Key Point

• Iron deficiency anemia is more prevalent in children, women, and older adults.

Family physicians develop communication styles and relationships with patients and families that facilitate the physician's ability to define and prioritize patient problems, develop diagnostic and treatment plans for more common problems, and coordinate patients' care of less common problems with the rest of the health care system. Recognizing this primary function, the family physician needs to know how to diagnose a variety of conditions, understand their pathophysiology, know when and how to treat more common disorders, and know how to diagnose and refer more unusual disorders. This chapter organizes the subject of hematology by cellular, elemental, and functional categories; delineates the pathophysiology of hematologic disorders; and discusses the recognition, diagnostic criteria, and treatment of disorders more likely to be seen in family medicine.

Hematology is the study of the cellular elements of the blood—their origins, functions, and disorders. The frequency with which these disorders are discovered and treated in primary care varies with the population being served. The National Ambulatory Medical Care Survey of the 15 to 20 major diagnostic clusters seen in primary care practice by age group mentions only "anemia" in the cluster table of visits made by patients age 75 years and older (Woodwell and Cherry, 2004). In the National Health and

Nutrition Examination Survey (NHANES 1999-2000), the prevalence of iron deficiency anemia was 7% in 1- to 2-year-old and 12% in 12- to 49-year-old females, versus 3% to 5% in 12- to 60-year-old males (NCHS, 2005a). This remains largely unchanged. In a practice largely populated by younger African American patients, predominantly women of child-bearing age, the prevalence of sickle cell anemia and iron deficiency anemia would be greater than in more heterogeneous populations. Disorders of white blood cells, such as neutropenia and leukemia, are encountered infrequently in most primary care practices. Nonetheless, understanding the presentation of uncommon disorders and their pathophysi-ology, diagnostic criteria, and treatment principles is imperative for a competent family physician.

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