From the Guidelines
The initial workup for anemia should include a complete blood count, absolute reticulocyte count, serum ferritin level, transferrin saturation, and serum vitamin B12 and folate levels, as recommended by the KDIGO guideline 1.
Initial Evaluation
The initial evaluation of anemia should include the following tests:
- Complete blood count, which should include Hb concentration, red cell indices, white blood cell count, and differential and platelet count
- Absolute reticulocyte count
- Serum ferritin level
- Transferrin saturation (TSAT)
- Serum vitamin B12 and folate levels These tests are essential in determining the cause of anemia and guiding further management.
Importance of Iron Studies
Iron studies, including serum ferritin and TSAT, are crucial in evaluating iron deficiency anemia, which is the most common cause of anemia worldwide 1.
Additional Tests
Additional tests, such as stool occult blood testing, may be necessary to evaluate for gastrointestinal blood loss, particularly in older patients or those with iron deficiency anemia 1.
Comprehensive Approach
A comprehensive approach to the initial workup of anemia allows for classification of anemia as microcytic, normocytic, or macrocytic, which narrows the differential diagnosis. The reticulocyte count helps determine if the anemia is due to decreased production or increased destruction of red blood cells. Based on these initial results, more specialized testing such as hemoglobin electrophoresis, bone marrow examination, or genetic testing may be indicated.
From the Research
Initial Workup for Anemia
The initial workup for anemia should include a thorough history and physical examination, as well as laboratory tests to determine the cause of the anemia.
- A complete blood cell count (CBC) is essential in the initial evaluation of anemia, as it provides important clues to the classification and cause of anemia 2.
- The mean corpuscular volume (MCV) is also crucial in the initial workup, as it helps to categorize the anemia as microcytic, macrocytic, or normocytic 3.
- A reticulocyte count is a useful screen for hemolysis or blood loss and should be included in the initial workup 4.
Supplemental Tests
Supplemental tests may be necessary to confirm the diagnosis and determine the underlying cause of the anemia.
- A peripheral blood smear can provide important information about the morphology of the red blood cells 2.
- An iron panel, including ferritin and iron levels, total iron-binding capacity, and transferrin saturation, can help to diagnose iron deficiency anemia 2, 5.
- However, serum iron and total iron-binding capacity (TIBC) may not be necessary if serum ferritin is available, as they do not provide additional information in the diagnosis of iron deficiency anemia 5.
- Levels of vitamin B12, folate, lactate dehydrogenase, haptoglobin, and bilirubin may also be helpful in determining the underlying cause of the anemia 2.