From the Guidelines
To evaluate anemia, I recommend ordering a complete blood count (CBC) with differential, peripheral blood smear, reticulocyte count, iron studies (serum iron, total iron binding capacity, ferritin), and evaluation of red blood cell morphology, as these tests are essential for determining the underlying cause of anemia and guiding appropriate treatment. When evaluating anemia, it is crucial to consider the most recent and highest quality studies, such as the ESPEN micronutrient guideline 1, which recommends a combination of tests including plasma iron, transferrin, transferrin saturation, ferritin, CRP, hepcidin, and evaluation of red blood cell morphology. The British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1 also emphasize the importance of iron studies, including serum ferritin, which is the single most useful marker of iron deficiency anaemia. Key tests for anemia evaluation include:
- Complete blood count (CBC) with differential to confirm anemia and classify it as microcytic, normocytic, or macrocytic
- Peripheral blood smear to reveal morphological abnormalities
- Reticulocyte count to assess bone marrow response to anemia
- Iron studies, including serum iron, total iron binding capacity, and ferritin, to identify iron deficiency
- Evaluation of red blood cell morphology to guide further testing and treatment. These tests provide a comprehensive evaluation to determine the underlying cause of anemia, which is essential for appropriate treatment, as noted in the ESPEN micronutrient guideline 1 and the British Society of Gastroenterology guidelines 1.
From the Research
Labs for Anemia Evaluation
- The initial evaluation of anemia consists of a thorough history and physical examination and a complete blood cell count (CBC) 2.
- Careful examination of the CBC and the mean corpuscular volume provides important clues to the classification and cause of anemia 2.
- Supplemental tests may include:
- Peripheral blood smear
- Reticulocyte count
- Iron panel (ie, ferritin and iron levels, total iron-binding capacity, transferrin saturation)
- Levels of vitamin B12, folate, lactate dehydrogenase, haptoglobin, and bilirubin 2.
- A complete blood count (CBC) gives serious information on changes in the size and shape of RBCs and an indication of inclusion bodies that will help exclude anemia 3.
- RBC indices suggest potential reasons for the anemia in a particular patient 3.
- The diagnostic capabilities of the peripheral blood smear (PBS) procedure are expected to match with RBC histograms and indices in the CBC report for the detection of anemia 3.
- The reticulocyte count serves as a useful screen for hemolysis or blood loss 4.
- Testing for specific causes of the anemia is performed, and occasionally, examination of the bone marrow is required for diagnosis 4.
- Molecular testing is increasingly being used to aid the diagnostic process 4.
- Note that the study on methionine transport in Pseudomonas aeruginosa 5 and the study on speech intelligibility and comprehension in babble noise 6 are not relevant to the evaluation of anemia.