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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Doctors can easily detect anemia by drawing a blood sample for a complete blood count. Based on the results of the test and thorough evaluation of the patient, the doctor may order more tests to determine the exact cause of anemia. The complete blood count may be done as part of a routine general check-up or based upon the presence of signs and symptoms suggestive of anemia.

Physical examination and medical history also play a crucial role in diagnosing causes of anemia. Some of the important features in medical history cover questions about family history, previous personal history of anemia or other chronic conditions, medications, color of stool and urine, bleeding problems, and occupation and social habits (such as alcohol intake). While performing a complete physical examination, the physician may particularly focus on general appearance (signs of fatigue, paleness), jaundice (yellow skin and eyes), paleness of the nail beds, enlarged spleen (splenomegaly) or liver (hepatomegaly), heart sounds, and lymph nodes.

Because anemia is only a symptom of another disease, doctors will want to determine what condition is causing the anemia. Some people may need many additional tests, and others may need very few. For example, an anemic person with known stomach ulcers typically would not need multiple blood tests, but may need to have his or her stomach visually evaluated and have the ulcers treated. On the other hand, a person with a family history of anemia and without an obvious source of blood loss may need multiple laboratory blood tests and other types of diagnostic evaluation. Doctors also take into consideration the severity of the anemia when deciding what tests to order. When a person has severe anemia, the cause must be determined rapidly so that it can be treated appropriately.

Lab tests for anemia generally include the following:

• Complete blood count (CBC): Determines the severity and type of anemia (microcytic anemia or small-sized red blood cells, normocytic anemia or normal-sized red blood cells, or macrocytic anemia or large-sized red blood cells) and is typically the first test ordered. Information about other blood cells (white cells and platelets) is also included in the CBC report. Hemoglobin (Hgb) and hematocrit (Hct) measurements in a complete blood count test are commonly used to diagnose anemia. They measure the amount of hemoglobin, which an accurate reflection of red blood cell (RBC) quantity in the blood.
• Stool hemoglobin test: Tests for blood in the stool may detect bleeding from the stomach or the intestines (stool Guaiac test or stool occult blood test).
• Peripheral blood smear: Looks at the red blood cells under a microscope to determine the size, shape, number, and appearance as well as evaluate other cells in the blood.
• Iron level: A serum iron level may tell the doctor whether anemia may be related to iron deficiency or not. This test is usually accompanied by other tests that measure the body's iron storage capacity, such as transferrin level and ferritin level.
• Transferrin level: Evaluates a protein that transports iron in the body.
• Ferritin: Evaluates at the total iron available in the body.
• Folate: A vitamin needed to produce red blood cells, which is low in people with poor eating habits.
• Vitamin B12: A vitamin needed to produce red blood cells and low in people with poor eating habits or in pernicious anemia.
• Bilirubin: Useful to determine if the red blood cells are being destroyed within the body which may be a sign of hemolytic anemia.
• Lead level: Lead toxicity was formerly one of the more common causes of anemia in children.
• Hemoglobin electrophoresis: Sometimes used when a person has a family history of anemia; this test provides information on sickle cell anemia or thalassemia.
• Reticulocyte count: A measure of new red blood cells produced by the bone marrow
• Liver function tests: A common test to determine how the liver is working, which may give a clue to other underlying disease causing anemia.
• Kidney function test: A test that is very routine and can help determine whether any kidney dysfunction exists. Kidney failure can result in erythropoietin (Epo) deficiency, leading to anemia.
• Bone marrow biopsy: Evaluates production of red blood cells and may be done when a bone marrow problem is suspected.

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