4-9
in the field environment.
Subjective: Symptoms
Acute: Lightheadedness, pallor, shock, syncope, altered mental status.
Chronic: Lethargy, fatigue and decreased energy, rapid heartbeat and shortness of breath/dyspnea with
exertion.
Objective: Signs
Using Basic Tools: Acute: shock, hypotension, weak pulse, syncope, altered mental status. Chronic
(compensated for intravascular volume loss): pale skin, mucous membranes (eyelids, under the tongue), nail
beds and palm creases (compare color of normal palmar crease to patient’s).
Using Advanced Tools: Lab: spun hematocrit or hemoglobin; stool for occult blood; peripheral smear (see
Laboratory Procedures Chapter)
Assessment:
Differential Diagnosis: (see Color Plates: Identification of Cellular Blood Components):
Elevated total white blood cell (WBC) count with great preponderance of polymorphonuclear leukocytes
(PMNs), along with fever and chills, suggests a bacterial infection.
Significantly low lymphocytes suggest viral infection, including HIV and others.
Increased eosinophils suggest either infection (parasites, especially visceral larval migrans, or chlamydia),
hypersensitivity or allergic reactions.
Increased basophils are so unusual as to suggest a problem with the stain or staining procedure.
Macrocytosis suggests folic acid or B12 deficiency.
Microcytosis suggests iron deficiency or thalassemia.
Aniso, Poikilocytosis and target cells suggest thalassemia.
Banana or “sickle” shaped cells suggests one of the sickle cell conditions.
*NOTE: Confirmatory testing for these anemias is beyond the scope of the SOF medic. Unusual hemoglobins
or hemoglobin levels may be common within certain ethnic groups. Attempting to correct these presumed
anemias is inappropriate.
Plan:
Treatment
- Iron supplementation is appropriate only for menstruating females and patients whose stool is positive for
occult blood, pending further evaluation. - Iron supplementation is not otherwise appropriate without laboratory determination of iron deficiency.
- Correct obvious nutritional deficiencies and treat infections or inflammation.
- Blood replacement in the face of rapid loss is addressed in Procedure: Field Transfusion*.
- Treat acute sickle crisis with:
a. Fluids - orally if possible and IV if needed--3-4 liters/day in adults;
b. Liberal use of medications for pain (Selection of medications is determined by the severity of the pain.
Non-steroidal anti-inflammatory drugs like ibuprofen, acetaminophen with codeine, or intravenous
morphine are appropriate for mild, moderate and severe pain, respectively, and should be continued
until pain levels decrease.)
c. Treatment of predisposing conditions, such as infections.
d. Steroids and antibiotics are not routinely indicated.
*NOTE: No non-US sources of blood can be trusted for accuracy of blood types, freedom from infection, or
deterioration from improper storage. US Embassies can often provide information on where the safest blood
products may be obtained within a specific country or region, but use of these products always entails an