From the Guidelines
The initial workup for anemia should include a complete blood count (CBC) with differential, peripheral blood smear, reticulocyte count, iron studies (serum iron, total iron binding capacity, ferritin), vitamin B12, folate levels, and a comprehensive metabolic panel, as recommended by the most recent guidelines 1. The workup should start with a thorough history and physical examination focusing on symptoms like fatigue, shortness of breath, and signs of bleeding.
- For iron deficiency anemia, prescribe ferrous sulfate 325 mg orally three times daily with vitamin C to enhance absorption, taken between meals.
- For B12 deficiency, administer cyanocobalamin 1000 mcg daily orally for 7 days, then weekly until resolution, followed by monthly maintenance.
- Folate deficiency requires folic acid 1 mg daily orally. If hemolytic anemia is suspected, order Coombs test, haptoglobin, LDH, and bilirubin levels.
- For suspected blood loss, perform stool occult blood testing and consider endoscopy or colonoscopy. Severe anemia (hemoglobin <7 g/dL) with symptoms may require blood transfusion, as indicated by the severity of the condition and the patient's clinical presentation 1. The workup should be tailored to the patient's age, gender, and clinical presentation, as anemia in a premenopausal woman might suggest menstrual blood loss, while in an elderly patient might indicate gastrointestinal malignancy. In patients with chronic kidney disease (CKD), the investigation and management of anemia are complex and require consultation with specific guidelines relevant to UK practice published by NICE and the Renal association 1.
- Assessment of iron deficiency in CKD can be difficult, and measurement of ferritin and transferrin saturation may be helpful, but the interpretation of results is not the same as in patients who do not have CKD.
- Patients with CKD may of course also have GI pathology underlying their confirmed iron deficiency, and the decision about the need for endoscopic evaluation of the upper and lower GI tract in CKD should be made in conjunction with a nephrologist.
From the FDA Drug Label
Correct or exclude other causes of anemia (e. g., vitamin deficiency, metabolic or chronic inflammatory conditions, bleeding, etc.) before initiating RETACRIT. The anemia workup should correct or exclude other causes of anemia before initiating epoetin alfa, such as:
- Vitamin deficiency
- Metabolic conditions
- Chronic inflammatory conditions
- Bleeding 2
From the Research
Anemia Workup Approach
The approach to anemia workup involves a logical clinical and laboratory evaluation [ 3 ].
- The complete blood count (CBC) with red cell indices is a crucial initial step, as it provides clues to the diagnosis of anemia [ 3 ].
- Red cell morphology can also be characteristic of many anemias, aiding in the diagnostic process [ 3 ].
Diagnostic Tests
Several diagnostic tests are utilized in the workup of anemia, including:
- Reticulocyte count, which serves as a useful screen for hemolysis or blood loss [ 3 ].
- Testing for specific causes of anemia, which is performed to determine the underlying etiology [ 3 ].
- Bone marrow examination, which is occasionally required for diagnosis [ 3 ].
- Molecular testing, which is increasingly being used to aid in the diagnostic process [ 3 ].