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


Diagnosis

History: Symptoms depend on the suddenness of onset, severity of the condition, and the 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 to a gastrointestinal cause of the anemia. Individuals with iron deficiency anemia also may complain of a tingling in the arms or legs (paresthesias) 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, the nail beds, and the mucous membranes that line the eye (conjunctiva). The 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. The 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 sudden onset of anemia due to blood loss 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 malignancy or cardiac, liver, kidney, endocrine, and infectious diseases 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 the RBCs (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 RBCs), deformed RBCs (such as the crescent shaped 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 hemoglobin or RBCs in the urine. A test for occult blood may be performed on a stool sample (fecal occult blood test [FOBT]). 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. The 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 RBCs. 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). Levels of methylmalonic acid and homocysteine can confirm B12 deficiency. Disorders of hemoglobin (e.g., thalassemia, sickle cell disease) 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 to detect 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, and liver function tests.

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, magnetic resonance imaging [MRI], computed tomography [CT] scanning), endoscopy, or exploratory surgery.

Source: Medical Disability Advisor