Anemia is the most common blood disorder. According to the National Heart, Lung, and Blood Institute, anemia affects more than three million Americans. Anemia occurs when blood doesn’t have enough healthy red blood cells to deliver oxygen to tissues throughout the body.
Anemia often develops gradually, so most people don’t even realize they have a problem. People may blame their shortness of breath, restless leg syndrome (RLS), low energy or feeling depressed on other things, not realizing that anemia could be the underlying cause. People at high risk for anemia include menstruating women, pregnant women, adults over 60, people with autoimmune diseases, cancer and inflammatory bowel disease (Crohn's disease or ulcerative colitis).
Red Blood Cells and Indices
- Red Blood Cells (RBC)
- Mean Corpuscular Volume (MCV)
- Mean Corpuscular Hemoglobin
- Mean Corpuscular Hemoglobin Concentration
- Red-cell Distribution Width
Direct Indicators of Iron Status
- Total Iron Binding Capacity (TIBC)
Vitamins Important for Red Blood Cell Health
- Folic acid (Folate)
- Vitamin B12
- Blood urea nitrogen (BUN)
- BUN/Creatinine Ratio (calculated)
- Estimated glomerular filtration rate (eGFR)
Electrolytes, Acid-Base (pH) Balance and Minerals
- Carbon Dioxide
- Albumin/Globulin Ratio (calculated)
- Alkaline Phosphatase (ALP)
- Alanine Aminotransferase (ALT)
- Aspartate Aminotransferase (AST)
- Bilirubin (total)
- Globulin (calculated)
- Protein (total)
White Blood Cells
- White blood cells (WBC)
- Absolute and Percent Neutrophils
- Absolute and Percent Lymphocytes
- Absolute and Percent Monocytes
- Absolute and Percent Eosinophils
- Absolute and Percent Basophils
- Platelet Count
- Mean Platelet Volume
If abnormal cells are noted on a manual review of the peripheral blood smear or if the automated differential information meets specific criteria, a full manual differential will be performed.
Methodology: Electronic Cell Sizing/Counting/Cytometry/Microscopy
Fasting: You can fast (nothing to eat for 12 hours), or the test may be done 2-6 hours after eating. Either way will give helpful information.
Water: Drink plenty of water to stay well hydrated.
Medications: Take all medications as prescribed.
Dietary supplements: If you take iron, vitamin B12 or folic acid dietary supplements, avoid taking them the day of the test.
Special considerations: If you donate blood or have a blood transfusion, wait for one week before taking this test.
3-6 business days
Result turnaround times are estimates and not guaranteed. Due to factors outside of our control, such as weather, holidays, confirmation/repeat testing or equipment maintenance, our lab may require additional time to complete tests.
Iron deficiency is the number one cause of anemia; however, infections, kidney or liver problems, and low vitamin B12 or folic can also cause anemia. This panel tests all those categories.
- Chemistry Panel. A crucial test done during annual exams, the metabolic (or chemistries) panel provides important markers for understanding liver and kidney health, cardiovascular risk, metabolic function and electrolyte status,.
- Complete Blood Count (CBC). The CBC test evaluates three categories of blood cells—red blood cells, white blood cells and platelets. These cells can help provide important information about the potential cause of anemia, your immune function, whether there may be an infection, blood disorders, nutritional deficiencies, your body's ability to form blood clots and more.
- Ferritin. Ferritin is a major iron storage protein and its levels reflect the available iron stores present in the body. Decreased ferritin indicates lower iron storage. When elevated, ferritin can indicate inflammation, hemochromatosis (iron overload), iron poisoning, or recent blood transfusions.
- Total iron binding capacity (TIBC) is a measure of all the proteins to which iron can bind. High TIBC can indicate low iron.
- Vitamin B12 and Folate, Serum. Vitamin B12 and folate are part of the B complex family of vitamins. Folate is necessary for the normal function of red blood cells (RBCs) and white blood cells (WBCs) and for the synthesis of DNA. Serum folate levels are measured to evaluate hemolytic disorders, assess for folate availability during pregnancy, and to detect anemia caused by folate deficiency (where RBCs would be abnormally large resulting in megaloblastic anemia). Vitamin B12 is necessary for converting the inactive form of folate to its active form, playing an important role in the production and function of RBCs. Low B12 levels are associated with cognitive impairment and dementia, specifically, Alzheimer’s disease, vascular dementia, and Parkinson’s disease.
Dr. Neustadt’s Anemia Special Report, by Dr. John Neustadt
The Most Important Lab Test Women Aren’t Getting, by Dr. John Neustadt
Tired? Breathless? RLS? Iron Deficiency Might be the Cause, by Dr. John Neustadt
Anemia (Mayo Clinic)
Le CH. The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012). PLoS One. 2016;11(11):e0166635.
Moore E., Mander A., Ames D., Carne R., Sanders K., Watters D. Cognitive impairment and vitamin B12: a review. Int Psychogeriatr. 2012 Apr;24(4):541-56.