Appropriate Tests


Full blood count. Blood film.

Further investigation is guided by review of clinical features, red cell indices (MCH, MCHC, MCV) and report on blood film.

A Reticulocyte count may be helpful initially with the Full blood count.

Anaemia is often multifactorial - consult pathologist.

Hypochromic, microcytic (MCV <80 fl)


  • Iron deficiency anaemia
  • Thalassaemia
  • Sideroblastic anaemia (hereditary X-linked)
  • Lead poisoning

Iron studies. See also iron deficiency and Table 3. 

Diagnosis of iron deficiency made on low serum ferritin but may be difficult when associated chronic disease/inflammation present with reactive raised serum ferritin, eg, in rheumatoid arthritis.

Ratio of Soluble transferrin receptor / Ferritin may be useful in some cases to differentiate where iron studies are ambiguous.

Haemoglobinopathy/Thalassaemia screen

C-Reactive protein

Bone marrow biopsy (sideroblastic anaemia)


Normochromic, normocytic

Causes include: 

  • Anaemia of chronic disease/ Anaemia of inflammation
  • Early iron deficiency
  • Anaemia of bone marrow failure/infiltration
  • Dilutional anaemia - 'Physiological' anaemia of Pregnancy
  • Fluid overload (e.g. Cardiac failure)
  • Anorexia nervosa
  • Non-spherocytic haemolytic anaemia
  • Haemolysis with impaired bone marrow response
  • Acute blood loss, prior to marrow response

Tests will be guided by clinical history, Full blood count, Reticulocyte count and Blood film.
May include Iron studies, Vitamin B12, Folate, Liver function tests, Protein electrophoresis, inflammatory markers. Bone marrow biopsy, aspirate and trephine, may be indicated if bone marrow disease is suspected.
See also

Anaemia of chronic disease

Iron deficiency


Anorexia nervosa

Leucoerythroblastic anaemia

Normochromic, macrocytic

Causes include:

  • Alcoholism
  • Hepatic failure
  • Myelodysplasia
  • Megaloblastic anaemia
  • Folate deficiency
  • Vitamin B12 deficiency
  • Drug induced
  • Hypothyroidism
  • Paroxysmal nocturnal haemoglobinuria (PNH)
  • Lymphoma
  • Plasma cell myeloma

Tests will be guided by clinical history and Full blood count and Blood film. May include Vitamin B12, Folate, Liver function tests, Thyroid stimulating hormone, Protein electrophoresis including Free light chains (FLC). Bone marrow biopsy, aspirate and trephine, may be indicated if myelodysplasia or other marrow disease suspected.

See also

Paroxysmal nocturnal haemoglobinuria (PNH).

Myelodysplastic syndromes (classification)

Lymphoma (classification)

Plasma cell myeloma

Megaloblastic anaemia

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