From the Guidelines
Anemia is diagnosed when a person's hemoglobin level falls below the normal range for their age and sex, with criteria including hemoglobin less than 13 g/dL for adult men and less than 12 g/dL for adult non-pregnant women, as defined by the World Health Organization 1. The diagnostic criteria for anemia depend on various factors, including the level of inflammation and the presence of iron deficiency.
- In patients without clinical, endoscopic, or biochemical evidence of active disease, serum ferritin < 30 μg/L is an appropriate criterion for the diagnosis of iron deficiency anemia 1.
- In the presence of inflammation, a serum ferritin up to 100 μg/L may still be consistent with iron deficiency 1.
- The diagnostic criteria for anemia of chronic disease are serum ferritin > 100 μg/L and transferrin saturation < 20% 1.
- If the serum ferritin level is between 30 and 100 μg/L, a combination of true iron deficiency and anemia of chronic disease is likely 1. Additional tests, such as red blood cell count, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC), may be needed to determine the specific cause of anemia 1. It is essential to identify and treat the underlying cause of anemia, as anemia itself is a sign of an underlying condition rather than a disease in itself 1. The most recent and highest quality study, published in 2023, provides the most up-to-date guidance on the diagnosis and management of anemia in patients with inflammatory bowel disease 1.
From the FDA Drug Label
For adult patients with CKD on dialysis: Initiate PROCRIT treatment when the hemoglobin level is less than 10 g/dL. For adult patients with CKD not on dialysis: Consider initiating PROCRIT treatment only when the hemoglobin level is less than 10 g/dL For pediatric patients with CKD: Initiate PROCRIT treatment only when the hemoglobin level is less than 10 g/dL
The criteria for diagnosing anemia is a hemoglobin level of less than 10 g/dL for patients with chronic kidney disease (CKD), according to the provided drug labels 2 and 2.
- Key points:
- Hemoglobin level is the primary criterion for diagnosing anemia in CKD patients.
- The threshold for anemia diagnosis is a hemoglobin level of less than 10 g/dL.
- This criterion applies to adult patients with CKD on dialysis, adult patients with CKD not on dialysis, and pediatric patients with CKD.
From the Research
Criteria for Anemia Diagnosis
The criteria for diagnosing anemia vary based on age, sex, and other factors. According to the World Health Organization (WHO), anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men 3. However, new lower limits of normal Hb values have been proposed, taking into account ethnicity, gender, and age.
Classification of Anemia
Anemia can be classified into three main categories based on the mean corpuscular volume (MCV):
Diagnostic Approaches
The diagnostic approach to anemia involves a stepwise evaluation using readily accessible laboratory tests, including:
- Complete blood count (CBC) with reticulocyte hemoglobin content (CHr) 6
- Serum iron studies
- Lead levels
- Hemoglobin electrophoresis
- Vitamin B12 and folate levels
- Thyroid function testing 4, 5
Special Considerations
In children, anemia is defined as a hemoglobin level of less than the 5th percentile for age, and screening is recommended only for high-risk children 5. In adults, the differential diagnosis of anemia can be substantially narrowed by subcategorization into microcytic, normocytic, and macrocytic subtypes 4. In elderly people, anemia is often multifactorial and may be due to nutritional deficiency, chronic disease, or unexplained causes 3.