Anemia

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Initial evaluation

May consist of:

  • CBC with differential, MCV
  • Basic metabolic panel (BMP)
  • Liver function tests (LFTs)
  • Reticulocyte count
  • Iron, total iron binding capacity (TIBC), ferritin
  • Vitamin B12 +/- methylmalonic acid & homocysteine
  • Folic acid
  • TSH
  • Peripheral smear
  • Clinical history, lifestyle factors (e.g. alcohol)
  • Medications

GI bleeding or iron deficiency

  • Stool occult blood
  • EGD & colonoscopy
  • Celiac (TTG IgA)
  • H. pylori Ab, H. pylori stool antigen

Hemolysis?

  • LDH
  • Haptoglobin
  • Direct & indirect Coombs
  • LFTs (direct, indirect, total bilirubin)
  • Infectious: anaplasma, babesia, ehrlichia

Anemia of chronic disease/anemia chronic kidney disease

  • Basic metabolic panel (BMP) & iron labs as above
  • Serum erythropoietin
  • ESR
  • CRP

Chronic/inherited?

  • Hemoglobin electrophoresis
  • Sickle cell evaluation

Myeloma?

  • SPEP & IFE
  • UPEP
  • Free serum/urine kappa/lambda light chains
  • Skeletal survey

Primary marrow process/hematologic malignancy

Less common

  • Copper
  • Zinc