Indications directory

Basic evaluations (screening):

Blood: Full blood count, ESR or CRP, ferritin, haptoglobin, reticulocytes, direct and indirect Coombs-test, folic acid, vitamin B12, methylmalonic acid, hemoglobin-electrophoresis

Urine: Urine status and sedimentation

Stool: Investigation for blood (hemoccult test)

Analysis as per clinical suspicion:

Iron-deficiency anemia:

Iron, ferritin, transferrin, urine status, hemoccult, hemoglobin-electrophoresis, substituted anemia due to vitamin-B12-deficiency. In case of unclear transaminase-increase, also consider non-classical type of Celiac’s disease/sprue (see there).

Hemolytic anemia:

Haptoglobin, LDH, reticulocytes, bilirubin, urine status, direct and indirect Coombs-test, cold agglutinin, osmotic resistance, erythrocyte-enzymes (G-6-PDH, pyruvatkinase and others), hemoglobin-electrophoresis, MetHb, ANA, Ham’s test

Pernicious anemia:

Folic acid, vitamin B12, methylmalonic acid, intrinsic-factor-antibodies (60 %), parietal (or border-) cell antibodies (80 %), haptoglobin, LDH, reticulocytes, bilirubin, CDT, stool for fish tapeworm eggs, TSH, thyroid antibodies, vitamin B12-uptake-problems caused by medication.

Please refer to sections “pancreatitis and Zollinger-Ellison-syndrome”

Sideroblastic anemia:

ESR or CRP, iron, ferritin, haptoglobin, porphyrine in the urine, lead (EDTA-blood), vitamin-B6, CDT, bone marrow cytology- and histology

Tumor- and infection anemia:

ESR or CRP, blood in the stool, transferrin, ferritin, HIV-test (consent required), tbc-diagnostic

Hereditary spherocytosis:

Haptoglobin, LDH, reticulocytes, bilirubin, osmotic resistance, ESR

Erythrocyte enzyme defects:

Haptoglobin, LDH, reticulocytes, bilirubin, erythrocyte-enzymes (glucose-6-phosphatdehydrogenase, pyruvate kinase and others)

Please refer to section “erythrocyte enzymes” (analysis index)

 Hemoglobinopathy:

Hemoglobin-electrophoresis, haptoglobin, LDH, reticulocytes, bilirubin, ferritin

Paroxysmal nocturnal hemoglobinuria:

PNH-diagnostics, evidence of cell membrane defect by flow cytometry, haptoglobin, LDH, reticulocytes, bilirubin, ferritin

Aplastic anemia:

Ham’s test, bone marrow cytology- and histology, pathogen evidence and infection serology (meningococcus, parvovirus B19, CMV, EBV and others), medication anamnesis- or screening from urine

MTHFR-polymorphism:

In hyperhomocysteine-anemia, evaluation of MTHFR-polymorphism

Please also refer to sections “reticulocytes, table DD of anemia (analysis index)