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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

Normocytic, normochromic Microcytic, hypochromic Macrocytic Yes


(normal MCV, MCHC) (low MCV, MCHC) (high MCV) No
(suggests hemolysis)
(suggests hypoproliferation) (suggests maturation defects) (suggests maturation defects)

B12 deficiency, (less Suggests Metabolic defect (see PNH


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

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

Abbreviations and Formula

Suggests Bone marrow MCV = mean cell volume


Iron deficiency
Inflammation biopsy may be MCHC = mean cell hemoglobin concentration
anemia
Chronic disease necessary TIBC = total iron binding capacity
Thalassemia
Reticulocyte correction for anemia:

If no obvious chronic disease present, Hgb 1 _


consider bone marrow biopsy; for ReticCount% x Htc x Maturation time correction
Thalassemia suspicion, consider (use 2% for most patients)
hemoglobin electrophoresis

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