Diagnostic evaluation-anemia

• History: bleeding, systemic illness, drugs, exposures, alcohol, diet (including pica), FHx

• CBC w/ diff.; RBC params incl. retics, MCV (nb, mixed disorder can → nl MCV), RDW

• Reticulocyte index

• Peripheral smear:

  • select area where roughly ⅓ RBCs touch each other;
  • ✓ RBC size, shape, inclusions
    • (see “Appendix” & “Peripheral Smear”),
  • WBC morphology,
  • plt count

• Additional labs as indicated:

  • hemolysis labs (if RI >2%, see below),
  • iron/TIBC, ferritin,
  • folate, B12,
  • LFTs, BUN, & Cr,
  • TFTs,
  • Hb electrophoresis,
  • enzyme/gene mutation screens

• Bone marrow (BM) aspirate and biopsy (bx) with cytogenetics as indicated