by Polsdorfer R

Diagnosis of Nutritional Anemia

Many types of anemia are diagnosed early by routine blood tests during regular physical exams. If not, anemia may be diagnosed when you describe your symptoms to a doctor. The doctor will ask about your symptoms and medical history and perform a physical exam. If your symptoms suggest anemia or other blood conditions, you will have a blood test called a complete blood count (CBC). A CBC determines the number of red blood cells and the amount of hemoglobin in your blood. If you have too few red blood cells or too little hemoglobin, you are considered to have anemia.
The next task for your doctor is to determining what type of anemia you have and what is causing it. Based on your medical history and your CBC, your doctor may be able to determine the cause. A careful assessment of your dietary intake, medical and surgical history, and bowel function may be helpful. Common causes of nutritional anemia include:
  • Iron deficiency, which can be detected in the results of your CBC
  • Hidden blood loss, which may appear to be iron deficiency according to your CBC if the leak is slow enough
  • B12 deficiency
  • Folic acid deficiency
  • Anemia associated with chronic illnesses such as rheumatoid arthritis, though this is not strictly from nutritional causes
Tests to determine the type and cause of anemia include:
CBC—Counts your red and white blood cells, your platelets, and measures your hemoglobin.
Blood Smear—Blood is taken from your finger and smeared on a microscope slide so that red blood cells can be examined directly. Red blood cells have a different appearance depending on the type of anemia. They can be deformed, too big, too small, too variable in size or shape, or filled with visible abnormalities.
Reticulocyte Count—Counts young red blood cells to determine how fast they are being made. Red blood cells only a few days old look different from older ones.
Serum Iron, Iron Binding Capacity, and Ferritin—Tests to determine if you have enough iron in your blood.
Folic Acid and B 12 Levels —Blood tests of these nutrients.
Hemoglobin Electrophoresis—Determines if you have a genetic/hereditary abnormality of your hemoglobin such a sickle cell trait.
Red Cell Fragility—Identifies red blood cells that can be destroyed too easily.
Coombs Tests—Detects antibodies that increase the fragility of red blood cells.
Bone Marrow Biopsy —Removal of a sample of bone marrow tissue to examine the blood-making cells under a microscope.
Your evaluation may be more focused if other organs are involved. For instance, the kidneys make the hormone erythropoietin, which is necessary for red blood cell production. Chronic kidney disease causes a unique kind of anemia that has a specific and effective treatment. (This is not a form of nutritional anemia.)

References

Culleton, BF, Manns, BJ, et al. Impact of anemia on hospitalization and mortality in older adults. Blood. 2006; 107:3841.

Harrison's Principles of Internal Medicine. 16th ed. McGraw-Hill; 2004.

Patel, KV, Harris, TB, et al. Racial variation in the relationship of anemia with mortality and mobility disability among older adults. Blood. 2007.

The Merck Manual of Diagnosis and Therapy 18th ed. Merck & Co; 2006.

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov.

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