Anemia Testing
Click here for topics associated with this algorithm
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
ORDER
Classify by RBC indices Peripheral smear
Fragmented cells on
Microcytic, hypochromic Macrocytic peripheral smear
Normocytic, normochromic
(low MCV, MCHC) (suggests (high MCV) (suggests
(normal MCV, MCHC)
maturation defects) maturation defects)
(suggests hypoproliferation)
Yes
No (suggests hemolysis)
B12 deficiency, (rarely
Bone marrow disorder folate deficiency) see
(eg, infiltration, aplasia) Megaloblastic Anemia
Inflammation Iron deficiency
Testing Algorithm Acute blood See the following Consult
Autoimmune disease Chronic disease Drugs loss topics based on presentation
Chronic renal disease Thalassemia see Excessive alcohol use Consider Hemolytic Anemias
Critical illness Hemoglobinopathies topic Hypothyroidism other workup Thrombotic
Chronic endocrine Sideroblastic anemia Myelodysplasia see based on Microangiopathies
disorders Lead toxicity Myelodysplastic smear HELLP Syndrome
Aplastic anemia, pure
Syndromes Consult topic findings (eg, Cold Agglutinin Disease
red cell aplasia
bone marrow Paroxysmal Nocturnal
biopsy) Hemoglobinuria
Unstable
ORDER Hemoglobinopathies
ORDER Vitamin B12 & Folate Disseminated
Intravascular Cogaulation
Iron and Iron Binding
Capacity
Ferritin
High TIBC Low/normal TIBC
Low iron Normal/high ferritin
Low ferritin Low/normal iron
Suggests Abbreviations and Formula
Iron deficiency
anemia Inflammation
Chronic disease MCV = mean cell volume
Thalassemia MCHC = mean cell hemoglobin concentration
TIBC = total iron binding capacity
Consider hemoglobin electrophoresis if Reticulocyte correction for anemia:
suspicious for hemoglobinopathy
Consider peripheral smear, bone marrow Hgb 1 _
biopsy if no chronic disease present ReticCount% x Htc x Maturation time correction
(use 2% for most patients)
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