All Anemia Tests

Anemia Lab Tests and health information

Anemia occurs when the hemoglobin level in a person's blood falls below normal. A decrease in hemoglobin is often accompanied by a reduction of hematocrit and red blood cells (or RBCs). Red blood cells contain hemoglobin, which is required to transfer oxygen from the lungs to the rest of the body. Many organs and tissues in the body may suffer if not given adequate oxygen. Anemia causes weakness, weariness, and loss of energy. 

Anemia is a prevalent condition. It affects men and women of all ages and ethnic backgrounds. Some people, however, are more susceptible to anemia than others. Low vitamin and iron consumption, chronic diseases such as cancer, diabetes, and renal illness, a family history of anemia, significant blood loss after surgery or an accident, and persistent infections such as HIV or TB are also risk factors. Based on hemoglobin or RBC count, anemia is classed as severe, moderate, or mild. 

Below is a list of lab tests used to detect, monitor, and manage all types of anemia; click on the appropriate condition for a list of particular lab tests performed for the most prevalent types of anemia. 

Click here to learn more about anemia and the lab tests used to diagnose and monitor it.


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Pernicious Anemia Diagnostic Panel Includes

Intrinsic Factor Blocking Antibody, Methylmalonic Acid, Vitamin B12


DC - Anemia Panel

Test not available in the following States: CA, MD, NY, PA and RI.


Description: A Complete Blood Count or CBC (H/H, RBC, Indices, WBC, Plt) test is a blood test that measures many important features of your blood and counts your red blood cells, white blood cells, and platelets. A Complete Blood Count can be used to evaluate your overall health and detect a wide variety of conditions such as infection, anemia, and leukemia. It also looks at other important aspects of your blood health such as hemoglobin, which carries oxygen.

Also Known As: CBC test, Complete Blood Count Test, Total Blood Count Test, CBC with White Blood Cell Count and Platelets Test, Hemogram Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a CBC test ordered?

The complete blood count is an extremely common test. When people go to the doctor for a standard checkup or blood work, they often get a CBC. Suppose a person is healthy and their results are within normal ranges. In that case, they may not need another CBC unless their health condition changes, or their healthcare professional believes it is necessary.

When a person exhibits a variety of signs and symptoms that could be connected to blood cell abnormalities, a CBC may be done. A health practitioner may request a CBC to help diagnose and determine the severity of lethargy or weakness, as well as infection, inflammation, bruises, or bleeding.

When a person is diagnosed with a disease that affects blood cells, a CBC is frequently done regularly to keep track of their progress. Similarly, if someone is being treated for a blood condition, a CBC may be performed on a regular basis to see if the treatment is working.

Chemotherapy, for example, can influence the generation of cells in the bone marrow. Some drugs can lower WBC counts in the long run. To monitor various medication regimens, a CBC may be required on a regular basis.

What does a CBC blood test check for?

The complete blood count is a blood test that determines the number of cells in circulation. White blood cells, red blood cells, and platelets are three types of cells suspended in a fluid called plasma. They are largely created and matured in the bone marrow and are released into the bloodstream when needed under normal circumstances.

A CBC is mainly performed with an automated machine that measures a variety of factors, including the number of cells present in a person's blood sample. The findings of a CBC can reveal not only the quantity of different cell types but also the physical properties of some of the cells. The following items are included in a conventional CBC:

  • White blood cell count.
  • RBC count, hemoglobin, hematocrit, and RBC indicators such as mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width are all used to assess red blood cells. The reticulocyte count may or may not be included in the RBC evaluation.
  • Platelet count; may or may not include mean platelet volume and platelet distribution width in platelet evaluation

The CBC focuses on three different types of cells:

White Blood Cells

The body uses five different types of WBCs, also known as leukocytes, to keep itself healthy and battle infections and other types of harm. They are found in relatively steady numbers in the blood. Depending on what is going on in the body, these values may momentarily rise or fall. An infection, for example, can cause the body to manufacture more in order to combat bacterial infection. The amount of white blood cells in the body may increase as a result of allergies. A viral infection may cause an increase in white blood cell production. Abnormal white cells multiply fast in certain illness situations, such as leukemia, raising the WBC count.

Red Blood Cells

The bone marrow produces red blood cells, also known as erythrocytes, which are transferred into the bloodstream after maturing. Hemoglobin, a protein that distributes oxygen throughout the body, is found in these cells. Because RBCs have a 120-day lifespan, the bone marrow must constantly manufacture new RBCs to replace those that have aged and disintegrated or have been lost due to hemorrhage. A variety of diseases, including those that cause severe bleeding, can alter the creation of new RBCs and their longevity.

The CBC measures the number of RBCs and hemoglobin in the blood, as well as the proportion of RBCs in the blood, and if the RBC population appears to be normal. RBCs are generally homogeneous in size and shape, with only minor differences; however, considerable variances can arise in illnesses including vitamin B12 and folate inadequacy, iron deficiency, and a range of other ailments. Anemia occurs when the concentration of red blood cells and/or the amount of hemoglobin in the blood falls below normal, resulting in symptoms such as weariness and weakness. In a far smaller percentage of cases, there may be an excess of RBCs in the blood. This might obstruct the flow of blood through the tiny veins and arteries in extreme circumstances.

Platelets

Platelets, also known as thrombocytes, are small cell fragments that aid in the regular clotting of blood. A person with insufficient platelets is more likely to experience excessive bleeding and bruises. Excess platelets can induce excessive clotting or excessive bleeding if the platelets are not operating properly. The platelet count and size are determined by the CBC.

Lab tests often ordered with a CBC test:

  • Reticulocytes
  • Iron and Total Iron Binding Capacity
  • Basic Metabolic Panel
  • Comprehensive Metabolic Panel
  • Lipid Panel
  • Vitamin B12 and Folate
  • Prothrombin with INR and Partial Thromboplastin Times
  • Sed Rate (ESR)
  • C-Reactive Protein
  • Epstein-Barr Virus
  • Von Willebrand Factor Antigen

Conditions where a CBC test is recommended:

  • Anemia
  • Aplastic Anemia
  • Iron Deficiency Anemia
  • Vitamin B12 and Folate Deficiency
  • Sickle Cell Anemia
  • Heart Disease
  • Thalassemia
  • Leukemia
  • Autoimmune Disorders
  • Cancer
  • Bleeding Disorders
  • Inflammation
  • Epstein-Barr Virus
  • Mononucleosis

Commonly Asked Questions:

How does my health care provider use a CBC test?

The complete blood count is a common, comprehensive screening test used to measure a person's overall health status. It can be used for a variety of purposes, including:

  • To check for a variety of ailments and disorders.
  • Assist in the diagnosis of a variety of illnesses, including anemia, infection, inflammation, bleeding disorders, and leukemia, to mention a few.
  • After a diagnosis has been made, keep an eye on the patient's condition and/or the treatment's effectiveness.
  • Treatments that are known to influence blood cells, such as chemotherapy or radiation therapy, should be monitored.

A complete blood count is a set of tests that assesses the three types of cells that circulate in the bloodstream. The following items are included in a CBC:

White blood cells, which are part of the body's defensive system against infections and cancer, as well as playing a role in allergies and inflammation, are assessed:

  • The total number of white blood cells in a person's blood sample is measured by a white blood cell count.

Red blood cells, which transport oxygen throughout the body, are assessed as follows:

  • The quantity of red blood cells in a person's blood sample is measured by a red blood cell count.
  • The overall amount of oxygen-carrying protein in the blood is measured by hemoglobin, which generally indicates the number of red blood cells in the blood.
  • Hematocrit is a measurement of how many red blood cells make up a person's total blood volume.
  • RBC indices are calculations that give information about the physical features of RBCs:
  • The average size of a single red blood cell is measured by the mean corpuscular volume.
  • The average quantity of hemoglobin inside a single red blood cell is calculated as mean corpuscular hemoglobin.
  • The average concentration of hemoglobin inside a single red blood cell is calculated as mean corpuscular hemoglobin concentration.
  • The red cell distribution width is a measurement of RBC size variation.

The reticulocyte count, which is a measurement of the absolute count or percentage of immature red blood cells in the blood, may also be included in the CBC.

Platelets, which are cell fragments that are critical for proper blood coagulation, are assessed as follows:

  • The number of platelets in a person's blood sample is known as the platelet count.

With a CBC, the mean platelet volume can be reported. It's a calculation of platelet size on average.

A CBC can also reveal the platelet distribution width. It reflects the size uniformity of platelets.

Can a blood transfusion affect my CBC results?

Yes, a recent blood transfusion will have an effect on your CBC test results.

What do my Complete Blood Count results mean?

A low Red Blood Cell Count, also known as anemia, could be due many different causes such as chronic bleeding, a bone marrow disorder, and nutritional deficiency just to name a few. A high Red Blood Cell Count, also known as polycythemia, could be due to several conditions including lung disease, dehydration, and smoking. Both Hemoglobin and Hematocrit tend to reflect Red Blood Cell Count results, so if your Red Blood Cell Count is low, your Hematocrit and Hemoglobin will likely also be low. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health.

What do my Platelet results mean?

A low Platelet Count, also known as thrombocytopenia, could be due to a number of different disorders including autoimmune issues, viral infection, and leukemia. A high Platelet Count, also known as Thrombocytosis, can also be due to many different disorders including cancer, iron deficiency, and rheumatoid arthritis. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

NOTE: Only measurable biomarkers will be reported.


Note: Before ordering this test consider The Complete Blood Count (CBC) with Differential and Platelets Blood Test (Test # 6399) which is a better value.

In Quest's internal studies of more than two thousand patient samples, no significant abnormalities were detected with manual differentials associated with test code 20253 that were not otherwise identified thru the test code 6399 CBC.

Description: A CBC or Complete Blood Count with Differential and Platelets with Smear Review test is a blood test that measures many important features of your blood’s red and white blood cells and platelets. A Complete Blood Count can be used to evaluate your overall health and detect a wide variety of conditions such as infection, anemia, and leukemia. It also looks at other important aspects of your blood health such as hemoglobin, which carries oxygen. 

Also Known As: CBC test, Complete Blood Count Test, Total Blood Count Test, CBC with Differential and Platelets test, Hemogram test, Smear Review Test

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

When is a Complete Blood Count with Smear Review test ordered?  

The complete blood count (CBC) is an extremely common test. When people go to the doctor for a standard checkup or blood work, they often get a CBC. Suppose a person is healthy and their results are within normal ranges. In that case, they may not need another CBC unless their health condition changes, or their healthcare professional believes it is necessary. 

When a person exhibits a variety of signs and symptoms that could be connected to blood cell abnormalities, a CBC may be done. A health practitioner may request a CBC to help diagnose and determine the severity of lethargy or weakness, as well as infection, inflammation, bruises, or bleeding. 

When a person is diagnosed with a disease that affects blood cells, a CBC is frequently done regularly to keep track of their progress. Similarly, if someone is being treated for a blood condition, a CBC may be performed on a regular basis to see if the treatment is working. 

Chemotherapy, for example, can influence the generation of cells in the bone marrow. Some drugs can lower WBC counts in the long run. To monitor various medication regimens, a CBC may be required on a regular basis. 

When a CBC  indicates the presence of aberrant or immature cells, a blood smear is typically recommended. It may also be done if a person exhibits signs and symptoms that point to a problem with blood cell production or longevity.

What does a Complete Blood Count with Smear Review test check for? 

The complete blood count (CBC) is a blood test that determines the number of cells in circulation. White blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs) are three types of cells suspended in a fluid called plasma. They are largely created and matured in the bone marrow and are released into the bloodstream when needed under normal circumstances. 

A CBC is mainly performed with an automated machine that measures a variety of factors, including the number of cells present in a person's blood sample. The findings of a CBC can reveal not only the quantity of different cell types but also the physical properties of some of the cells. 

Significant differences in one or more blood cell populations may suggest the presence of one or more diseases. Other tests are frequently performed to assist in determining the reason for aberrant results. This frequently necessitates visual confirmation via a microscope examination of a blood smear. A skilled laboratory technician can assess the appearance and physical features of blood cells, such as size, shape, and color, and note any anomalies. Any extra information is taken note of and communicated to the healthcare provider. This information provides the health care provider with further information about the cause of abnormal CBC results. 

The CBC focuses on three different types of cells: 

WBCs (White Blood Cells) 

The body uses five different types of WBCs, also known as leukocytes, to keep itself healthy and battle infections and other types of harm. The five different leukocytes are eosinophiles, lymphocytes, neutrophiles, basophils, and monocytes. They are found in relatively steady numbers in the blood. Depending on what is going on in the body, these values may momentarily rise or fall. An infection, for example, can cause the body to manufacture more neutrophils in order to combat bacterial infection. The amount of eosinophils in the body may increase as a result of allergies. A viral infection may cause an increase in lymphocyte production. Abnormal (immature or mature) white cells multiply fast in certain illness situations, such as leukemia, raising the WBC count. 

RBCs (Red Blood Cells) 

The bone marrow produces red blood cells, also known as erythrocytes, which are transferred into the bloodstream after maturing. Hemoglobin, a protein that distributes oxygen throughout the body, is found in these cells. Because RBCs have a 120-day lifespan, the bone marrow must constantly manufacture new RBCs to replace those that have aged and disintegrated or have been lost due to hemorrhage. A variety of diseases, including those that cause severe bleeding, can alter the creation of new RBCs and their longevity. 

The CBC measures the number of RBCs and hemoglobin in the blood, as well as the proportion of RBCs in the blood (hematocrit), and if the RBC population appears to be normal. RBCs are generally homogeneous in size and shape, with only minor differences; however, considerable variances can arise in illnesses including vitamin B12 and folate inadequacy, iron deficiency, and a range of other ailments. Anemia occurs when the concentration of red blood cells and/or the amount of hemoglobin in the blood falls below normal, resulting in symptoms such as weariness and weakness. In a far smaller percentage of cases, there may be an excess of RBCs in the blood (erythrocytosis or polycythemia). This might obstruct the flow of blood through the tiny veins and arteries in extreme circumstances. 

Platelets 

Platelets, also known as thrombocytes, are small cell fragments that aid in the regular clotting of blood. A person with insufficient platelets is more likely to experience excessive bleeding and bruises. Excess platelets can induce excessive clotting or excessive bleeding if the platelets are not operating properly. The platelet count and size are determined by the CBC. 

Lab tests ofern ordered with a Complete Blood Count with Smear Review test: 

  • Reticulocytes
  • Iron and Total Iron Binding Capacity
  • Basic Metabolic Panel
  • Comprehensive Metabolic Panel
  • Lipid Panel
  • Vitamin B12 and Folate
  • Prothrombin with INR and Partial Thromboplastin Times
  • Sed Rate (ESR)
  • C-Reactive Protein
  • Epstein-Barr Virus
  • Von Willebrand Factor Antigen

Conditions where a Complete Blood Count with Smear Review test is recommended: 

  • Anemia
  • Aplastic Anemia
  • Iron Deficiency Anemia
  • Vitamin B12 and Folate Deficiency
  • Sickle Cell Anemia
  • Heart Disease
  • Thalassemia
  • Leukemia
  • Autoimmune Disorders
  • Cancer
  • Bleeding Disorders
  • Inflammation
  • Epstein-Barr Virus
  • Mononucleosis

Commonly Asked Questions: 

How does my health care provider use a Complete Blood Count with Smear Review test? 

The complete blood count (CBC) is a common, comprehensive screening test used to measure a person's overall health status.  

What do my Complete Blood Count results mean? 

A low Red Blood Cell Count, also known as anemia, could be due many different causes such as chronic bleeding, a bone marrow disorder, and nutritional deficiency just to name a few. A high Red Blood Cell Count, also known as polycythemia, could be due to several conditions including lung disease, dehydration, and smoking. Both Hemoglobin and Hematocrit tend to reflect Red Blood Cell Count results, so if your Red Blood Cell Count is low, your Hematocrit and Hemoglobin will likely also be low. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Differential results mean? 

A low White Blood Cell count or low WBC count, also known as leukopenia, could be due to a number of different disorders including autoimmune issues, severe infection, and lymphoma. A high White Blood Cell count, or high WBC count, also known as leukocytosis, can also be due to many different disorders including infection, leukemia, and inflammation. Abnormal levels in your White Blood Cell Count will be reflected in one or more of your different white blood cells. Knowing which white blood cell types are affected will help your healthcare provider narrow down the issue. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Platelet results mean? 

A low Platelet Count, also known as thrombocytopenia, could be due to a number of different disorders including autoimmune issues, viral infection, and leukemia. A high Platelet Count, also known as Thrombocytosis, can also be due to many different disorders including cancer, iron deficiency, and rheumatoid arthritis. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Smear test results mean?

Blood smear results aren't always diagnostic in and of themselves; they usually indicate the presence of an underlying illness, its severity, and the necessity for additional diagnostic testing. The results are compared to the results of the CBC and other laboratory tests, as well as the clinical signs and symptoms of the person being tested.

The appearance of red blood cells, white blood cells, and platelets, as well as any abnormalities visible on the slide, are usually described in the results of a blood smear.

NOTE: Only measurable biomarkers will be reported. Certain biomarkers do not appear in healthy individuals.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

 


Description: A CBC or Complete Blood Count with Differential and Platelets test is a blood test that measures many important features of your blood’s red and white blood cells and platelets. A Complete Blood Count can be used to evaluate your overall health and detect a wide variety of conditions such as infection, anemia, and leukemia. It also looks at other important aspects of your blood health such as hemoglobin, which carries oxygen. 

Also Known As: CBC test, Complete Blood Count Test, Total Blood Count Test, CBC with Differential and Platelets test, Hemogram test  

Collection Method: Blood Draw 

Specimen Type: Whole Blood 

Test Preparation: No preparation required 

When is a Complete Blood Count test ordered?  

The complete blood count (CBC) is an extremely common test. When people go to the doctor for a standard checkup or blood work, they often get a CBC. Suppose a person is healthy and their results are within normal ranges. In that case, they may not need another CBC unless their health condition changes, or their healthcare professional believes it is necessary. 

When a person exhibits a variety of signs and symptoms that could be connected to blood cell abnormalities, a CBC may be done. A health practitioner may request a CBC to help diagnose and determine the severity of lethargy or weakness, as well as infection, inflammation, bruises, or bleeding. 

When a person is diagnosed with a disease that affects blood cells, a CBC is frequently done regularly to keep track of their progress. Similarly, if someone is being treated for a blood condition, a CBC may be performed on a regular basis to see if the treatment is working. 

Chemotherapy, for example, can influence the generation of cells in the bone marrow. Some drugs can lower WBC counts in the long run. To monitor various medication regimens, a CBC may be required on a regular basis. 

What does a Complete Blood Count test check for? 

The complete blood count (CBC) is a blood test that determines the number of cells in circulation. White blood cells (WBCs), red blood cells (RBCs), and platelets (PLTs) are three types of cells suspended in a fluid called plasma. They are largely created and matured in the bone marrow and are released into the bloodstream when needed under normal circumstances. 

A CBC is mainly performed with an automated machine that measures a variety of factors, including the number of cells present in a person's blood sample. The findings of a CBC can reveal not only the quantity of different cell types but also the physical properties of some of the cells. 

Significant differences in one or more blood cell populations may suggest the presence of one or more diseases. Other tests are frequently performed to assist in determining the reason for aberrant results. This frequently necessitates visual confirmation via a microscope examination of a blood smear. A skilled laboratory technician can assess the appearance and physical features of blood cells, such as size, shape, and color, and note any anomalies. Any extra information is taken note of and communicated to the healthcare provider. This information provides the health care provider with further information about the cause of abnormal CBC results. 

The CBC focuses on three different types of cells: 

WBCs (White Blood Cells) 

The body uses five different types of WBCs, also known as leukocytes, to keep itself healthy and battle infections and other types of harm. The five different leukocytes are eosinophiles, lymphocytes, neutrophiles, basophils, and monocytes. They are found in relatively steady numbers in the blood. Depending on what is going on in the body, these values may momentarily rise or fall. An infection, for example, can cause the body to manufacture more neutrophils in order to combat bacterial infection. The amount of eosinophils in the body may increase as a result of allergies. A viral infection may cause an increase in lymphocyte production. Abnormal (immature or mature) white cells multiply fast in certain illness situations, such as leukemia, raising the WBC count. 

RBCs (Red Blood Cells) 

The bone marrow produces red blood cells, also known as erythrocytes, which are transferred into the bloodstream after maturing. Hemoglobin, a protein that distributes oxygen throughout the body, is found in these cells. Because RBCs have a 120-day lifespan, the bone marrow must constantly manufacture new RBCs to replace those that have aged and disintegrated or have been lost due to hemorrhage. A variety of diseases, including those that cause severe bleeding, can alter the creation of new RBCs and their longevity. 

The CBC measures the number of RBCs and hemoglobin in the blood, as well as the proportion of RBCs in the blood (hematocrit), and if the RBC population appears to be normal. RBCs are generally homogeneous in size and shape, with only minor differences; however, considerable variances can arise in illnesses including vitamin B12 and folate inadequacy, iron deficiency, and a range of other ailments. Anemia occurs when the concentration of red blood cells and/or the amount of hemoglobin in the blood falls below normal, resulting in symptoms such as weariness and weakness. In a far smaller percentage of cases, there may be an excess of RBCs in the blood (erythrocytosis or polycythemia). This might obstruct the flow of blood through the tiny veins and arteries in extreme circumstances. 

Platelets 

Platelets, also known as thrombocytes, are small cell fragments that aid in the regular clotting of blood. A person with insufficient platelets is more likely to experience excessive bleeding and bruises. Excess platelets can induce excessive clotting or excessive bleeding if the platelets are not operating properly. The platelet count and size are determined by the CBC. 

Lab tests often ordered with a Complete Blood Count test: 

  • Reticulocytes
  • Iron and Total Iron Binding Capacity
  • Basic Metabolic Panel
  • Comprehensive Metabolic Panel
  • Lipid Panel
  • Vitamin B12 and Folate
  • Prothrombin with INR and Partial Thromboplastin Times
  • Sed Rate (ESR)
  • C-Reactive Protein
  • Epstein-Barr Virus
  • Von Willebrand Factor Antigen

Conditions where a Complete Blood Count test is recommended: 

  • Anemia
  • Aplastic Anemia
  • Iron Deficiency Anemia
  • Vitamin B12 and Folate Deficiency
  • Sickle Cell Anemia
  • Heart Disease
  • Thalassemia
  • Leukemia
  • Autoimmune Disorders
  • Cancer
  • Bleeding Disorders
  • Inflammation
  • Epstein-Barr Virus
  • Mononucleosis

Commonly Asked Questions: 

How does my health care provider use a Complete Blood Count test? 

The complete blood count (CBC) is a common, comprehensive screening test used to measure a person's overall health status.  

What do my Complete Blood Count results mean? 

A low Red Blood Cell Count, also known as anemia, could be due many different causes such as chronic bleeding, a bone marrow disorder, and nutritional deficiency just to name a few. A high Red Blood Cell Count, also known as polycythemia, could be due to several conditions including lung disease, dehydration, and smoking. Both Hemoglobin and Hematocrit tend to reflect Red Blood Cell Count results, so if your Red Blood Cell Count is low, your Hematocrit and Hemoglobin will likely also be low. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Differential results mean? 

A low White Blood Cell count or low WBC count, also known as leukopenia, could be due to a number of different disorders including autoimmune issues, severe infection, and lymphoma. A high White Blood Cell count, or high WBC count, also known as leukocytosis, can also be due to many different disorders including infection, leukemia, and inflammation. Abnormal levels in your White Blood Cell Count will be reflected in one or more of your different white blood cells. Knowing which white blood cell types are affected will help your healthcare provider narrow down the issue. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

What do my Platelet results mean? 

A low Platelet Count, also known as thrombocytopenia, could be due to a number of different disorders including autoimmune issues, viral infection, and leukemia. A high Platelet Count, also known as Thrombocytosis, can also be due to many different disorders including cancer, iron deficiency, and rheumatoid arthritis. Results should be discussed with your health care provider who can provide interpretation of your results and determine the appropriate next steps or lab tests to further investigate your health. 

NOTE: Only measurable biomarkers will be reported. Certain biomarkers do not appear in healthy individuals. 

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
     
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
>1000 
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
     
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Most Popular

Description: A Ferritin test is a blood test that measures Ferritin levels in your blood’s serum to evaluate the level of iron stored in your body.

Also Known As: Ferritin Serum Test, Ferritin Test, Ferritin Blood Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Ferritin test ordered?

When a CBC test’s implies iron deficiency anemia due to small red blood cells or low hematocrit and hemoglobin levels, the ferritin test, and other iron tests, may be requested, even if other clinical symptoms have not yet arisen.

There are frequently no physical symptoms in the early stages of iron insufficiency. Symptoms rarely develop before hemoglobin falls below dangerous levels. However, when the iron deficit continues, symptoms emerge, prompting a doctor to order ferritin and other iron-related testing. The following are the most prevalent symptoms of iron deficiency anemia:

  • Chronic tiredness/fatigue
  • Weakness
  • Dizziness
  • Headaches
  • Skin that is pale

Shortness of breath, ringing in the ears, sleepiness, and irritability may occur as iron levels are reduced. Chest pain, headaches, limb pains, shock, and even heart failure may occur as the anemia worsens. Learning impairments can occur in children. There are some symptoms that are specific to iron deficiency, in addition to the usual signs of anemia. Pica, a burning feeling in the tongue or a smooth tongue, ulcers at the corners of the mouth, and spoon-shaped finger- and toe-nails are only a few of the symptoms.

When iron overload is suspected, a ferritin level may be requested. Iron overload symptoms differ from person to person and tend to worsen over time. They are caused by an excess of iron in the blood and tissues. Among the signs and symptoms are:

  • Joint discomfort
  • Weakness and exhaustion
  • Loss of weight
  • Energy deficiency
  • Pain in the abdomen
  • Suffering from a lack of sexual desire
  • Hair loss on the body
  • Congestive heart failure is an example of a cardiac issue

Other iron tests including a genetic test for hereditary hemochromatosis may be conducted to confirm the existence of iron excess.

What does a Ferritin blood test check for?

Ferritin is an iron-containing protein that stores iron in cells in its most basic form. The amount of total iron stored in the body is reflected in the little amount of ferritin released into the blood. This test determines how much ferritin is present in the blood.

About 70% of the iron consumed by the body is integrated into the hemoglobin of red blood cells in healthy humans. The remaining 30% is stored primarily as ferritin or hemosiderin, which is a combination of iron, proteins, and other elements. Hemosiderin and ferritin are typically found in the liver, although they can also be found in the bone marrow, spleen, and skeletal muscles.

Iron stores are depleted and ferritin levels fall when available iron is insufficient to meet the body's needs. This can happen owing to a lack of iron, poor absorption, or an increased need for iron, such as during pregnancy or if you have a condition that causes persistent blood loss. Before any indicators of iron shortage appear, significant loss of iron reserves may occur.

When the body absorbs more iron than it needs, iron storage and ferritin levels rise. Chronic iron absorption causes a gradual buildup of iron compounds in organs, which can eventually lead to organ malfunction and failure. Even on a typical diet, this happens in hemochromatosis, a hereditary disorder in which the body absorbs too much iron.

Lab tests often ordered with a Ferritin test:

  • Complete Blood Count
  • Iron Total
  • Iron Total and Total Iron binding capacity
  • Transferrin
  • Comprehensive Metabolic Panel
  • Lipid Panel
  • Zinc Protoporphyrin

Conditions where a Ferritin test is recommended:

  • Anemia
  • Hemochromatosis
  • Lead poisoning
  • Pregnancy
  • Restless Leg Syndrome

How does my health care provider use a Ferritin test?

The ferritin test is used to determine the amount of iron a person has in their body. To determine the existence and severity of iron shortage or iron overload, the test is sometimes ordered in conjunction with an iron test and a TIBC test.

One source of iron overload can be the use of iron supplements.

What does my ferritin lab test result mean?

Ferritin levels are frequently measured alongside other iron tests.

Ferritin levels are low in iron deficient people and high in people who have hemochromatosis or have had several blood transfusions.

Ferritin is an acute phase reactant that can be elevated in persons who have inflammation, liver illness, chronic infection, autoimmune disorders, or cancer. Ferritin isn't commonly utilized to detect or monitor these problems.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Ferritin, Iron and Total Iron Binding Capacity (TIBC)

  • Ferritin
  • Iron and Total Iron Binding Capacity (TIBC)

Ferritin, Iron and TIBC Panel contains: Ferritin, Iron and Total Iron Binding Capacity (TIBC)


Description: Iron and Total Iron Binding Capacity is a blood panel used to determine iron levels in your blood, your body’s ability to transport iron, and help diagnose iron-deficiency and iron overload.

Also Known As: Serum Iron Test, Serum Fe Test, Iron Binding Capacity Test, IBC Test, Serum Iron-Binding Capacity Siderophilin Test, TIBC Test, UIBC Test, Iron Lab Test, TIBC Blood test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Iron and Total Iron Binding Capacity test ordered?

When a doctor feels that a person's symptoms are caused by iron overload or poisoning, an iron and TIBC test, as well ferritin assays, may be done. These may include the following:

  • Joint discomfort
  • Weakness and exhaustion
  • Energy deficiency
  • Pain in the abdomen
  • Suffering from a lack of sexual desire
  • Problems with the heart

When a child is suspected of ingesting too many iron tablets, a serum iron test is required to detect the poisoning and to determine its severity.

A doctor may also request iron and TIBC when the results of a standard CBC test are abnormal, such as a low hematocrit or hemoglobin, or when a doctor suspects iron deficiency based on signs and symptoms such as:

  • Chronic tiredness/fatigue
  • Dizziness
  • Weakness
  • Headaches
  • Skin that is pale

What does a Iron and Total Iron Binding Capacity blood test check for?

Iron is a necessary ingredient for survival. It is a vital component of hemoglobin, the protein in red blood cells that binds and releases oxygen in the lungs and throughout the body. It is required in small amounts to help form normal red blood cells and is a critical part of hemoglobin, the protein in RBCs that binds oxygen in the lungs and releases it as blood circulates to other parts of the body.

By detecting numerous components in the blood, iron tests are ordered to determine the quantity of iron in the body. These tests are frequently ordered at the same time, and the data are analyzed together to determine the diagnosis and/or monitor iron deficiency or overload.

The level of iron in the liquid component of the blood is measured by serum iron.

Total iron-binding capacity is a measurement of all the proteins in the blood that may bind to iron, including transferrin.

The percentage of transferrin that has not yet been saturated is measured by the UIBC. Transferrin levels are also reflected in the UIBC.

Low iron levels can cause anemia, resulting in a decrease in the production of microcytic and hypochromic RBCs. Large amounts of iron, on the other hand, might be hazardous to the body. When too much iron is absorbed over time, iron compounds build up in tissues, particularly the liver, heart, and pancreas.

Normally, iron is absorbed from food and distributed throughout the body by binding to transferrin, a liver protein. About 70% of the iron delivered is used in the synthesis of hemoglobin in red blood cells. The rest is stored as ferritin or hemosiderin in the tissues, with minor amounts being utilized to make other proteins like myoglobin and enzymes.

Insufficient intake, limited absorption, or increased dietary requirements, as observed during pregnancy or with acute or chronic blood loss, are all signs of iron deficiency. Excessive intake of iron pills can cause acute iron overload, especially in children. Excessive iron intake, genetic hemochromatosis, multiple blood transfusions, and a few other disorders can cause chronic iron overload.

Lab tests often ordered with a Iron and Total Iron Binding Capacity test:

  • Complete Blood Count
  • Ferritin
  • Transferrin
  • Zinc Protoporphyrin

Conditions where a Iron and Total Iron Binding Capacity test is recommended:

  • Anemia
  • Hemochromatosis

How does my health care provider use a Iron and Total Iron Binding Capacity test?

The amount of circulating iron in the blood, the capacity of the blood to carry iron, and the amount of stored iron in tissues can all be determined by ordering one or more tests. Testing can also assist distinguish between different types of anemia

The level of iron in the blood is measured by serum iron.

Total iron-binding capacity is a measurement of all the proteins in the blood that may bind to iron, including transferrin. The TIBC test is a useful indirect assessment of transferrin because it is the predominant iron-binding protein. In response to the requirement for iron, the body generates transferrin. Transferrin levels rise when iron levels are low, and vice versa. About one-third of the binding sites on transferrin are used to transport iron in healthy humans.

The reserve capacity of transferrin, or the part of transferrin that has not yet been saturated, is measured by UIBC. Transferrin levels are also reflected in the UIBC.

The iron test result, as well as TIBC or UIBC, are used to calculate transferrin saturation. It represents the proportion of transferrin that is iron-saturated.

Ferritin is the major storage protein for iron inside cells, and serum ferritin represents the quantity of stored iron in the body.

These tests are frequently ordered together, and the results can assist the doctor figure out what's causing the iron deficit or overload.

Additional information about iron

A balance between the quantity of iron received into the body and the amount of iron lost is required to maintain normal iron levels. Because a tiny quantity of iron is lost each day, a deficiency will develop if too little iron is consumed. In healthy persons, there is usually enough iron to prevent iron deficiency and/or iron deficiency anemia, unless they eat a bad diet. There is a greater need for iron in some circumstances. People who have persistent gut bleeding or women who have heavy menstrual periods lose more iron than they should and can develop iron deficiency. Females who are pregnant or breastfeeding lose iron to their babies and may develop an iron shortage if they do not consume enough supplemental iron. Children may require additional iron, especially during periods of rapid growth, and may suffer iron shortage.

Low serum iron can also arise when the body is unable to adequately utilize iron. The body cannot correctly utilize iron to generate additional red cells in many chronic disorders, particularly malignancies, autoimmune diseases, and chronic infections. As a result, transferrin production slows, serum iron levels drop because little iron is absorbed from the stomach, and ferritin levels rise. Malabsorption illnesses like sprue syndrome can cause iron deficiency.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


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Description: Iron is a blood test used to determine iron levels in your blood, your body’s ability to transport iron, and help diagnose iron-deficiency and iron overload.

Also Known As: Serum Iron Test, Serum Fe Test, Iron Total Test, IBC Test, Iron Lab Test, Iron Blood test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: The patient should be fasting 9-12 hours prior to collection and collection should be done in the morning.

When is an Iron Total test ordered?

When a doctor feels that a person's symptoms are caused by iron overload or poisoning, an iron test, as well ferritin assays, may be done. These may include the following:

  • Joint discomfort
  • Weakness and exhaustion
  • Energy deficiency
  • Pain in the abdomen
  • Suffering from a lack of sexual desire
  • Problems with the heart

When a child is suspected of ingesting too many iron tablets, a serum iron test is required to detect the poisoning and to determine its severity.

A doctor may also request iron testing when the results of a standard CBC test are abnormal, such as a low hematocrit or hemoglobin, or when a doctor suspects iron deficiency based on signs and symptoms such as:

  • Chronic tiredness/fatigue
  • Dizziness
  • Weakness
  • Headaches
  • Skin that is pale

What does an Iron Total blood test check for?

Iron is a necessary ingredient for survival and is a critical component of hemoglobin, the protein in red blood cells that binds oxygen in the lungs and releases it to other parts of the body. It is required in small amounts to help form normal red blood cells and is a critical part of hemoglobin, the protein in RBCs that binds oxygen in the lungs and releases it as blood circulates to other parts of the body.

By detecting numerous components in the blood, iron tests are ordered to determine the quantity of iron in the body. These tests are frequently ordered at the same time, and the data are analyzed together to determine the diagnosis and/or monitor iron deficiency or overload.

The level of iron in the liquid component of the blood is measured by serum iron.

Low iron levels can cause anemia, resulting in a decrease in the production of microcytic and hypochromic RBCs. Large amounts of iron, on the other hand, might be hazardous to the body. When too much iron is absorbed over time, iron compounds build up in tissues, particularly the liver, heart, and pancreas.

Normally, iron is absorbed from food and distributed throughout the body by binding to transferrin, a liver protein. About 70% of the iron delivered is used in the synthesis of hemoglobin in red blood cells. The rest is stored as ferritin or hemosiderin in the tissues, with minor amounts being utilized to make other proteins like myoglobin and enzymes.

Insufficient intake, limited absorption, or increased dietary requirements, as observed during pregnancy or with acute or chronic blood loss, are all signs of iron deficiency. Excessive intake of iron pills can cause acute iron overload, especially in children. Excessive iron intake, genetic hemochromatosis, multiple blood transfusions, and a few other disorders can cause chronic iron overload.

Lab tests often ordered with an Iron Total test:

  • Complete Blood Count
  • Ferritin
  • Transferrin
  • Zinc Protoporphyrin

Conditions where an Iron Total test is recommended:

  • Anemia
  • Hemochromatosis

How does my health care provider use an Iron Total test?

The amount of circulating iron in the blood, the capacity of the blood to carry iron, and the amount of stored iron in tissues can all be determined by ordering one or more tests. Testing can also assist distinguish between different types of anemia

The level of iron in the blood is measured by serum iron.

Total iron-binding capacity is a measurement of all the proteins in the blood that may bind to iron, including transferrin. The TIBC test is a useful indirect assessment of transferrin because it is the predominant iron-binding protein. In response to the requirement for iron, the body generates transferrin. Transferrin levels rise when iron levels are low, and vice versa. About one-third of the binding sites on transferrin are used to transport iron in healthy humans.

The reserve capacity of transferrin, or the part of transferrin that has not yet been saturated, is measured by UIBC. Transferrin levels are also reflected in the UIBC.

The iron test result, as well as TIBC or UIBC, are used to calculate transferrin saturation. It represents the proportion of transferrin that is iron-saturated.

Ferritin is the major storage protein for iron inside cells, and serum ferritin represents the quantity of stored iron in the body.

These tests are frequently ordered together, and the results can assist the doctor figure out what's causing the iron deficit or overload.

Additional information about iron

A balance between the quantity of iron received into the body and the amount of iron lost is required to maintain normal iron levels. Because a tiny quantity of iron is lost each day, a deficiency will develop if too little iron is consumed. In healthy persons, there is usually enough iron to prevent iron deficiency and/or iron deficiency anemia, unless they eat a bad diet. There is a greater need for iron in some circumstances. People who have persistent gut bleeding or women who have heavy menstrual periods lose more iron than they should and can develop iron deficiency. Females who are pregnant or breastfeeding lose iron to their babies and may develop an iron shortage if they do not consume enough supplemental iron. Children may require additional iron, especially during periods of rapid growth, and may suffer iron shortage.

Low serum iron can also arise when the body is unable to adequately utilize iron. The body cannot correctly utilize iron to generate additional red cells in many chronic disorders, particularly malignancies, autoimmune diseases, and chronic infections. As a result, transferrin production slows, serum iron levels drop because little iron is absorbed from the stomach, and ferritin levels rise. Malabsorption illnesses like sprue syndrome can cause iron deficiency.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


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Description: Reticulocytes are red blood cells that are not fully developed yet. The reticulocyte test is used to measure the amount of underdeveloped red blood cells.

Also Known As: Retic Count Reticulocyte Percent Test, Reticulocyte Index Test, Corrected Reticulocyte Test, Reticulocyte Production Index Test, RPI Test

Collection Method: Blood Draw

Specimen Type: Whole Blood

Test Preparation: No preparation required

When is a Reticulocyte Count test ordered?

A reticulocyte count may be requested in the following situations:

  • A low RBC count, as well as a low hemoglobin and hematocrit, are found on a complete blood count.
  • A doctor wants to check the function of the bone marrow.
  • Paleness, loss of energy, exhaustion, weakness, shortness of breath, and/or blood in the stool are signs and symptoms of anemia or persistent bleeding.
  • A disorder known to impact RBC production, such as iron deficiency anemia, vitamin B12 or folate deficiency, or renal illness, has been recognized and is being treated.
  • A person is receiving radiation or chemotherapy.
  • A bone marrow transplant has been performed.

When a person has an increased quantity of RBCs and an elevated hemoglobin and hematocrit, a blood test is performed to evaluate the degree and pace of RBC overproduction.

What does a Reticulocyte Count blood test check for?

Reticulocytes are young red blood cells that have just been created. The number and/or percentage of reticulocytes in the blood is determined by a reticulocyte test, which is a reflection of recent bone marrow function or activity.

Red blood cells are made in the bone marrow, where blood-forming stem cells differentiate and grow into reticulocytes, which then mature into mature RBCs. When compared to mature RBCs, reticulocytes have a volume of about 24 percent more. Although adult RBCs do not have a nucleus like most other cells in the body, reticulocytes still contain some genetic material. Reticulocytes lose the last traces of RNA as they mature, and most of them are fully matured within a day of being released from the bone marrow into the bloodstream. The reticulocyte count or percentage is an excellent measure of a person's ability to manufacture enough red blood cells in their bone marrow.

RBCs last around 120 days in circulation, and the bone marrow must constantly manufacture new RBCs to replace those that have aged and degraded or have been lost due to hemorrhage. Normally, a steady number of RBCs is maintained in the blood by replacing deteriorated or lost RBCs on a regular basis.

A range of diseases and conditions, including those that cause severe bleeding, can impair the creation of new RBCs and/or their survival. These situations can cause an increase or decrease in the number of RBCs, as well as a change in the reticulocyte count.

Reticulocyte % higher than normal: Anemia is caused by a lack of RBCs in the blood due to acute or chronic bleeding or enhanced RBC breakdown (hemolysis). The body adjusts for this loss or responds to deficiency anemia treatment by increasing RBC production and releasing RBCs into the bloodstream before they mature. When this happens, the number and percentage of reticulocytes in the blood grows until the bone marrow's production capacity is reached or until a sufficient number of RBCs replaces those that were lost.

A lower-than-normal percentage of reticulocytes: When the bone marrow isn't working properly, RBC production can suffer. A bone marrow condition, such as aplastic anemia, can cause this. Other causes that might cause decreased production include liver cirrhosis, kidney disease, cancer treatments such as radiation or chemotherapy, a low amount of the hormone erythropoietin, or dietary shortages such as iron, vitamin B12, or folate. As old RBCs are eliminated from the blood but not entirely replaced, there are fewer RBCs in circulation, poorer hemoglobin and oxygen-carrying capacity, a lower hematocrit, and a lower number of reticulocytes.

Due to excessive RBC production by the bone marrow, both the reticulocyte and RBC counts might occasionally rise. This could be caused by increased erythropoietin production, diseases that cause chronic RBC overproduction (polycythemia vera), or cigarette smoking.

Some medications can increase or reduce the number of reticulocytes in the body.

Lab tests often ordered with a Reticulocyte Count test:

  • Complete Blood Count (CBC)
  • Red Blood Cell Count
  • Hemoglobin
  • Hematocrit
  • Blood Smear
  • Erythropoietin
  • Vitamin B12
  • Folate
  • Haptoglobin
  • G6PD
  • Iron Total
  • Iron and Total Iron Binding Capacity
  • Ferritin

Conditions where a Reticulocyte Count test is recommended:

  • Anemia
  • Bone Marrow Disorders
  • Myeloproliferative Neoplasms

How does my health care provider use a Reticulocyte Count test?

A reticulocyte test is used to assess the number and/or percentage of reticulocytes in the blood to aid in the diagnosis of red blood cell abnormalities such as anemia and bone marrow illnesses. Reticulocytes are young red blood cells that have just been created. Before being released into the circulation, they develop and mature in the bone marrow.

The reticulocyte test can be used in the following situations:

  • To help determine the reason of aberrant results on a complete blood count, RBC count, hemoglobin, or hematocrit.
  • To see if the bone marrow is appropriately functioning and reacting to the body's need for red blood cells.
  • To aid in the detection and differentiation of various kinds of anemia
  • To track how well people are responding to treatments, such as those for iron deficiency anemia.
  • To track the activity of the bone marrow after therapies like chemotherapy.
  • To keep track of how well you're doing after a bone marrow transplant.

A reticulocyte count is usually done using an automated device and can be done in conjunction with a complete blood count, which includes an RBC count, hemoglobin, and hematocrit. It is possible to report either an absolute number of reticulocytes or a percentage of reticulocytes. The number of reticulocytes is compared to the total number of red blood cells as a percentage:

[ Number of Reticulocytes / Total Red Blood Cells ] X 100 = Reticulocyte Percentage

Several more tests, in addition to a reticulocyte count, can be done to further screen someone for a disorder that affects RBC production. Here are a few examples:

  • Iron testing
  • Haptoglobin
  • G6PD
  • Erythropoietin
  • Vitamin B12 and Folate

Following up on abnormal results from early tests, a bone marrow aspiration and biopsy may be performed. This is an invasive operation that is not performed on everyone. If necessary, it can, however, supply extra information.

What do my reticulocyte count test results mean?

The results must be carefully evaluated in conjunction with the results of other tests, such as a red blood cell count, hemoglobin, hematocrit, or a complete blood count. The reticulocyte count, in general, reflects recent bone marrow activity. The results could reveal whether a disease or condition is present that is causing an elevated need for new RBCs, as well as whether the bone marrow is capable of meeting that demand. Overproduction of RBCs may be detected in some cases.

When anemia is present and the bone marrow responds adequately to the demand for more RBCs, the bone marrow will create more and allow for the early release of more immature RBCs, resulting in an increase in the number of reticulocytes in the blood.

A high reticulocyte count along with low RBCs, hemoglobin, and hematocrit may indicate the following conditions:

  • When a person bleeds, the number of reticulocytes increases after a few days to make up for the loss of red blood cells. If someone has chronic blood loss, the marrow will try to keep up with the need for new RBCs by increasing the number of reticulocytes.
  • Anemia is caused by an increase in the breakdown of RBCs in hemolytic anemia. To compensate, the bone marrow boosts RBC production, resulting in a high reticulocyte count.
  • Hemolytic illness of the newborn: Similar to hemolytic anemia, this syndrome causes an increase in RBC destruction.

For example, a low reticulocyte count with low hemoglobin, low red blood cells, and low hematocrit can be detected when:

  • Anemia due to a lack of iron
  • Folic acid deficiency or pernicious anemia
  • Aplastic anemia is a kind of anemia that occurs when the
  • Radiation therapy is a type of treatment that uses a
  • Infection or malignancy can induce bone marrow failure.
  • A low level of erythropoietin can be caused by severe kidney disease.
  • Alcoholism
  • Endocrine illness

When a person has anemia, the percentage of reticulocytes in their blood may appear to be higher than the total number of RBCs. A calculation known as a corrected reticulocyte count or reticulocyte index may be reported to get a more accurate estimate of bone marrow function. When a person's hematocrit is compared to a normal hematocrit reading, the RI is computed. The reticulocyte production index and an immature reticulocyte fraction are two more estimates that may be presented. The IRF was once known as the reticulocyte maturity index, but it is currently the most widely used phrase to describe the younger percentage of reticulocytes.

The existence of a disease or condition is indicated by the reticulocyte test, however it is not specifically diagnostic of any disease. It's a warning that more research is needed, as well as a method for monitoring therapy effectiveness.

When reticulocyte numbers increase after chemotherapy, a bone marrow transplant, or treatment for an iron, vitamin B12, or folate shortage, bone marrow RBC production is on the mend.

A high reticulocyte count can indicate an overproduction of RBCs in people who do not have anemia or have a high RBC count. This can be caused by a variety of factors, including:

  • Polycythemia vera
  • Excess erythropoietin-producing tumor

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


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Description: Transferrin is a blood test used to measure the amount of transferrin in the blood's serum. It is used to evaluate if there is a proper amount of iron being transport throughout the body. A test called Total Iron Binding Capacity, or TIBC, will tell you how much of that transferrin is capable of transporting, or binding to the iron in the blood.

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Fasting for at least 12 hours is required

When is a Transferrin test ordered?

When a doctor wants to analyze or monitor a person's nutritional health, a transferrin test may be ordered along with additional tests like prealbumin.

What does a Transferrin blood test check for?

The primary protein in the blood that bonds to iron and transfers it across the body is transferrin. Total iron binding capacity, unsaturated iron binding capacity, and transferrin saturation are all measures of how much transferrin is available to bind to and transport iron.

The transferrin serum test, along with TIBC, UIBC, and transferrin saturation, measures the blood's ability to bind and transport iron, and is an indicator of iron storage.

Lab tests often ordered with a Transferrin test:

  • Iron Total
  • Iron Total and Total Iron Binding Capacity
  • Ferritin
  • Complete Blood Count (CBC)
  • Hemoglobin
  • Hematocrit
  • Reticulocyte Count

Conditions where a Transferrin test is recommended:

  • Iron Deficiency Anemia
  • Hemochromatosis
  • Liver Disease
  • Malnutrition

How does my health care provider use a Transferrin test?

When assessing a person's nutritional state or liver function, a transferrin test is commonly performed. Transferrin will be low in people with liver disease because it is produced in the liver. Transferrin levels fall when there isn't enough protein in the diet, so this test is used to keep track of your diet.

What do my transferrin test results mean?

The findings of transferrin testing are frequently compared to the results of other iron tests.

If you have the following conditions, you may have a low transferrin level:

  • Hemochromatosis
  • Anemia caused by a build-up of iron in the body can cause a variety of symptoms.
  • Malnutrition
  • Inflammation
  • Hepatitis
  • A kidney ailment that causes protein loss in the urine such as nephrotic syndrome

When there is an iron deficit, transferrin saturation decreases, and when there is an overabundance of iron, such as in iron overload or poisoning, it increases.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A Vitamin B12 test is a blood test that measures the level of Vitamin B12 in the blood’s serum and is used to detect Vitamin B12 deficiency.

Also Known As:  B12 Test, Cobalamin Test, Vitamin B12 test, Serum B12 Test 

Collection Method: Blood Draw 

Specimen Type: Serum 

Test Preparation: No preparation required. 

When is a Vitamin B12 test ordered?  

When a complete blood count and/or blood smear, performed as part of a health checkup or anemia evaluation, reveal a low red blood cell count with the presence of big RBCs, vitamin B12 levels may be ordered. A high mean corpuscular volume implies that the RBCs have grown in size. 

When a person exhibits the following signs and symptoms of a deficit, testing for B12 levels may be necessary: 

  • Diarrhea 
  • Dizziness 
  • Muscle weakness, fatigue 
  • Appetite loss. 
  • Skin that is pale 
  • Irregular heartbeats, rapid heart rate 
  • Breathing problems 
  • Tongue and mouth ache 
  • In the feet, hands, arms, and legs, there is tingling, numbness, and/or burning 
  • Confusion or obliviousness 
  • Paranoia 

When a person is at risk of deficiency, such as those with a history of malnutrition or a condition associated to malabsorption, B12 tests may be required. 

Individuals being treated for malnutrition or a B12 or folate deficit may have these tests done on a frequent basis to see how effective their treatments are. This could be part of a long-term therapy plan for people who have a disease that causes chronic deficiency.  

What does a Vitamin B12 blood test check for? 

Vitamin B12 is a member of the vitamin B complex. It is required for the creation of normal red blood cells, tissue and cell healing, and the synthesis of DNA, the genetic material in cells. Vitamin B12 is a nutrient that the body cannot make and must be obtained through the diet. 

Vitamin B12 deficiency is detected by measuring vitamin B12 in the liquid portion of the blood. 

A B12 deficiency can cause macrocytic anemia, which is characterized by red blood cells that are bigger than normal. Megaloblastic anemia is a kind of macrocytic anemia marked by the generation of fewer but larger RBCs known as macrocytes, as well as cellular abnormalities in the bone marrow. Reduced white blood cell and platelet count are two other test results linked to megaloblastic anemia. 

B12 is also necessary for nerve function, and a lack of it can induce neuropathy, which causes tingling and numbness in the hands and feet of those who are affected. 

B12 deficiency is most commonly caused by a lack of vitamin B12 in the diet or supplements, insufficient absorption, or an increased requirement, such as during pregnancy. 

Lab tests often ordered with a Vitamin B12 test: 

  • Folate 
  • Methylmalonic Acid (MMA) 
  • Homocysteine 
  • Vitamin B1 
  • Vitamin B2 
  • Vitamin B3 
  • Vitamin B5 
  • Vitamin B6 
  • Vitamin B7 
  • Rheumatoid factor 

Conditions where a Vitamin B12 test is recommended:

  • Vitamin B12 Deficiency 
  • Pernicious Anemia 
  • Nerve Damage 
  • Malabsorption 
  • Malnutrition 

How does my health care provider use a Vitamin B12 test? 

Vitamin B12 and folate are frequently used in conjunction to detect deficiencies and to aid in the diagnosis of anemias such as pernicious anemia, an inflammatory condition that inhibits B12 absorption. 

B12 and folate are two vitamins that the body cannot generate and must be obtained from the diet. They are essential for the creation of normal red blood cells, tissue and cell repair, and the synthesis of DNA, the genetic material in cells. B12 is required for normal nerve function. 

B12 and folate tests can also be used to assess someone who is experiencing mental or behavioral changes, especially in the elderly. A B12 test can be ordered with or without folate, as well as with other screening laboratory tests like a complete blood count, comprehensive metabolic panel, antinuclear antibody, C-reactive protein, and rheumatoid factor to help determine why a person is exhibiting signs and symptoms of a nerve condition. 

B12 and folate tests can also be performed in conjunction with a variety of other tests to assess a person's overall health and nutritional status if they have signs and symptoms of substantial malnutrition or dietary malabsorption. People with alcoholism, liver disease, stomach cancer, or malabsorption diseases including celiac disease, inflammatory bowel disease, or cystic fibrosis may fall into this category. 

Testing may be performed to assess the success of treatment in patients with known B12 and folate deficits. This is especially true for people who cannot absorb B12 and/or folate effectively and must be treated for the rest of their lives. 

Folate levels in the blood's serum might fluctuate depending on a person's recent diet. Because red blood cells contain 95 percent of circulating folate, a test to evaluate folate levels inside RBCs could be employed instead of or in addition to the serum test. Some doctors believe that the RBC folate test is a better predictor of long-term folate status and is more clinically useful than serum folate, however there is no consensus on this. 

Homocysteine and methylmalonic acid are two more laboratory tests that can be used to detect B12 and folate deficits. In B12 deficiency, both homocysteine and MMA are high, whereas in folate deficit, only homocysteine, not MMA, is elevated. This distinction is critical because treating anemia with folate treats the anemia but not the brain damage, which may be irreparable. 

What do my Vitamin B12 test results mean? 

Normal B12 and folate levels may indicate that a person does not suffer from a deficiency and that the signs and symptoms they are experiencing?are caused by something else. Normal levels, on the other hand, may indicate that a person's stored B12 and/or folate has not yet been depleted. 

A health practitioner may order a methylmalonic acid test as an early sign of B12 deficiency if a B12 level is normal but a deficiency is still suspected. 

A low B12 and/or folate level in a person with signs and symptoms implies a deficiency, although it does not always indicate the severity of the anemia or related neuropathy. Additional tests are frequently performed to determine the source of the deficit. Low B12 or folate levels can be caused by a variety of factors. 

Dietary folate or B12 deficiency, which?is uncommon in the United States. It can be evident in people who are malnourished in general and vegans who do not eat any animal products. Folate deficiency has become extremely rare since the development of fortified cereals, breads, and other grain products. 

Both B12 and folate deficits can be caused by diseases that prevent them from being absorbed in the small intestine. These may include the following: 

  • Pernicious anemia 
  • Celiac disease 
  • Crohn's disease and ulcerative colitis are examples of inflammatory bowel disease. 
  • Bacterial overgrowth or the presence of parasites in the intestines, such as tapeworms 
  • Long-term usage of antacids or H2 proton pump inhibitors reduces stomach acid production. 
  • Absorption can be considerably reduced by surgery that removes part of the stomach or the intestines, such as gastric bypass. 
  • Insufficiency of the pancreas 
  • Chronic alcoholism or heavy drinking 
  • Some treatments, such as metformin, omeprazole, methotrexate, or anti-seizure medications like phenytoin, are used. 
  • Increased requirements for healthy fetal development, all pregnant women require an increased amount of folate and are advised to consume 400 micrograms of folic acid every day. The need for folate is higher in those who have cancer that has spread or who have chronic hemolytic anemia. 
  • Smoking 

If a person is being treated for a B12 or folate deficit with supplements, normal or higher findings suggest that the treatment is working. 

High amounts of B12 are uncommon, and they aren't routinely evaluated clinically. If a person has a condition such chronic myeloproliferative neoplasm, diabetes, heart failure, obesity, AIDS, or severe liver disease, their vitamin B12 level may be elevated. High B12 levels can also be caused by using estrogens, vitamin C, or vitamin A. 

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.


Description: A B12 and Folate test measures the levels of B12 and folic acid in the blood. These results can be used to determine a B12 and/or folate deficiency and evaluate a person's nutritional status. Anemia and Neuropathy can also be evaluated using the results from this test.

Also Known As: Vitamin B12 and Folate test, Cobalamin and Folic Acid Test, Vitamin B12 and Vitamin B9 Test, Vitamin B12 Test, Vitamin B9 Test, Cobalamin Test, Folic Acid Test, Folate Test

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is Vitamin B12 and Folate panel test ordered?

When a complete blood count and/or blood smear, performed as part of a health checkup or anemia evaluation, reveal a low red blood cell count with the presence of big RBCs, B12 and folate levels may be ordered. A high mean corpuscular volume, in particular, implies that the RBCs are enlarged.

When a person exhibits the following signs and symptoms of a deficit, testing for B12 and folate levels may be necessary.

  • Diarrhea
  • Dizziness
  • Muscle weakness, fatigue
  • Appetite loss.
  • Skin that is pale
  • Irregular heartbeats, rapid heart rate
  • Breathing problems
  • Tongue and mouth ache
  • In the feet, hands, arms, and legs, there is tingling, numbness, and/or burning 
  • Confusion or obliviousness
  • Paranoia

When a person is at risk of deficiency, such as those with a history of malnutrition or a condition associated to malabsorption, B12 and folate testing may be ordered.

Individuals being treated for malnutrition or a B12 or folate deficit may have these tests done on a frequent basis to see how effective their treatments are. This could be part of a long-term therapy plan for people who have a disease that causes chronic deficiency.

What does a Vitamin B12 and Folate panel blood test check for?

The B complex of vitamins includes vitamins including vitamin B12 and folate. They are required for the creation of normal red blood cells, tissue and cell repair, and the synthesis of DNA, the genetic material in cells. Both are nutrients that the body cannot make and must be obtained from the diet.

Vitamin B12 and folate tests diagnose vitamin deficiencies by measuring vitamin levels in the liquid section of the blood. The amount of folate in red blood cells is sometimes tested as well.

Folate is a naturally occurring form of the vitamin, whereas folic acid is a supplement that can be added to foods and beverages. Leafy green vegetables, dry beans and peas, citrus fruits, yeast, and liver all contain it. Vitamin B12, also known as cobalamin, can be found in animal-based foods such red meat, fish, poultry, milk, yogurt, and eggs. Fortified cereals, breads, and other grain products have become key sources of B12 and folate in recent years.

A lack of B12 or folate can cause macrocytic anemia, a condition in which red blood cells are bigger than normal. Megaloblastic anemia is a kind of macrocytic anemia marked by the generation of fewer but larger RBCs known as macrocytes, as well as cellular abnormalities in the bone marrow. Reduced white blood cell and platelet counts are two more test results linked to megaloblastic anemia.

B12 is also necessary for nerve function, and a lack of it can induce neuropathy, which causes tingling and numbness in the hands and feet of those who are affected.

Folate is required for cell division, which occurs in the developing fetus. In a growing fetus, a lack of folate during early pregnancy can raise the chance of neural tube abnormalities such spina bifida.

B12 and folate deficiency is most commonly caused by not getting enough of the vitamins through diet or supplements, poor absorption, or increased requirement, as observed during pregnancy:

  • Dietary deficiencies are uncommon in the United States since many meals and beverages are fortified with vitamins that the body stores. Adults normally have many years' worth of vitamin B12 and around three months' worth of folate stored in their liver. Dietary deficiencies normally do not manifest symptoms until the body's vitamin supplies have been exhausted. Vegans and their breast-fed infants can suffer from B12 deficiency.
  • Inadequate absorption—the absorption of vitamin B12 is a multi-step process. B12 is normally released from food by stomach acid and then bound to intrinsic factor, a protein produced by parietal cells in the stomach, in the small intestine. After being absorbed by the small intestine and bound by carrier proteins, the B12-IF complex reaches the blood. B12 absorption is hampered if any of these processes are disrupted by a disease or condition.
  • Increased demand—this can occur as a result of a range of diseases and disorders. When a woman is pregnant or nursing, in early childhood, with malignancies, or with chronic hemolytic anemias, there is an increased demand for folate.

Lab tests often ordered with a Vitamin B12 and Folate panel test:

  • Complete Blood Count
  • Methylmalonic Acid
  • Homocysteine
  • Vitamin B1
  • Vitamin B3
  • Vitamin B5
  • Vitamin B6
  • Vitamin B7
  • Intrinsic Factor Antibody
  • Parietal Cell Antibody
  • Reticulocyte Count

Conditions where a Vitamin B12 and Folate panel test is recommended:

  • Neural Tube Defects
  • Vitamin B12 and Folate Deficiencies
  • Anemia
  • Alcoholism
  • Malnutrition
  • Celiac Disease
  • Malabsorption
  • Neuropathy
  • Inflammatory Bowel Disease

How does my health care provider use a Vitamin B12 and Folate panel test?

Separate tests for vitamin B12 and folate are frequently used in conjunction to detect deficiencies and to aid in the diagnosis of anemias such as pernicious anemia, an inflammatory condition that inhibits B12 absorption.

B12 and folate are two vitamins that the body cannot generate and must be obtained from the diet. They're needed for red blood cell creation, tissue and cell repair, and DNA synthesis, which is the genetic material in cells. B12 is required for normal nerve function.

B12 and folate tests can also be used to assess someone who is experiencing mental or behavioral changes, especially in the elderly. A B12 test can be ordered with or without folate, as well as with other screening laboratory tests like a complete blood count, comprehensive metabolic panel, antinuclear antibody, C-reactive protein, and rheumatoid factor, to help determine why a person is exhibiting signs and symptoms of a nerve disorder.

B12 and folate tests can also be performed in conjunction with a variety of other tests to assess a person's overall health and nutritional status if they have signs and symptoms of substantial malnutrition or dietary malabsorption. People with alcoholism, liver disease, stomach cancer, or malabsorption diseases including celiac disease, inflammatory bowel disease, or cystic fibrosis may fall into this category.

Testing may be performed to assess the success of treatment in patients with known B12 and folate deficits. This is especially true for people who cannot absorb B12 and/or folate effectively and must be treated for the rest of their lives.

Folate levels in the blood's liquid part might fluctuate depending on a person's recent diet. Because red blood cells contain 95 percent of circulating folate, a test to evaluate folate levels inside RBCs could be employed instead of or in addition to the serum test. Some doctors believe that the RBC folate test is a better predictor of long-term folate status and is more clinically useful than serum folate, however there is no consensus on this.

Homocysteine and methylmalonic acid are two more laboratory tests that can be used to detect B12 and folate deficits. In B12 deficiency, both homocysteine and MMA are high, whereas in folate deficit, only homocysteine, not MMA, is elevated. This distinction is critical because treating anemia with folate treats the anemia but not the brain damage, which may be irreparable.

What do my Vitamin B12 and Folate test results mean?

Normal B12 and folate levels may indicate that a person does not suffer from a deficiency and that the signs and symptoms are caused by something else. Normal levels, on the other hand, may indicate that a person's stored B12 and/or folate has not yet been depleted.

A health practitioner may request a methylmalonic acid test as an early sign of B12 insufficiency if a B12 level is normal but a deficiency is still suspected.

A low B12 and/or folate level in a person with signs and symptoms implies a deficiency, although it does not always indicate the severity of the anemia or related neuropathy. Additional tests are frequently performed to determine the source of the deficit. Low B12 or folate levels can be caused by a variety of factors, including:

Dietary folate or B12 deficiency is uncommon in the United States. It can be evident in people who are malnourished in general and vegans who do not eat any animal products. Folate deficiency has become extremely rare since the development of fortified cereals, breads, and other grain products.

Both B12 and folate deficits can be caused by diseases that prevent them from being absorbed in the small intestine. These may include the following:

  • Pernicious anemia.
  • Celiac disease
  • Crohn's disease and ulcerative colitis
  • Bacterial overgrowth or the presence of parasites in the intestines, such as tapeworms
  • Long-term usage of antacids or H2 proton pump inhibitors reduces stomach acid production.
  • Absorption can be considerably reduced by surgery that removes part of the stomach or the intestines, such as gastric bypass.
  • Insufficiency of the pancreas
  • Chronic alcoholism or heavy drinking
  • Some treatments, such as omeprazole, metformin, methotrexate, and/or anti-seizure medications like phenytoin.
  • Increased requirement for healthy fetal development, all pregnant women require an increased amount of folate and are advised to consume 400 micrograms of folic acid every day. People who have cancer that has spread or who have chronic hemolytic anemia require more folate.
  • Smoking

If a person is taking supplements to treat a B12 or folate deficiency, normal or higher findings indicate that the treatment is working.

High amounts of B12 are uncommon, and they aren't routinely evaluated clinically. If a person has a condition such chronic myeloproliferative neoplasm, diabetes, heart failure, obesity, AIDS, or severe liver disease, their vitamin B12 level may be elevated. High B12 levels can also be caused by using estrogens, vitamin C, or vitamin A.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.



Anemia is a type of condition that arises whenever the hemoglobin amount within an individual’s blood dips below normal. Often, a reduction in hemoglobin is associated with a reduction in the number of hematocrit and red blood cells (or RBCs). Hemoglobin is contained inside of red blood cells, and it is necessary for transporting and delivering oxygen from a person’s lungs to the other parts of their body. If the supply of oxygen is not enough, many organs and tissues in the body may be affected adversely. Individuals with anemia might lack energy and experience weakness and fatigue. 

Anemia is a common condition. It affects both women and men of all ethnic groups, races, and ages. However, certain individuals have an increased risk of developing anemia. Those people include ones with diets lacking in vitamin and irons, chronic diseases like inflammatory bowel disease, cancer, diabetes, and kidney disease, a family history for inheriting anemia, those with significant blood loss due to surgery or an injury, and chronic infections like HIV or tuberculosis. Anemia may be severe, moderate, or mild, depending on how much hemoglobin or RBC count is reduced.

The primary causes of anemia include the following:

  • Decreased or impaired production of red blood cells by bone marrow because of a nutritional deficiency (e.g., B vitamin deficiencies or an iron deficiency)
  • A disease involving bone marrow (e.g., solid tumor, lymphoma, or an infection)
  • Bone marrow failure (e.g., myelodysplastic syndrome, aplastic anemia)
  • Loss of red blood cells from bleeding or increased RBC destruction, as in hemolytic anemia

Anemia can be chronic or acute. Chronic anemic might develop over a long period of time with long-term illnesses like cancer, chronic kidney disease, or diabetes. In those circumstances, the anemia-related symptoms might not be apparent due to the underlying disease masking it and/or anemia is adapted to by the body when it is developed over an extended period. When anemia is present in chronic conditions, it often goes undetected for a while. It might only be discovered after examinations or tests are conducted for other conditions. 

Anemia might also arise in acute episodes like with significant loss of blood (invasive surgery or extensive injury) or with specific conditions where a high number of red blood cells are destroyed. Symptoms and signs can become apparent very fast, and the cause may be determined through a combination of testing, medical history, and physical examination.

Types of Anemia

Anemias may also be described based on the size of the red blood cells and the concentration of hemoglobin that is contained inside of them. If the size of the cells is a lot smaller than normal, this is referred to as microcytic anemia. It is called macrocytic anemia when it is much larger than normal. Also, if the hemoglobin concentration is a lot lower than normal, it is referred to as hypochromic anemia. The RBCs are referred to as hyperchromic if the concentration is a lot higher than normal.

Within the two major categories of general anemia causes, several kinds have different specific causes. The following are some of the most common types, with each section containing information on each of them. 

Iron-deficiency Anemia

Iron-deficiency anemia is a common form of anemia that has many different causes. The symptoms relate to the level of hemoglobin and the overall reduction in the number of RBCs. In mild to moderate iron-deficiency anemia, there might not be any symptoms or signs. Along with the most common symptoms and signs, iron deficiency anemia has some that unique to it. It might appear in the form of iron stores inside bodies that are chronically depleted.

They can include the following: 

  • A craving for eating unusual non-food substances like dirt or ice (also referred to as “pica”)
  • Difficulty in swallowing
  • Ulcers or cracks in the corners of the mouth
  • Sore or swollen tongue
  • Spoon-shaped or brittle nails

Iron is a critical trace element that is needed for producing healthy red blood cells. It is a heme component, part of the hemoglobin, which is a protein inside of red blood cells that bind with oxygen and makes it possible for oxygen to be transported by RBCS throughout the entire body. If there is not a enough iron taken compared to what is needed by the body, then the iron that is stored inside of the body starts being used up. As the stores of iron are depleted, fewer RBCs are made by the body with a reduced amount of hemoglobin contained in them, which results in anemia.

Some iron deficiency causes include the following:

  • Chronic bleeding – When there is excessive bleeding over an extended time (chronic), then the iron stored in the body is depleted gradually, and this results in the body being unable to produce a enough red blood cells and hemoglobin. Iron deficiency in women might be due to bleeding fibroids or heavy menstrual periods. In older men and women, the bleeding is generally from intestinal diseases like cancer and ulcers.
  • Dietary deficiency – An iron deficiency might be caused by a diet that lacks a enough iron. Certain beans, dark leafy greens, iron-fortified foods, fish, poultry, and meat are all excellent iron sources. Children and nursing or pregnant women especially need to have more iron because they have increased requirements. Lack of iron in pregnant women may lead to premature delivery and low birth weight infants. Women who plan to become pregnant or who are pregnant take iron supplements regularly to prevent those complications from occurring. Newborns who nurse from a mother who is iron deficient will tend also to develop iron deficiency anemia.
  • Absorption problem – Certain conditions affect iron being absorbed from the food inside of the gastrointestinal (GI) tract. Malabsorption can result in anemia over time. Those conditions include Crohn disease, celiac disease, intestinal surgery like gastric bypass, and a reduction in stomach acid due to the use of prescription medicines.

Laboratory Tests

Typically, initial blood tests will include conducting a complete blood count (CBC).Test results might show:

Hemoglobin (Hb) – levels might be normal during the early phases of the disease, but as anemia worsens, it will decrease.

Red blood cell indices – During the early stages, the red blood cells might be a normal color (normocytic, normochromic) and size. However, as the anemia continues to progress, the red blood cells become paler (hypochromic) and smaller (microcytic) than average.

The average size of red blood cells (MCV, mean corpuscular volume) – decreased

Average amounts of hemoglobin contained in red blood cells (MCH, mean corpuscular hemoglobin) – decreased

Hemoglobin concentration (MCHC, mean corpuscular hemoglobin concentration) – decreased

Increased variations in red blood cell size (RDW, red cell distribution width)

A blood smear might reveal red blood cells that are paler and smaller than normal and red blood cells that vary in shape (poikilocytosis) and size (anisocytosis). 

If a healthcare professional suspects that an iron deficiency is causing a person’s anemia, then several follow-up tests might be conducted to confirm the suspected iron deficiency. They can include the following:

Serum iron – the iron level in a person’s blood, normally decreased ferritin – which is a protein used for storing iron. The small amount of ferritin released in the blood reflects the amount of iron that is stored in the body and is usually low with iron deficiency anemia. It is viewed as the most specific test to identify iron deficiency anemia unless there is inflammation or infection present.

Total iron-binding capacity (TIBC) and transferrin – transferrin is a type of protein that binds to iron and carries it throughout the blood; TIBC reflects the amount of transferrin that is available for binding to iron. With iron deficiency anemia, TIBC and the transferrin level are both high.

Reticulocyte count – the reticulocytes are immature, young red blood cells. There is a low number of reticulocytes contained in iron deficiency anemia since there is insufficient iron for producing new red blood cells.

Soluble transferrin receptor (sTfR) – the test is mainly ordered to help with distinguishing between anemia caused by a chronic illness or inflammation and anemia that is caused by an iron deficiency. It might be ordered instead of ferritin whenever an individual has inflammation suspected or present or has a chronic illness. In iron deficiency, it is high. 

If iron deficiency is believed to be caused by chronic loss of blood, like with GI tract bleeding, other procedures and tests might be conducted. Lab tests that might have the ability to detect GI bleeding are fecal immunochemical test (FIT) or fecal occult blood test (FOBT).

Testing for Helicobacter pylori might detect a bacterium that might cause ulcers within the GI tract that could be due to chronic bleeding. If there are any positive test results, or if there is a strong suspicion that GI bleeding does exist, then procedures like colonoscopy or endoscopy might be performed in order to find where the bleeding is located so that it may be treated.

Treatment

Typically, treating iron deficiency involves changes in diet and/or iron supplements. Vitamin C can also help with absorbing iron. However, if it is suspected that iron deficiency is the result of abnormal blood loss, additional testing may be necessary in order to determine what is causing the bleeding. Individuals who have severe iron deficiency might need iron therapy via injections or intravenous (IV) or a transfusion of blood cells. Once the underlying cause has been discovered and treated, the anemia usually resolves.

Pernicious anemia as well as Other Types of B Vitamin Deficiencies

Pernicious anemia is where not enough vitamin B12 is absorbed by the body to produce a enough RBCs. This occurs whenever the body does not produce enough of a substance referred to as “intrinsic factor,” which is a protein that the cells inside the stomach lining produce that binds with vitamin B12 so that it can be absorbed inside of the small intestine. When there is an insufficient amount of intrinsic factor, the body is unable to absorb vitamin B12 from the person’s diet, which reduces the body’s ability to produce a enough healthy red blood cells. This leads to anemia. Other causes of anemia and vitamin B12 deficiency include dietary deficiency as well as conditions affecting the absorption of vitamin B12 from the small intestines like infections, digestive disorders (Chrohn disease, celiac disease), certain drugs, and surgery. The most common of the causes of B12 deficiency is pernicious anemia.

Vitamin B12 deficiency may result in general anemia symptoms in addition to nerve problems. They might include the following:

  • Unsteady walking
  • Loss of balance
  • Slow reflexes
  • Muscle weaknesses
  • Tingling and numbness that begins in the feet and hands (from nerve damage)
  • In severe cases, dementia, depressions, memory loss, and/or confusion

Another B vitamin is folic acid, and deficiency in that vitamin might also result in anemia. Folic acid, which is also called folate, is contained in numerous foods, particularly in leafy, green vegetables. In the U.S., folic acid gets added to most grain products, so folic acid is seen only rarely in the U.S. these days. During pregnancy, folic acid is required for the regular development of the spinal cord and brain. It is essential for women who are considering pregnancy to ingest the right amounts of folate supplements before becoming pregnant and throughout their pregnancies, to ensure they do not become folate deficient.

Anemia that results from a folate or vitamin B12 deficiency is frequently called “megaloblastic anemia” since the red blood cells are bigger than normal. Lacking these vitamins does not allow red blood cells to develop in a normal way, which results in their larger size. That results in anemia and a reduced number of abnormally larger sized RBCs.

Laboratory Tests

Additional tests are normally conducted to ensure the diagnosis. Some of those include the following:

A biopsy or bone marrow aspiration might be performed sometimes to find out if the appearance of the marrow is consistent with megaloblastic anemia as well as to rule other types of bone marrow disorders out that might cause anemia as well with larger red blood cells.

Treatment

Treatment for these conditions involves supplementation with whatever vitamin is deficient. If the deficiency is caused by the inability to absorb vitamin B12 out of the digestive tract, the vitamin might be given in the form of injections. Treating underlying causes like infection or digestive disorders might also help with resolving anemia.

Aplastic Anemia

Aplastic Anemia is a rare disease that is caused by a reduction in the number of all blood cell types that are produced by the bone marrow. The bone marrow normally produces a enough new platelets, white blood cells, and red blood cells for normal body functioning. Each kind of cell enters the blood circulates and finally dies within a certain amount of time. For example, red blood cells have a normal lifespan of around 120 days. If bone marrow is unable to produce a enough blood cells as replacements for the ones that die, then several symptoms might result, including those caused by anemia. This type of anemia may be severe, and in some cases, fatal. 

Aplastic anemia symptoms might develop slowly or appear abruptly. Some of the common general symptoms to various kinds of anemia might appear first and due to the reduction in red blood cells.

Some additional symptoms and signs that might arise with aplastic anemia include ones that are due to a reduction in platelets include the following:

  • Heavy menstrual bleeding
  • Blood within the stool
  • Pinpoint red spots on the skin
  • Easy bruising
  • Frequent bleeding gums and nose bleeds
  • Prolonged bleeding
  • There might also be symptoms and signs as a result of low white blood cell count:
  • Fever
  • Increased severity and frequency of infections
  • Usually, aplastic anemia causes are related to damage to stem cells within the bone marrow, which are responsible for producing blood cells. Some of the factors that might be involved with damage to bone marrow that might result in aplastic anemia include the following:
  • Medicines like chloramphenicol (this is an antibiotic that is used rarely in the U.S.)
  • Viral infections like CMV, EBV, HIV, or hepatitis
  • Autoimmune disorders like rheumatoid arthritis or lupus
  • Cancer therapy (chemotherapy or radiation)
  • Exposure to certain toxic substances such as pesticides, benzene (contained in gasoline), or arsenic
  • Aplastic anemia is rarely due to a genetic (inherited) disorder like Fanconi anemia. Consult the Fanconi Anemia Research website for more on the rare blood condition
  • Other genetic disorders that lead to aplastic anemia include dyskeratosis congenita and Shwachman-Diamond syndrome

Laboratory Tests

Complete blood count (CBC) is the initial anemia test, and it can reveal many different abnormal results, including the following:

Differential white blood counts are reduced in most kinds of cells other than lymphocytes

  • Usually, red blood indices are normal
  • Low platelet count
  • White blood cell and red blood cell counts are low
  • Hematocrit and/or hemoglobin levels might be low
  • Some of the additional tests that might be conducted to help determine the cause and type of anemia include the following:
  • ANA – for determining if autoimmune disease is the cause
  • Vitamin B12 tests or iron tests might be performed for ruling out other causes
  • Tests for the heavy metal arsenic and other toxins  
  • Tests for infections like CMVEBV, HIV, and hepatitis can help with determining what the cause is
  • Biopsy or bone marrow aspiration will show a reduction in the number of all kinds of cells
  • Erythropoietin – normally is increased in aplastic anemia
  • Reticulocyte count – the count is low

Treatment

A complete medical history or physical examination might reveal potential aplastic anemia causes, like prior cancer treatment, certain drugs (such as chloramphenicol), or exposure to toxins. Some aplastic anemia cases are temporary, but others permanently damage the bone marrow. So, the treatment will depend on what the cause is. Eliminating or reducing exposure to certain drugs or toxins might help with resolving the condition. Medications might be given in order to stimulate the production of the bone marrow, for treating infections, and with autoimmune disorder cases to suppress the immune system. In severe cases, a bone marrow transplant and blood transfusions might be necessary.

Hemolytic Anemia

Anemia is rarely due to problems causing red blood cells to be destroyed or die prematurely. Red blood cells normally live within the blood for around four months. The time is shortened with hemolytic anemia, to just a few days in some cases. The bone marrow is unable to produce new red blood cells fast enough to replace the ones that have been destroyed. The lack of red blood cells leads to a reduced capacity for supplying oxygen to the body’s tissues. That results in typical anemia symptoms. 

Depending on what the cause is, hemolytic anemia might be acute, developing, and last for a long time, or chronic. The various types may have a wide range of symptoms and signs. For more information on this, see the discussions on the various kinds below.

The various hemolytic anemia causes fall into two major categories:

  • Acquired forms where some factor results in red blood cells being destroyed early.
  • Inherited forms where genes or a gene is passed from generation to generation that may result in abnormal hemoglobin or red blood cells.

Inherited Hemolytic Anemia

Thalassemia and sickle cell anemia are two of the more common inherited hemolytic anemia causes:

Sickle cell anemia is a type of disorder where the body produces abnormal hemoglobin. Sickle cell anemia causes the RBCs to become crescent-shaped, and under certain conditions, sickle cells. This “trait” (where one mutated gene is carried from one parent) may cause some minor difficulties. This “disease” (where two mutated genes are carried, one from each parent) can cause severe clinical issues. Misshapen blood cells are very unstable and lead to hemolysis. These misshaped blood cells may block blood vessels, which causes anemia and pain. Usually, newborns are screened for sickle cell anemia, especially those of African descent, since it is more likely that they will have this inherited trait. Screening is sometimes done prenatally on an amniotic fluid sample. Hemoglobin variant follow-up tests might be conducted in order to confirm a diagnosis. Usually, treatment is based on the severity, frequency, and type of symptoms. 

Thalassemia is a type of inherited blood disorder that has an imbalance in the production of hemoglobin globin chains that result in smaller red blood cells and anemia.  The red blood cells only break apart (hemolysis) in rare cases and have reduced lifespans. The “beta major” form (which is also referred to as Cooley’s anemia) might result in severe anemia, jaundice, and growth problems. There is not any significant hemolysis in milder forms. The “beta minor” minor form (which is sometimes referred to as beta thal trait) has no obvious symptoms and might cause mild anemia.

Some of the other less common kinds of inherited hemolytic anemia forms include the following:

  • Hereditary spherocytosis – This results in abnormally shaped red blood cells (spherocytes) that might be observed on a blood smear. The cells are quite rigid and unable to pass through the spleen the way that normal red blood cells can and, therefore, are prematurely destroyed.
  • Hereditary elliptocytosis – this is another cause of red blood cells that are abnormally oval-shaped that may be observed on blood smears.
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency – This is an enzyme that is required for red blood cell survival. If deficient, red blood cells will encounter specific substances within the blood, and the cells will rupture and be destroyed. The substances may include fava beans, antimalarial medications, or naphthalene. G6PD deficiency can be diagnosed by testing for activity. 
  • Pyruvate kinase deficiency – this is another enzyme that is essential for red blood cell survival. Its deficiency causes significant anemia. This disease is rare and can be diagnosed with an enzyme activity test.

Laboratory Tests

Given that some of the inherited forms might have mild symptoms, they might be initially detected on a routine blood smear and complete blood count (CBC), which may reveal different abnormal results that provide clues as to what the cause might be. Then usually, follow-up tests are conducted to make the diagnosis. Some of those tests include the following:

  • Osmotic fragility test – red blood cells are detected that are more fragile than normal, that is sometimes found with hereditary spherocytosis
  • G6PD test – for detecting a deficiency of this enzyme
  • DNA analysis – is not performed routinely but may be used to help with diagnosing thalassemia, hemoglobin variants, and for determining carrier status
  • Hemoglobinopathy evaluation
  • There are no cures for these genetic disorders. However, frequently the symptoms that result from anemia can be alleviated with treatment.

Acquired Hemolytic Anemia

Some factors or conditions involved with acquired hemolytic anemia forms include the following:

  • Autoimmune disorders – conditions where antibodies are produced by the body that act against their very own blood cells. There is not a good understanding of why this might happen. However, it accounts for around half of all hemolytic anemia cases. Certain diseases like hepatitis, HIV, and lupus can increase the risk that a person has for it.
  • Transfusion reaction from an incompatible blood donor. It occurs only rarely. However, it may have serious complications when it does.
  • Infections, like infectious mononucleosis (mono) and malaria
  • Incompatibility of the mother-baby blood group – can result in the newborn developing hemolytic disease.
  • Medications – there are certain medications like penicillin that may trigger the body to start producing antibodies that are directed against the red blood cells or cause the RBCs to be destroyed.
  • Physical destruction of the red blood cells by, for instance, a cardiac bypass machine utilized during open-heart surgery or an artificial heart valve
  • Paroxysmal Nocturnal Hemoglobinuria (PNH) – this is a rare condition where different kinds of blood cells, which include platelets, white blood cells, and red blood cells are abnormal due to lacking certain surface proteins. Since the red blood cells are defective, they are destroyed by the body earlier than what their normal lifespan would be. The disease happens due to a mutation or change in the gene PIGA within the stem cells that produce blood. Although this is a genetic disorder, it is not passed down from generation to generation (it is not an inherited condition). People who are affected frequently pass dark urine because of the hemoglobin that is released by the destroyed red blood cells. It is most noticeable in the morning since that is when urine is in its most concentrated form. 

Laboratory Tests

Quite often, hemolytic anemias are initially identified by symptoms and signs, by medical history, and during physical examination. For example, medical history may reveal cardiac surgery, penicillin treatment, or a recent transfusion. A blood smear and/or CBC might show different abnormal results. Depending on what the findings are, additional follow-up tests might be conducted. Some of them might include the following:

  • Flow cytometry when PNH is suspected
  • Reticulocyte count – which tends to be high
  • Haptoglobin – normally is low
  • Direct antiglobulin test (DAT) – in cases of autoimmune hemolytic anemia, mother-baby blood type incompatibility, or transfusion reaction
  • Autoantibody tests for autoimmune disorders that are suspected
  • Treatment
  • Hemolytic anemia treatments are just as varied as their causes are. However, they have the same goal: treating the anemia’s underlying cause to stop or reduce the destruction of red blood cells and increase hemoglobin level and/or RBC count in order to alleviate symptoms. That might involve the following:
  • Drugs used for suppressing the production of the autoantibodies that destroy red blood cells
  • Blood transfusions for increasing the number of healthy red blood cells
  • Bone marrow transplant – for increasing the production of normal red blood cells
  • Avoiding triggers that may cause anemia, like the cold in some autoimmune hemolytic anemia forms, or for those who have G6PD deficiency, certain medicines, naphthalene, or fava beans.
  • Anemia That is Caused by Certain Chronic Diseases

Some long-term or chronic illnesses can cause anemia. Anemia that is caused by chronic disease often goes undetected until a complete blood count (CBC) or other routine test shows abnormal results. That can result in several follow-up tests being utilized to determine what the underlying cause is. There are numerous chronic diseases and conditions that may cause anemia, including the following:

Kidney disease – the bone marrow produces red blood cells in response to the erythropoietin hormone, which is primarily made by the kidneys. Anemia can be caused by chronic kidney disease from too little of this hormone being produced. Erythropoietin injections can be used to treat the anemia.

Anemia from chronic disease – when chronic diseases are stimulating the inflammatory response of the body, the bone marrow’s ability to respond to erythropoietin is reduced. This mainly due to iron regulation being impaired in the body. Rheumatoid arthritis, for example, (which is a serious joint disease and autoimmune disease that is caused when the body attacks its own joints) may cause anemia via this mechanism. Other diseases that might produce anemia this way include such chronic infections as tuberculosis or HIV. 

Laboratory Tests

Several tests may be utilized to follow up on the abnormal results derived from initial tests like a blood smear and CBC for determining the chronic anemia’s underlying cause. Some of the tests might include the following:

Treatment

Usually, treating anemia caused by chronic conditions involves resolving and/or determine the underlying disease. In the short term, blood transfusions might be used for treating the condition.