVAD
Baseline function
Functional baseline
Usual activity tolerance
Baseline dyspnea level
Physical Exam
General and vital sign patterns
General appearance
Pallor
Toxic appearance
Work of breathing
Vital sign interpretation
Orthostatic changes
Persistent tachycardia
Fever
Hemodynamic and volume status
Perfusion exam
Capillary refill
Skin temperature
Mental status
Volume assessment
Dry mucous membranes
Jugular venous pressure
Cardiopulmonary
Cardiac exam
Flow murmur
Signs of heart failure
Lung exam
Crackles
Wheeze
Abdominal and GI bleed exam
Abdominal exam
Tenderness
Hepatosplenomegaly
Rectal exam when indicated
Melena
Hematochezia
Skin and hematologic stigmata
Skin findings
Petechiae
Purpura
Ecchymoses
Hemolysis clues
Jaundice
Dark urine report correlation
Neuro
Neurologic screening
Gait assessment
Proprioception
Cognitive changes
Lab Studies
Core labs and transfusion readiness
CBC with indices
Hemoglobin and hematocrit
MCV
RDW
Platelets and WBC
Type and screen
Crossmatch if transfusion likely
Antibody screen implications
Basic metabolic panel
Creatinine and urea
Electrolytes in mmol/L
Etiology focused labs
Reticulocyte count
Low retic suggests underproduction
High retic suggests hemolysis or blood loss
Peripheral smear
Schistocytes
Spherocytes
Target cells
Hypersegmented neutrophils
Iron studies
Ferritin
Transferrin saturation
Serum iron
TIBC
B12 and folate
Serum B12
Folate
Hemolysis panel
LDH
Haptoglobin
Total bilirubin
Direct antiglobulin test
Bleeding evaluation labs
Coagulation tests
INR
aPTT
Pregnancy test when applicable
Urine hCG
Serum hCG if high suspicion
Stool testing when indicated
Fecal occult blood test limitations
Do not use to rule out GI bleeding
Cardiac and respiratory labs when indicated
Troponin testing
Symptoms consistent with ischemia
Demand ischemia risk with severe anemia
Venous blood gas when unstable
Lactate in mmol/L
pH and pCO2 in mmHg
Imaging
Scoring Systems
Upper GI bleed risk tools
Glasgow Blatchford Score
Low risk supports outpatient pathway if stable and reliable local protocol dependent
Not for massive hemorrhage or shock
Upper GI bleed inpatient risk tools
Rockall score
Post endoscopy application
Limitations in pre endoscopy decisions
MRI
Limited routine role for isolated anemia
Spinal cord compression concern with malignancy
Neurologic deficits with B12 deficiency evaluation adjunct
Safety
Implanted device compatibility
Claustrophobia management considerations
CT
Bleeding source localization
CT angiography for brisk GI bleeding when unstable and endoscopy not immediately feasible local protocol dependent
Contrast nephropathy risk assessment
Malignancy evaluation when indicated
CT abdomen pelvis for weight loss or mass concern
CT chest for malignancy staging if known cancer
Ultrasound
Pregnancy related bleeding
Transvaginal ultrasound for ectopic concern
Free fluid assessment if unstable
POCUS for shock phenotype
Cardiac function and pericardial effusion
IVC assessment limitations
Abdominal free fluid screening
Special Tests
Bedside and procedural tests
Orthostatic vitals when safe
Heart rate rise suggests hypovolemia
Symptom provocation supports perfusion limitation
Rectal exam when indicated
Gross blood assessment
Melena assessment
Pelvic exam when indicated
Cervical or vaginal bleeding source
Products of conception concern
Hematology specific tests
Direct antiglobulin test
Supports autoimmune hemolysis when positive
False negatives possible with low antibody burden
Hemoglobin electrophoresis
Microcytosis with normal ferritin
Family history of hemoglobinopathy
Bone marrow evaluation coordination
Pancytopenia or blasts on smear
Suspected marrow failure syndrome
ECG
When to perform ECG and what to look for
Indications
Chest pain
Dyspnea with risk factors
Syncope
Persistent tachycardia
High risk patterns
ST elevation or depression
New T wave inversion
New bundle branch block
Sustained ventricular arrhythmia
Serial ECG logic
Ongoing symptoms
Repeat ECG within 15 to 30 minutes if ongoing chest pain
Repeat ECG after transfusion if ischemic symptoms present
Rate related changes
Treat anemia and reassess tachycardia
Consider alternate causes if tachycardia persists
Assessment
Problem representation and severity
Symptomatic anemia
Severity by hemoglobin level
Severity by hemodynamic status
Symptom burden at rest versus exertion
Suspected etiology category
Blood loss
Underproduction
Hemolysis
Risk stratification
High risk features
Ongoing bleeding
Hemodynamic instability
Ischemic symptoms or ECG changes
Special populations risk
Pregnancy
Coronary artery disease
Heart failure
Chronic kidney disease
Key supporting data
Labs and trends
Hemoglobin trend if available
MCV category
Reticulocyte response
Hemolysis markers
Exam correlates
Orthostatic intolerance
Signs of active bleeding
Signs of heart failure
Plan
Approach to the critical patient first 5 minutes
Stabilization priorities
Cardiac monitor
Pulse oximetry
Frequent blood pressure cycling
Two large bore IVs if unstable or active bleeding
Oxygen if hypoxic or respiratory distress
Immediate tests and targets
CBC and type and screen within 30 minutes if transfusion possible
ECG within 10 minutes if chest pain or syncope
Point of care glucose if altered mental status
Early activation triggers
If shock, activate massive hemorrhage protocol per local protocol dependent
If suspected ectopic pregnancy with instability, immediate OB GYN involvement
If ischemia, cardiology pathway per local protocol dependent
Transfusion strategy and thresholds
RBC transfusion indications
Hemoglobin less than 70 g/L in stable adults suggests transfusion threshold in many restrictive strategies local protocol dependent
Higher threshold may be appropriate with active ischemia or ongoing bleeding local protocol dependent
Transfusion dosing and monitoring
1 unit PRBC then reassess symptoms and vitals
Recheck hemoglobin after 1 to 2 units or sooner if ongoing bleeding
Monitor for transfusion reaction
Transfusion cautions
Heart failure risk for TACO
Hypocalcemia risk with massive transfusion
Hyperkalemia risk with older blood or massive transfusion
Etiology directed treatment
Suspected GI bleeding
IV crystalloid only as bridge to blood products in hemorrhagic shock
PPI therapy when upper GI bleed suspected local protocol dependent
GI consultation for endoscopy timing local protocol dependent
Suspected heavy uterine bleeding
Tranexamic acid dosing per local protocol dependent
Gynecology consultation triggers
Suspected hemolysis
If autoimmune hemolysis suspected, hematology consultation
If thrombotic microangiopathy suspected, urgent specialty escalation
Iron deficiency without instability
Oral iron as outpatient when stable and cause addressed local protocol dependent
IV iron consideration when malabsorption or intolerance local protocol dependent
Diagnostic sequencing
Underproduction workup when indicated
Reticulocyte count interpretation branch
Smear review for blasts
Consider marrow evaluation if pancytopenia or blasts
Blood loss workup when indicated
Identify overt bleeding source
Imaging or endoscopy pathway per stability and local protocol dependent
Reassessment loop
Timed reassessment
Repeat vitals every 15 to 30 minutes if moderate to severe symptoms
Repeat symptom check after each unit transfused
Repeat exam for new bleeding
Disposition changing findings
New chest pain
New hypoxia
Persistent tachycardia despite transfusion and fluids
Disposition
Level of care criteria
ICU or resuscitation level care
Ongoing hemodynamic instability
Massive transfusion requirement
Active myocardial ischemia with instability
Severe respiratory distress or hypoxia
Inpatient admission
Suspected GI bleed requiring inpatient endoscopy
Hemolysis requiring urgent treatment
Symptomatic anemia requiring transfusion and monitoring
New pancytopenia or blasts
Observation pathway
Stable vitals after limited transfusion
Etiology evaluation pending but low immediate risk
Discharge criteria
Clinical stability
Stable vitals without orthostatic symptoms
No ongoing bleeding
Symptoms improved to baseline function
Diagnostic clarity and follow up
Etiology plan established
Follow up arranged within 72 hours to 2 weeks based on severity
Reliability
Able to return if worse
Access to medications and labs
Discharge Instructions
Copy discharge instructions
Summary
You were seen for symptoms related to low blood count called anemia
Your testing today did not show signs of life threatening instability at this time
Medications
Take iron only if prescribed
Avoid NSAIDs unless your clinician says it is safe
Activity
Avoid heavy exertion until cleared
Rise slowly from sitting or lying to reduce dizziness
Follow up
Follow up with your primary care clinician within the recommended timeframe
Complete repeat blood work as arranged
Additional testing may be needed to find the cause of anemia
Return to emergency department now if
Fainting
Chest pain
Trouble breathing at rest
Black stools or red blood in stools
Vomiting blood
Heavy vaginal bleeding
New severe weakness or confusion
References
Guidelines and key sources
RBC transfusion thresholds and strategy
AABB clinical practice guideline for red blood cell transfusion 2016
Restrictive transfusion strategy evidence summary and limitations
Iron deficiency anemia evaluation
British Society of Gastroenterology guideline on iron deficiency anemia in adults 2021
GI malignancy evaluation considerations
Upper GI bleeding management
American College of Gastroenterology guideline for upper GI and ulcer bleeding 2021
Risk stratification tool context
Hemolysis and autoimmune hemolytic anemia
British Society for Haematology guideline on autoimmune hemolytic anemia 2017
Escalation triggers for thrombotic microangiopathy
WHO anemia definitions
World Health Organization hemoglobin thresholds 2011
Population level definitions and limitations for acute care
Project instructions source file
Formatting and structure requirements
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.