Anemia Testing

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INDICATIONS FOR TESTING

Fatigue, weakness, pallor, dizziness, fainting

ORDER
CBC with Platelet Count and Automated
Differential (including RBC indices and
morphology on manual differential)
Reticulocytes, Percent & Number

Anemia present on CBC (males Hgb <13g/dL,

females Hgb <12g/dL)
AND
Corrected reticulocyte index ≥2.5

No Yes

Classify by RBC indices Fragmented cells on

peripheral smear

No Yes
Normocytic, normochromic Microcytic, hypochromic Macrocytic
(normal MCV, MCHC) (low MCV, MCHC) (high MCV)
(suggests hypoproliferation) (suggests maturation defects) (suggests maturation defects)

Suspect Suggests hemolytic process:

hemorrhage Metabolic defect (see PNH
Bone marrow disorder Folate, B12 deficiency and acute Consult topic)
(infiltration, aplasia) (see Megaloblastic blood loss Hemoglobinopathies (eg,
Inflammation Anemia Testing sickle cell) (see Hemolytic
Iron deficiency Algorithm)
Autoimmune disease Anemias Testing Algorithm)
Chronic disease Drug effect
Chronic renal disease Autoimmune destruction
Thalassemia (see Excessive alcohol use
Critical illness Splenic sequestration
Hemoglobinopathies Hypothyroidism
Chronic endocrine RBC membrane defect (see
topic) Myelodysplasia (see
disorders Hemolytic Anemias Consult
Sideroblastic anemia Myelodysplastic
Aplastic anemia, pure topic)
Lead toxicity Syndromes Consult topic)
red cell aplasia Intravascular hemolysis (see
Hemolytic Anemias Consult
topic)
Abnormal peripheral smear

ORDER No
Iron and Iron Binding
No Yes
Capacity
Ferritin
Vitamin
B12 &
Folate
Low/normal TIBC High TIBC Workup based on
Normal/high ferritin Low iron smear
Low/normal iron Low ferritin characteristics

Abbreviations and Formula

Suggests: Iron deficiency Bone marrow MCV = mean cell volume

Inflammation anemia biopsy may be MCHC = mean cell hemoglobin concentration
Chronic disease necessary TIBC = total iron binding capacity

Reticulocyte correction for anemia:

If no obvious chronic
disease present, Hgb 1 _
consider bone marrow ReticCount% x Htc x Maturation time correction
biopsy (use 2 for most patients)

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