Anemia: Algorithms / Iron Panel Tests

Anemia:

  1. Microcytic (MCV <80 fL) – check serum Fe, TIBC, ferritin
    1. iron deficiency – Low Fe and Ferritin, high TIBC
    2. chronic disease / inflammation / malignancy – low Fe, normal TIBC, normal or high ferritin
    3. sideroblastic anemia – high iron, high ferritin, any TIBC; blood smear with siderocytes, BMA with sideroblasts
    4. alpha or beta thalassemia – high iron, high ferritin, any TIBC; blood smear with teardrop cells, target cells; abd US (splenomegaly)
  2. Normocytic (MCV 80-96 fL)
    1. check blood smear
    2. check for hemolysis (high LDH, high IB, low haptoglobin)
    3. check blood loss
    4. check retic count (bone marrow suppression)
    5. check creatinine (CKD)
  3. Macrocytic (>100 fL)
    1. B12 deficiency – low B12, high MM, high homocysteine
    2. Folate deficiency – low folate, normal MM, high homocysteine
    3. myelopastic disorder – dysplastic features, cytopenias
    4. Others:
      1. reticulocytosis
      2. liver disease
      3. hypothyroidism
      4. drugs

 

Anemia Labs Checklist:

  1. creatinine
  2. TSH
  3. LFTs
  4. reticulocyte count
  5. IRON PROFILE:  serum iron, ferritin, TIBC
  6. peripheral blood smear
  7. Hemolysis labs:  LDH, indirect bilirubin, haptoglobin
  8. B12/folate labs:  B12, folate, methymalonic acid, homocysteine
  9. Hb electrophoresis
  10. Abd ultrasound (splenomegaly)
  11. *review of meds
  12. *BMA / hematology consult

 

DDx:

  1.  iron deficiency anemia
  2. anemia of chronic disease, infection, inflammation, malignancy
  3. sideroblastic anemia
  4. alpha or beta thalasemia
  5. hemolytic anemia
  6. blood loss
  7. bone marrow suppression
  8. anemia of CKD
  9. myelodysplastic disorder
  10. B12 deficiency
  11. folate deficiency
  12. liver disease
  13. hypothyroidism
  14. drug adverse effect

Evaluation_anemia_adult

Reference:

Uptodate.com. (2017). Evaluation of anemia in the adult. [online] Available at: http://www.uptodate.com/contents/image?imageKey=HEME/99491&topicKey=HEME%2F7133&source=outline_link&search=anemia+work-up&selectedTitle=1~150&utdPopup=true [Accessed 14 Jul. 2017].

 

 

 

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