Diagnostic approach to Anemia

HEMOGLOBIN decreased

MCV or MCH decreased

Red blood cell count normal / decreased

Iron decreased
Transferrin increased
Transferrin saturation < 20%
Ferritin decreased

Investigate cause and provide treatment

Iron decreased
Transferrin normal / decreased
Transferrin saturation normal / increased
Ferritin normal / increased

Urea, Creatinine increased -> Renal investigation
Globulins increased -> Myeloma investigation
LDH increased -> Hemolysis investigation

Serum Protein electrophoresis
Immunofixation
Immunoglobulin quantification
Serum free light chains

Refer to hematologist for investigation of myeloma

CRP
ESR
Ferritin

Investigate for systemic inflammatory disease or malignancy

Testosterone levels

Refer to hematologist

MCV increased

Reticulocytes decreased or normal

Investigate and treat appropriately

Refer to hematologist for further assessment

Reticulocytes increased

LDH
Bilirubin-indirect Haptoglobin
Direct Coombs Test normal
Blood smear abnormal

Refer to hematologist for further assessment

Evaluate for bleeding

Hemoglobin electrophoresis

Beta thalassemia

Refer to hematologist for further testing for thalassemia

Refer to endocrinologist