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

ORDER no
Iron and Iron Binding
no yes
Capacity
Ferritin
B12, folate
studies
Low/normal TIBC
High TIBC Workup based on
Normal/high ferritin
Low/normal iron Low iron smear
Low ferritin characteristics

Abbreviations and Formula

Suggests: Bone marrow MCV = mean cell volume

Inflammation Iron deficiency 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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