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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

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 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
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. 01/11/2016 www.arupconsult.com

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