Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Anemia


Related Terms

  • Aplastic Anemia
  • Cooley Anemia
  • Essential Anemia
  • Fanconi Anemia
  • Hemolytic Anemia
  • Hereditary Spherocytosis
  • Idiopathic Anemia
  • Iron Deficiency Anemia
  • Megaloblastic Anemia
  • Pernicious Anemia
  • Profound Anemia
  • Sickle Cell Anemia
  • Sideroblastic Anemia
  • Spur Cell Anemia
  • Thalassemia Alpha
  • Thalassemia Beta

Differential Diagnosis

  • Cancer
  • Heart failure

Specialists

  • Emergency Medicine Physician
  • Family Physician
  • General Surgeon
  • Hematologist
  • Internal Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Length of disability will be influenced by the type of anemia, rapidity of onset, severity of symptoms, the individual's age, health status, alcohol or illicit substance use, method of treatment, and individual's compliance with and response to treatment.

Medical Codes

ICD-9-CM:
280.0 - Iron Deficiency Anemia Secondary to Blood Loss (Chronic); Normocytic Anemia Due to Blood Loss
280.1 - Iron Deficiency Anemia Secondary to Inadequate Dietary Iron Intake
280.8 - Iron Deficiency Anemias, Other Specified; Paterson-Kelly Syndrome; Plummer-Vinson Syndrome; Sideropenic Dysphagia
280.9 - Iron Deficiency Anemia, Unspecified; Anemia, Achlorhydric, Chlorotic, Idiopathic hypochromic, Iron Deficiency NOS
281.0 - Pernicious Anemia; Anemia, Addisons, Biermers, Congenital Pernicious, Congenital Pernicious
281.1 - Vitamin B12 Deficiency Anemia, Other; Anemia, Vegans, Vitamin B12 Deficiency (Dietary), Due to Selective vitamin B12 Malabsorption with Proteinuria; Syndrome, Imerslunds, Imerslund-Gräsbeck
281.2 - Folate-deficiency Anemia; Congenital Folate Malabsorption; Folate or Folic Acid Deficiency Anemia: NOS, Dietary, Drug-induced; Goats Milk Anemia; Nutritional Megaloblastic Anemia (of Infancy)
281.3 - Megaloblastic Anemias, Not Elsewhere Classified, Other Specified; Combined B12 and Folate-deficiency Anemia; Refractory Megaloblastic Anemia
281.4 - Protein-deficiency Anemia; Amino-Acid-Deficiency Anemia
281.8 - Anemia Associated with Other Specified Nutritional Deficiency; Scorbutic Anemia
281.9 - Deficiency Anemia, , Unspecified; Dimorphic, Macrocytic, Megaloblastic NOS, Nutritional NOS, Simple Chronic
282.0 - Hereditary Spherocytosis; Acholuric (Familial) Jaundice; Congenital Hemolytic Anemia (Spherocytic); Congenital Spherocytosis; Minkowski-Chauffard Syndrome; Spherocytosis (Familial)
282.3 - Hemolytic Anemias Due to Enzyme Deficiency, Other; Hemolytic Nonspherocytic (Hereditary), Type II, Hexokinase Deficiency, Pyruvate Kinase [PK] Deficiency, Triosephosphate Isomerase Deficiency
282.40 - Thalassemia, Unspecified
282.41 - Sickle-cell Thalassemia without Crisis; Microdrepanocytosis; Sickle-cell Thalassemia NOS; Thalassemia Hb-S Disease without Crisis
282.42 - Sickle-cell Thalassemia with Crisis; Sickle-cell Thalassemia with Vaso-occlusive Pain; Thalassemia Hb-S Disease with Crisis
282.43 - Alpha Thalassemia
282.44 - Beta Thalassemia
285.1 - Anemia, Posthemorrhagic, Acute; Anemia Due to Acute Blood Loss
285.9 - Anemia, Unspecified, NOS, Essential, Normocytic, Not Due to Blood Loss, Profound, Progressive, Secondary
776.5 - Congenital Anemia

Diagnosis

History: Symptoms depend on the suddenness of onset, severity of the condition, and individual's age and general state of health. Mild anemia and anemia with a gradual onset often cause no symptoms and are not always investigated. Sudden loss of blood (hemorrhage) resulting in rapid onset of anemia produces immediate, dramatic symptoms such as a significant drop in blood pressure and oxygen levels or unconsciousness (hypovolemic shock). In this case, no prior symptoms will likely be reported unless the individual was aware of a sudden, significant nosebleed, injury, hemorrhage from mouth or rectum, or vaginal bleeding. Symptoms develop slowly in other forms of anemia.

General symptoms of anemia include fatigue, weight loss, headache, ringing in the ears (tinnitus), inability to concentrate, heart palpitations, and light-headedness when standing up. Some individuals may have abdominal discomfort, loss of appetite, nausea, diarrhea, or constipation, related with the primary cause of the anemia. Individuals with iron-deficiency anemia also may complain of a tingling in the arms or legs (paresthesia) and a burning sensation of the tongue. In severe anemia, exertion may cause breathing difficulties, dizziness, and chest pain.

Pregnancy and abortion history should be obtained for women of childbearing age or older.

It is important to inquire about a family history of anemia, abnormal hemoglobin levels, bleeding disorders, splenectomy, or transfusions. A record of prior blood studies may be helpful, as may a history of transfusions or prior treatment for nutritional deficiencies. Dietary history of foods consumed regularly and those avoided may be obtained. Rejection of the individual as a blood donor may also provide useful information.

Physical exam: Physical findings may include paleness (pallor) of the skin, creases in the palm of the hand, and the mucous membrane that lines the eye (conjunctiva). Heart rate may be increased (tachycardia), and blood pressure may be low when standing up (orthostatic hypotension). If anemia is severe, a heart murmur may be detected. Breathing rate also may be increased (tachypnea). The liver or spleen may be enlarged (hepatomegaly or splenomegaly). In individuals with pernicious anemia, nerve function may be impaired (peripheral neuritis, neuropathy).

Psychiatric symptoms, such as depression or confusion, also may be present. Individuals with anemia due to chronic disease may have evidence of infection, inflammation, or abnormal tissue growth. Iron-deficiency anemia may cause inflammation of the lips (cheilitis) or tongue (glossitis). Fingernails may be fragile or spoon-shaped (koilonychia). Individuals with severe anemia often have decreased urinary output.

Weight loss may indicate wasting due to metabolic or infectious diseases or malignancy. A complete physical exam may be done to rule out or include underlying cardiac, liver, kidney, endocrine, and infectious diseases, or malignancy, as a possible cause of anemia.

Tests: A complete blood count (CBC) may reveal a low number of RBCs. A reduced average size of red cells (mean corpuscular volume [MCV]) and reduced amount of hemoglobin within RBC (mean corpuscular hemoglobin [MCH]) may be noted. Microscopic examination of a blood smear may reveal reduced or enlarged size of red cells (microcytic or macrocytic RBC), deformed RBC (such as the elongated sickle cell), or RBC fragments (schistocytes). Other findings may include low hemoglobin concentration and/or a low hematocrit. CBC results and information related to the size and appearance of the RBCs provide clues as to the cause of anemia and what tests to perform next. Special hematology tests or consultation with a hematologist may be needed to confirm diagnosis of a specific type of anemia.

Urinalysis may reveal the presence of RBCs in urine, and a test for occult blood may be performed on a stool sample. These tests may indicate chronic gastrointestinal bleeding or another possible bleeding site (e.g., rectal bleeding due to hemorrhoids). Urine of an abnormal color may suggest hemolytic anemia, kidney disease, or liver disease. Stool may be examined for color, bulk, odor, and density, which can point to malabsorption of nutrients.

A reticulocyte count helps differentiate anemia caused by decreased RBC production from that caused by blood loss or increased RBC destruction. Reticulocytes are immature RBCs, newly released from the bone marrow. A normal number of reticulocytes in the blood indicates that the bone marrow is appropriately producing RBCs. A low number of reticulocytes indicates that the anemia may be due to a problem in the bone marrow.

An indirect bilirubin test may help to confirm hemolysis indicative of hemolytic anemia and increased destruction of RBC. Individuals whose reticulocyte count is reduced and whose indirect bilirubin is elevated have a hemolytic disorder. A direct Coombs test also may be positive in acquired hemolytic anemia, underlying autoimmune lupus erythematosus, or certain viral infections (e.g., hepatitis, infectious mononucleosis).

Tests for iron include ferritin, serum iron, and total iron-binding capacity (TIBC). These tests differentiate iron-deficiency anemia from other types of anemia involving iron, such as sideroblastic anemia and anemia due to chronic disease.

Blood tests for folate and vitamin B12 differentiate between folate-deficiency anemia and vitamin B12 deficiency anemia (pernicious anemia). In some cases, a Schilling's test is needed to further study vitamin B12 deficiency. Levels of methylmalonic acid and homocysteine can confirm B12 deficiency. Disorders of hemoglobin (e.g., thalassemia, sickle cell anemia) can be confirmed with hemoglobin electrophoresis. This blood test identifies and measures abnormal forms of hemoglobin.

Sometimes a nutritional deficiency that results in anemia can be diagnosed by a therapeutic trial. Iron replacement therapy is given for a suspected case of iron-deficiency anemia. Vitamin B12 is given to detect vitamin B12 deficiency, and folate for folate-deficiency anemia. The diagnosis is made if improvement is seen after therapy.

If the individual's symptoms and initial test results are indicative of a serious form of anemia, a bone marrow aspiration or biopsy, where a sample of bone marrow is removed for microscopic examination, may be necessary to see whether normal RBCs are being produced at a normal rate. In rare equivocal cases, bone marrow examination may also be necessary to confirm iron-deficiency anemia or megaloblastic changes caused by folate or vitamin B12 deficiency.

Other potential underlying causes can be ruled out by additional tests, such as kidney function tests, blood coagulation tests, liver function tests, and fecal occult blood.

If acute or chronic bleeding is suspected as a cause of the anemia, a search for the site of bleeding is indicated. This may require imaging studies (x-ray, MRI, CT scanning), endoscopy, or exploratory surgery.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.