What should be the initial test in normocytic anemia?
Reticulocyte count: in all patients with normocytic anemia to evaluate bone marrow response
What does a normal/low reticulocyte count indicate?
Normal/low reticulocyte count (< 2%) indicates ineffective or decreased RBC production (hypoproliferative anemia
What should be further tests if there is a normal/low reticulocyte count?
Iron studies: to evaluate for iron deficiency anemia and/or anemia of chronic disease
Vitamin B12 and folate levels
Basic metabolic panel (BMP), LFTs, thyroid studies: if iron studies and vitamin B12 and folate levels are normal
Serum erythropoietin levels: consider if BUN and/or creatinine levels are abnormal
What does a high reticulocyte count indicate? What should be further tests?
Indicates hemolysis or blood loss
Reassess history for evidence of acute or chronic blood loss.
Check hemolysis labs: ↓ haptoglobin, ↑ LDH, and ↑ unconjugated bilirubin suggest a hemolytic anemia
When should a bone marrow aspirate and biopsy be performed?
consider in hypoproliferative anemia with normal nutritional assays and metabolic
Hemolytic anemia (peripheral blood smear)
Last changed2 years ago
