1st order laboratory parameters – obligatory laboratory tests.
- Small blood count [normocytic normochromic anemia:
- MCV normal → normocytic
- MCH normal → normochromic
- MCHC normal]]
- Differential blood count [see “Further notes” below]]
- Reticulocytes (“young erythrocytes”) [ ↑↑ ]
- Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate) [ ↑ ]
- Urine status [urinary urobilin ↑ (dark urine)]
- Hemolysis signs – values such as LDH ↑ (lactate dehydrogenase), HBDH ↑ (hydroxybutyrate dehydrogenase), reticulocytes ↑, haptoglobin ↓ and indirect bilirubin ↑ indicating hemolysis (dissolution of red blood cells).
- Methemoglobulin
- Liver parameters – alanine aminotransferase (ALT, GPT), aspartate aminotransferase (AST, GOT), glutamate dehydrogenase (GLDH) and gamma-glutamyl transferase (gamma-GT, GGT); alkaline phosphatase, bilirubin.
Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.
- Iron [serum iron: normal or ↑]
- Ferritin (iron storage protein) [normal or ↑]
- Folic acid
- Vitamin B12
- Transferrin (iron transport protein)
- Soluble transferrin receptor
- Zinc protoporphyrin – is present in excessive levels in iron deficiency.
- Coeruloplasmin – due tohypochromic, microcytic iron refractory anemia; suspected Wilson’s disease.
- Porphyrins – be determined: Delta-aminolevulinic acid in urine; porphobilinogen in urine; porphyrins total etc; wg.suspicion of lead poisoning, acute hepatic porphyrias, other heavy metal poisoning, drug damage to the liver, chronic hepatic porphyrias, acute intermittent porphyria (AIP).
- Cold agglutinins – V.a. acute-passing or chronic cold agglutinin disease, hemolytic anemia, hyperchromic anemia, infections, and many others.
- Hemopexin – estimation of the degree of intravascular hemolysis in the absence of measurable haptoglobin.
- Test for occult (non-visible) blood in stool.
- Infectious agents such as hantavirus.
- Hemoglobin electrophoresis – examination of hemoglobin, in which the individual parts are split.
- Antibody search test – are performed, for example, in transfusion incidents or suspected cold autoantibodies.
- Bone marrow biopsy
Further notes
- The combination of hemolysis, thrombocytopenia (deficiency of platelets/platelets), and fragmentocytes (fragments of destroyed erythrocytes/red blood cells) is suggestive of microangiopathic hemolytic anemia (hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP; Moschkowitz syndrome, Moschcowitz syndrome)).
- For spherocytosis or spherocytosis, small spherical erythrocytes are pathognomonic (evidential). Furthermore, in spherocytosis, there is a decreased osmotic resistance, ie, the erythrocytes hemolyze earlier. The disease manifests itself in childhood. Other symptoms may then be anemia (anemia), splenomegaly (splenomegaly), gallstones (from bilirubins) and jaundice (jaundice).
- Homozygous beta-thalassemia, also known as thalassemia majora, presents in the blood as a severe microcytic, hypochromic, low-grade hemolytic anemia:
- In detail, this presents as a decreased hemoglobin (Hb; blood pigment) level, with the mean hemoglobin content per erythrocyte (MCH ↓) lower than normal and the mean single erythrocyte volume (MCV ↓) decreased. This is called hypochromasia and classifies the anemia as a microcytic hypochromic anemia.
- In the differential blood picture, hypochromic erythrocytes with central compaction can be seen. These are referred to as target or shooting target cells.
