From the Guidelines
An anemia panel 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 sometimes hemoglobin electrophoresis to diagnose and determine the cause of anemia. The standard approach to evaluating anemia is through morphologic and kinetic methods, which help characterize the anemia based on the mean corpuscular volume (MCV) and the reticulocyte count, respectively 1. The morphologic approach categorizes anemia into microcytic, normocytic, and macrocytic, while the kinetic approach focuses on the underlying mechanism of anemia, distinguishing among production, destruction, and loss of red blood cells.
Key Components of an Anemia Panel
- Complete blood count (CBC) with differential to assess red blood cell size and hemoglobin content
- Peripheral blood smear to evaluate red blood cell morphology
- Reticulocyte count to assess bone marrow response to anemia
- Iron studies, including serum iron, total iron binding capacity, and ferritin, to identify iron deficiency
- Vitamin B12 and folate levels to detect nutritional deficiencies
- Sometimes, hemoglobin electrophoresis to diagnose hemoglobinopathies
According to the British Society of Gastroenterology guidelines, iron deficiency should be confirmed by iron studies prior to investigation, with serum ferritin being the single most useful marker of iron deficiency anemia 1. A good response to iron therapy, defined as a hemoglobin rise of ≥10 g/L within a 2-week timeframe, is highly suggestive of absolute iron deficiency, even if the results of iron studies are equivocal 1.
Additional Tests
- Tests for hemolysis, such as haptoglobin, LDH, and bilirubin, may be included based on clinical suspicion
- Kidney function tests, such as glomerular filtration rate, to evaluate for anemia of chronic kidney disease
- Inflammatory markers, such as erythrocyte sedimentation rate or C-reactive protein, to evaluate for anemia of chronic inflammation.
From the Research
Anemia Panel Components
- A complete blood count (CBC) is a crucial component of an anemia panel, providing important clues to the classification and cause of anemia 2, 3
- The CBC includes parameters such as red blood cell count, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) 4
- Additional tests that may be included in an anemia panel are:
- Reticulocyte count to screen for hemolysis or blood loss 2, 3
- Iron panel, including ferritin, iron levels, total iron-binding capacity, and transferrin saturation 2, 5
- Vitamin B12 and folate levels 2
- Lactate dehydrogenase and haptoglobin levels 2
- Bilirubin levels 2
- Peripheral blood smear to examine red blood cell morphology 2, 3
Diagnostic Accuracy of Anemia Panel Components
- CBC parameters, such as hematocrit, RBC count, MCV, MCH, and MCHC, can be used to diagnose iron deficiency anemia, especially in resource-limited settings 4
- Serum iron and total iron-binding capacity (TIBC) have limited diagnostic accuracy in detecting iron deficiency anemia, especially when serum ferritin is available 5
- Ferritin is considered the gold standard for diagnosing iron deficiency anemia, with a specificity of 99% and sensitivity of 80% at a concentration of 30 ng/ml 5