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
Normocytic, normochromic Microcytic, hypochromic Macrocytic peripheral smear
(normal MCV, MCHC) (low MCV, MCHC) (high MCV)
(suggests hypoproliferation) (suggests maturation defects) (suggests maturation defects)
Yes
No
(suggests hemolysis)
 Bone marrow disorder  B12 deficiency (rarely
(eg, infiltration, aplasia) folate deficiency) – see
 Inflammation Megaloblastic Anemia
 Iron deficiency Testing Algorithm  Acute blood See the following Consult
 Autoimmune disease  Chronic disease
 Chronic renal disease  Drugs loss topics based on presentation
 Thalassemia – see  Excessive alcohol use  Consider  Hemolytic Anemias
 Critical illness Hemoglobinopathies topic
 Chronic endocrine  Hypothyroidism other workup  Thrombotic
 Sideroblastic anemia  Myelodysplasia – see based on Microangiopathies
disorders  Lead toxicity Myelodysplastic smear  HELLP Syndrome
 Aplastic anemia, pure
red cell aplasia Syndromes Consult topic findings (eg,  Cold Agglutinin Disease
bone marrow  Paroxysmal Nocturnal
biopsy) Hemoglobinuria
 Unstable
ORDER Hemoglobinopathies
Vitamin B12 & Folate  Disseminated
ORDER Intravascular Cogaulation
 Iron and Iron Binding
Capacity
 Ferritin

High TIBC Low/normal TIBC

Low iron Normal/high ferritin
Low ferritin Low/normal iron

Iron deficiency Suggests

 Inflammation Abbreviations and Formula
anemia
 Chronic disease
MCV = mean cell volume
 Thalassemia
MCHC = mean cell hemoglobin concentration
TIBC = total iron binding capacity
 Consider hemoglobin electrophoresis if
suspicious for hemoglobinopathy Reticulocyte correction for anemia:
 Consider peripheral smear, bone marrow
biopsy if no chronic disease present Hgb 1 _
ReticCount% x Htc x Maturation time correction
(use 2% for most patients)

© 2006 ARUP Laboratories. All Rights Reserved. www.arupconsult.com Content reviewed: January 2016 Last updated: March 2018