From the Guidelines
In the workup of anemia in a young male, I recommend starting with a complete blood count (CBC) with differential, peripheral blood smear, reticulocyte count, iron studies (including ferritin, iron, TIBC), vitamin B12, folate levels, and hemoglobin electrophoresis, as this approach allows for the identification of the underlying cause of anemia and guides specific treatment. The initial evaluation should include assessment of the patient's medical history, physical examination, and laboratory tests to determine the severity and type of anemia. According to the study by 1, a minimum workup should include complete blood count with MCV, reticulocytes, serum ferritin, transferrin saturation, and CRP, which helps to distinguish between iron deficiency anemia and anemia of chronic disease. Common causes of anemia in young males include iron deficiency (often due to gastrointestinal blood loss), hemoglobinopathies (like thalassemia or sickle cell disease), and hemolytic anemias. If iron deficiency is identified, endoscopy and colonoscopy should be considered to identify potential bleeding sources, as iron deficiency may be caused by continuous blood loss from the ulcerated surface of the bowel, malnutrition with reduced iron intake, or impaired iron uptake through the duodeno-jejunal mucosa, as mentioned in the study by 1. For hemolytic anemia, additional tests like direct Coombs test, haptoglobin, LDH, and bilirubin are necessary, as indicated in the study by 1. Treatment depends on the underlying cause - iron deficiency requires iron supplementation (typically ferrous sulfate 325mg three times daily for 3-6 months) and addressing the cause of blood loss; B12 deficiency requires supplementation (1000mcg daily initially); while hemoglobinopathies may need specialist hematology input. The study by 1 suggests that if after 4 weeks the anemia does not respond to iron treatment despite compliance with the iron supplementation regimen and the absence of acute illness, further evaluate the anemia by using other laboratory tests, including MCV, RDW, and serum ferritin concentration. Key points to consider in the workup of anemia in young males include:
- Initial laboratory tests: CBC with differential, peripheral blood smear, reticulocyte count, iron studies, vitamin B12, folate levels, and hemoglobin electrophoresis
- Assessment of renal function, liver function, and inflammatory markers
- Consideration of endoscopy and colonoscopy if iron deficiency is identified
- Additional testing for hemolytic anemia, such as direct Coombs test, haptoglobin, LDH, and bilirubin
- Treatment guided by the underlying cause of anemia.
From the Research
Anaemia in Young Male Workup
- Anaemia is a common condition that can be caused by various factors, including nutritional deficiencies, genetic disorders, and chronic diseases 2, 3.
- The initial evaluation of anaemia consists of a thorough history and physical examination, as well as a complete blood cell count (CBC) 3.
- The CBC can provide important clues to the classification and cause of anaemia, and supplemental tests may include a peripheral blood smear, reticulocyte count, iron panel, and levels of vitamin B12 and folate 3.
- In young males, iron deficiency anaemia is a common cause of anaemia, and the diagnosis can be made by measuring serum iron, ferritin, and total iron-binding capacity 4, 5.
- Vitamin B12 deficiency can also cause anaemia, and the diagnosis can be made by measuring serum vitamin B12 levels and methylmalonic acid 5, 6.
- A diagnostic approach using a model based on age and homocysteine assessment can be useful in differentiating iron deficiency anaemia from combined deficiency of iron and vitamin B12 5.
- The treatment of anaemia depends on the underlying cause, and may include oral iron supplementation, vitamin B12 supplements, and other medications 4, 6.
Diagnostic Tests
- Complete blood cell count (CBC) is the first-line laboratory test for diagnosing anaemia 2, 3.
- Peripheral blood smear can help diagnose anaemia and other blood disorders 3.
- Reticulocyte count can help differentiate between different types of anaemia 3, 4.
- Iron panel, including serum iron, ferritin, and total iron-binding capacity, can help diagnose iron deficiency anaemia 3, 4.
- Vitamin B12 levels and methylmalonic acid can help diagnose vitamin B12 deficiency 5, 6.