Anemia Algorithm 16-5-2011

Anemia Testing Click here for topics associated with this algorithm INDICATIONS INDICATIONS FOR TE STING Fatigue, weakness, weakness, pallor, dizziness, fainting fainting ORDER

CBC with Platelet Count and Automated Differential Differential (including (including RBC R BC indices and morphology morphology on manual manual differential) Reticulocytes, Percent & Number

Anemia present on CBC (males Hgb <13g/dL, females Hgb <12g/dL) AND

Corrected reticulocyte index ≥2.5

no

yes

Fragmented cells on peripheral smear

Classify by RBC indices

Normocytic, normochromic normochromic (normal MCV, MCHC) (suggests hypoproliferation)

Bone marrow disorder (infiltration, aplasia) Inflammation Autoimmune disease dise ase Chronic renal disease Critical illness Chronic endocrine disorders Aplastic anemia, pure red cell aplasia

Microcytic, hypochromic hypochromic (low MCV, MCHC) (suggests maturation maturation defects)

no

yes

Suspect hemorrhage and acute blood loss

Suggests hemolytic process: Metabolic defect defect (see PNH P NH Consult topic) Hemoglobinopathies (eg, sickle cell) (see Hemolytic Anemias Testing Algorithm) Autoimmune destruction Splenic sequestration RBC membrane defect (see Hemolytic Anemias Consult topic) Intravascular hemolysis (see Hemolytic Anemias Consult topic)

Macrocytic (high MCV) (suggests maturation maturation defects)

Folate, B12 deficiency (see Megaloblastic Megaloblastic Anemia Testing Algorithm) Drug effect Excessive alcohol use Hypothyroidism Myelodysplasia Myelodysplasia (see Myelodysplastic Syndromes Consult topic)

Iron deficiency Chronic disease  Thala  Thalasse ssem mia (see (see Hemoglobinopathies topic) Sideroblastic anemia Lead toxicity

Abnormal peripheral smear

no

ORDER

Iron and Iron Binding Capacity Ferritin

Low/normal TIBC T IBC Normal/high ferritin Low/normal iron

no

yes Vitamin B12 & Folate

High TIBC Low iron Low ferritin

Workup based on smear characteristics Abbreviations and Formula

Suggests: Inflammation Chronic disease

Iron deficiency anemia

Bone marrow biopsy may be necessary

MCV MC V = mean cell volume MCHC = mean cell hemoglobin concentration  TIBC = tot total al iron iron bind bindin ing g capa capaci citty Reticulocyte correction for anemia:

If no obvious chronic disease present, consider bone marrow biopsy

©2006 ARUP Laboratories. All Rights Reserved. 5/16/2011

R eticCount% eticCo unt%

x

Hgb Htc

x

1 _  Maturation time time correction (use 2 for most patients)

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