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Super Advanced - Anemia Profile

Anemia

91 parameters

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Comprehensive anemia work-up panel.

₹2,999₹3,987

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Parameters

  • List of Tests
    • Calcium
    • Uric Acid
    • 25 OH Vitamin D
    • Ferritin
    • Folic Acid
    • Vitamin B12
    • BUN, Creatinine, BUN/Creatinine
    • Serum Electrolytes (Na, K, Cl)
    • Iron Studies (Iron, TIBC, Transferrin)
    • Liver Function Test (Albumin, Alkaline Phosphatase, Bilirubin - Total, Indirect & Direct, SGOT, SGPT, Total Protein, A/G Ratio, GGT, Globulin)
    • Lipid Profile (Cholestrol/HDL, LDL/HDL, Non-HDL, VLDL, Total Cholestrol, Triglycerides, HDL, LDL)
    • Thyroid Profile - Total T3, Total T4, TSH
    • Hba1c, estimated Average Glucose
    • Protein Electrophoresis (Total Protein, Serum Albumin, Alpha 1 Globulin, Alpha 2 Globulin, Beta 1 Globulin, Beta 2 Globulin, Gamma Globulin, M Band)
    • LDH Serum
    • Hemoglobinopathies (F-Band, A-Band, S-Band, C-Band, E-Band, A2-Band, D-Band, Unknown)
    • CBC - Complete Hemogram (28)
    • Blood Toxic Element Profile (Arsenic, Cadmium, Chromium, Cobalt, Lead, Mercury, Selenium, Barium, Caesium)

Super Advanced - Anemia Profile

  • Why is it done?
    • Comprehensive evaluation of anemia by assessing hemoglobin production, oxygen transport capacity, and red blood cell function
    • CBC (Complete Hemogram) determines hemoglobin levels, hematocrit, red blood cell count, and identifies morphological abnormalities in blood cells
    • Iron Studies (Iron, TIBC, Transferrin) and Ferritin assess iron metabolism and storage to evaluate iron-deficiency anemia
    • Vitamin B12 and Folic Acid levels identify megaloblastic anemia caused by vitamin deficiencies
    • Hemoglobinopathies testing detects abnormal hemoglobin variants associated with conditions like sickle cell disease and thalassemia
    • Liver Function Tests evaluate hepatic protein synthesis capacity and detect liver disease that may contribute to anemia
    • Thyroid Profile (TSH, Total T3, Total T4) screens for thyroid dysfunction which can affect red blood cell production
    • BUN, Creatinine assess kidney function as renal disease impairs erythropoietin production and causes anemia
    • Blood Toxic Element Profile (Arsenic, Cadmium, Lead, Mercury, etc.) identifies heavy metal exposure that may suppress bone marrow function
    • 25-OH Vitamin D and Calcium evaluate nutritional status affecting bone marrow and red blood cell production
    • LDH Serum detects hemolysis and cellular damage patterns in anemia
    • Protein Electrophoresis identifies monoclonal proteins and immunoglobulin abnormalities associated with multiple myeloma affecting red blood cell production
    • HbA1c and estimated Average Glucose screen for diabetes which increases anemia risk through multiple mechanisms
    • Serum Electrolytes (Na, K, Cl) and Lipid Profile provide baseline metabolic status and cardiovascular risk assessment in anemic patients
    • Indicated for patients with symptoms of anemia (fatigue, dyspnea, pallor), chronic disease, suspected nutritional deficiency, or abnormal CBC findings
    • Useful for establishing baseline assessment before treatment initiation and monitoring response to anemia management
  • Normal Range
    • Hemoglobin (CBC component): Males 13.5-17.5 g/dL, Females 12.0-15.5 g/dL; low values indicate anemia
    • Hematocrit (CBC component): Males 41-53%, Females 36-46%; reflects red blood cell percentage in blood volume
    • Red Blood Cell Count (CBC component): Males 4.5-5.9 million/µL, Females 4.1-5.1 million/µL
    • Mean Corpuscular Volume (MCV - CBC): 80-100 fL; defines red blood cell size (microcytic <80, normocytic 80-100, macrocytic >100)
    • Mean Corpuscular Hemoglobin (MCH - CBC): 27-33 pg; indicates hemoglobin amount per red blood cell
    • Red Cell Distribution Width (RDW - CBC): 11.5-14.5%; measures variability in red blood cell size
    • White Blood Cell Count (CBC): 4.5-11.0 × 10³/µL; detects infection or bone marrow disorders
    • Platelet Count (CBC): 150-400 × 10³/µL; normal coagulation function
    • Serum Iron: Males 70-180 µg/dL, Females 50-170 µg/dL; reflects circulating iron available for hemoglobin synthesis
    • Total Iron-Binding Capacity (TIBC): 250-425 µg/dL; measures iron transport capacity
    • Transferrin Saturation: 20-50%; indicates percentage of TIBC occupied by iron
    • Ferritin: Males 30-300 ng/mL, Females 15-200 ng/mL; reflects total iron body stores
    • Vitamin B12: 200-900 pg/mL or 148-665 pmol/L; essential for DNA synthesis and red blood cell maturation
    • Folic Acid (Serum Folate): 2.7-17.0 ng/mL or >5.4 nmol/L; required for red blood cell division
    • LDH (Lactate Dehydrogenase): 140-280 U/L; elevated in hemolytic anemia
    • Hemoglobinopathies: A-band (HbA) 96-98%, A2-band (HbA2) 2-3%, F-band (HbF) <1% in adults; abnormal bands indicate hemoglobinopathies
    • TSH: 0.4-4.0 mIU/L; elevated TSH suggests hypothyroidism affecting red blood cell production
    • Total T4: 5.0-12.0 µg/dL (64-154 nmol/L); low T4 indicates hypothyroidism
    • Total T3: 80-200 ng/dL (1.2-3.1 nmol/L); reflects thyroid function status
    • BUN (Blood Urea Nitrogen): 7-20 mg/dL; elevated indicates kidney dysfunction affecting erythropoietin production
    • Creatinine: Males 0.7-1.3 mg/dL, Females 0.6-1.1 mg/dL; reflects kidney function
    • BUN/Creatinine Ratio: 10:1 to 20:1; elevated ratio may indicate dehydration or prerenal disease
    • Sodium (Na): 136-145 mEq/L; maintains osmotic balance and fluid distribution
    • Potassium (K): 3.5-5.0 mEq/L; critical for cell membrane potential and red blood cell function
    • Chloride (Cl): 96-106 mEq/L; maintains acid-base balance
    • Total Protein: 6.0-8.3 g/dL; reflects nutritional status and bone marrow protein synthesis capacity
    • Serum Albumin: 3.5-5.0 g/dL; main protein synthesized by liver, indicator of nutritional and hepatic status
    • Globulin: 2.0-3.5 g/dL; calculated as Total Protein - Albumin
    • A/G Ratio (Albumin/Globulin): 1.0-2.5; normal ratio indicates balanced protein synthesis
    • Bilirubin - Total: 0.1-1.2 mg/dL; elevated indicates hemolysis or hepatic dysfunction
    • Bilirubin - Direct: 0.0-0.3 mg/dL; elevated suggests biliary obstruction or hepatocellular damage
    • Bilirubin - Indirect: 0.1-0.9 mg/dL; elevated indicates hemolysis
    • SGOT (AST): 10-40 U/L; enzyme present in liver and red blood cells, elevated in hemolysis
    • SGPT (ALT): 7-56 U/L; liver-specific enzyme, elevated in hepatic disease affecting protein synthesis
    • Alkaline Phosphatase: 30-120 U/L; reflects bone and liver activity
    • GGT (Gamma-Glutamyl Transferase): 0-65 U/L; elevated indicates biliary disease or cirrhosis
    • Alpha 1 Globulin (Protein Electrophoresis): 2.0-3.5% of total protein; represents alpha-1 antitrypsin
    • Alpha 2 Globulin (Protein Electrophoresis): 6.0-10.0% of total protein; includes haptoglobin and ceruloplasmin
    • Beta 1 Globulin (Protein Electrophoresis): 4.3-7.3% of total protein
    • Beta 2 Globulin (Protein Electrophoresis): 3.0-6.0% of total protein; includes transferrin and fibrinogen
    • Gamma Globulin (Protein Electrophoresis): 11.0-18.0% of total protein; represents immunoglobulins
    • M Band (Protein Electrophoresis): Absent in normal individuals; presence indicates monoclonal protein
    • Total Cholesterol: <200 mg/dL desired; ≥240 mg/dL indicates cardiovascular risk in anemic patients
    • HDL Cholesterol: >40 mg/dL in males, >50 mg/dL in females; protective factor
    • LDL Cholesterol: <100 mg/dL optimal; reflects atherogenic risk
    • VLDL: 5-40 mg/dL; carries triglycerides from liver
    • Triglycerides: <150 mg/dL; elevated levels affect blood viscosity in anemia
    • HbA1c: <5.7% normal, 5.7-6.4% prediabetic, ≥6.5% diabetic; diabetes increases anemia risk
    • Estimated Average Glucose (eAG): <100 mg/dL normal; calculated from HbA1c
    • Calcium: 8.5-10.5 mg/dL; affects erythroid progenitor cell differentiation and bone marrow function
    • 25-OH Vitamin D: 30-100 ng/mL optimal; deficiency impairs erythropoiesis
    • Uric Acid: Males 3.5-7.2 mg/dL, Females 2.6-6.0 mg/dL; elevated in hemolysis due to cell breakdown
    • Blood Toxic Elements - Arsenic: <10 µg/L (normal); >50 µg/L indicates toxicity affecting bone marrow
    • Blood Toxic Elements - Cadmium: <0.5 µg/L (normal); accumulates in kidneys and suppresses erythropoietin production
    • Blood Toxic Elements - Lead: <5 µg/dL in children, <10 µg/dL in adults; inhibits heme synthesis
    • Blood Toxic Elements - Mercury: <5 µg/L (normal); affects hemoglobin function
    • Blood Toxic Elements - Chromium, Cobalt, Selenium, Barium, Caesium: Laboratory-specific reference ranges; elevated levels suppress bone marrow function
  • Interpretation
    • Hemoglobin <12 g/dL in females or <13.5 g/dL in males indicates anemia; severity graded as mild (>10 g/dL), moderate (7-10 g/dL), or severe (<7 g/dL)
    • MCV classification: Microcytic anemia (MCV <80) suggests iron deficiency or thalassemia; Normocytic anemia (MCV 80-100) indicates hemolysis or acute blood loss; Macrocytic anemia (MCV >100) suggests B12 or folate deficiency or hypothyroidism
    • Iron Studies interpretation: Low iron + high TIBC + low transferrin saturation = iron deficiency; High iron + low TIBC + high ferritin = iron overload or hemochromatosis
    • Ferritin <15 ng/mL indicates depleted iron stores; >400 ng/mL suggests iron overload, infection, inflammation, or malignancy
    • Vitamin B12 <200 pg/mL or <148 pmol/L confirms B12 deficiency causing megaloblastic anemia; 200-400 pg/mL is low-normal and may require intervention
    • Folic Acid <2.7 ng/mL confirms folate deficiency causing megaloblastic anemia; pregnancy and certain medications deplete folate
    • LDH >280 U/L indicates hemolysis; elevated LDH with low haptoglobin and elevated indirect bilirubin confirms hemolytic anemia
    • Hemoglobinopathies interpretation: S-band presence indicates sickle cell trait or disease; C-band suggests hemoglobin C disease; E-band indicates hemoglobin E; Elevated A2-band (>3.5%) indicates beta-thalassemia trait; Elevated F-band (>1%) indicates hereditary persistence of fetal hemoglobin or thalassemia
    • TSH >4.0 mIU/L indicates hypothyroidism reducing erythropoiesis and causing anemia; <0.4 mIU/L suggests hyperthyroidism
    • Creatinine >1.3 mg/dL in males or >1.1 mg/dL in females indicates kidney dysfunction reducing erythropoietin production and causing anemia
    • Low serum albumin (<3.5 g/dL) indicates malnutrition or liver disease affecting protein and hemoglobin synthesis
    • Elevated indirect bilirubin with low haptoglobin indicates hemolysis; direct hyperbilirubinemia suggests hepatic disease affecting hemoglobin degradation
    • M Band present on protein electrophoresis suggests multiple myeloma with associated anemia; elevated gamma globulin supports this diagnosis
    • HbA1c ≥6.5% indicates diabetes mellitus increasing anemia risk through chronic kidney disease and inflammation
    • 25-OH Vitamin D <30 ng/mL indicates deficiency impairing bone marrow erythropoiesis; vitamin D regulates hepcidin and iron absorption
    • Elevated uric acid (>7.2 mg/dL in males, >6.0 mg/dL in females) occurs in hemolytic anemia from massive red blood cell breakdown
    • Lead levels >10 µg/dL cause sideroblastic anemia by inhibiting ALA dehydratase in heme synthesis; microcytic anemia results
    • Arsenic toxicity (>50 µg/L) causes aplastic anemia by suppressing bone marrow; pancytopenia develops
    • Cadmium exposure elevates with renal dysfunction, reducing erythropoietin production and causing anemia
    • Mercury toxicity causes hemolytic anemia and interferes with hemoglobin oxygen binding capacity
    • Abnormal electrolytes: Hyponatremia (<136 mEq/L) affects osmotic balance and hemolysis; Hyperkalemia (>5.0 mEq/L) may indicate hemolysis releasing intracellular potassium
    • RDW >14.5% indicates anisocytosis (variable red blood cell sizes), suggesting mixed anemia or early nutritional deficiency
    • Reticulocyte count (included in CBC): >2% indicates appropriate bone marrow response to anemia; <1% suggests bone marrow insufficiency
    • Leukopenia (WBC <4.5 × 10³/µL) with anemia suggests bone marrow suppression from toxins, medications, or autoimmune disease
    • Thrombocytopenia (<150 × 10³/µL) with anemia indicates pancytopenia from aplastic anemia or bone marrow infiltration
    • Elevated liver enzymes (SGOT, SGPT, ALP) with anemia suggests hemolysis, cirrhosis, or hepatic disease affecting erythropoiesis
  • Associated Organs
    • Bone Marrow: Primary site of red blood cell, white blood cell, and platelet production; CBC evaluates bone marrow function; suppression causes aplastic anemia
    • Iron Metabolism: Iron Studies and Ferritin assess iron stores and transport; deficiency causes microcytic anemia; overload leads to organ damage
    • Gastrointestinal Tract: Primary site of iron, vitamin B12, and folate absorption; malabsorption causes deficiency anemias; internal bleeding contributes to blood loss
    • Liver: Synthesizes albumin and transport proteins; produces haptoglobin (binds hemoglobin); metabolizes bilirubin from hemolysis; liver disease causes anemia through malnutrition and coagulopathy
    • Kidneys: Produce erythropoietin (EPO) stimulating red blood cell production; kidney disease impairs EPO secretion causing anemia; also involved in calcium and vitamin D metabolism
    • Thyroid Gland: Thyroid hormones regulate metabolic rate and red blood cell production; hypothyroidism causes anemia; evaluated by TSH, Total T3, Total T4
    • Pancreas: Insulin production affects glucose metabolism; diabetes increases anemia risk through multiple mechanisms including kidney disease
    • Bone: Calcium metabolism affects bone marrow function and red blood cell production; 25-OH Vitamin D regulates hepcidin and iron absorption
    • Red Blood Cells: Target of hemolysis in autoimmune or hemoglobinopathies; hemoglobinopathies testing identifies genetic variants
    • Spleen: Major site of red blood cell sequestration and destruction; enlargement (splenomegaly) increases hemolysis in hemoglobinopathies
    • Lymphatic System: Produces immunoglobulins detected in protein electrophoresis; plasma cell disorders (multiple myeloma) cause anemia
    • Immune System: Autoimmune hemolytic anemia results from antibody attack on red blood cells; indicated by elevated LDH and reticulocytosis
    • Nervous System: Vitamin B12 deficiency causes pernicious anemia and neurologic complications (paresthesias, neuropathy); deficiency also affects methylation pathways
    • Cardiovascular System: Anemia reduces oxygen delivery; chronic anemia causes high-output cardiac failure; lipid profile assesses cardiovascular risk in anemic patients
    • Lungs: Oxygen transport depends on hemoglobin; anemia causes dyspnea and reduced exercise tolerance; vitamin D insufficiency affects lung function
    • Blood Vessels: Heavy metal toxins accumulate in vascular endothelium; lead and mercury reduce hemoglobin oxygen-carrying capacity
    • Associated diseases evaluated: Iron deficiency anemia, Vitamin B12 deficiency anemia, Folate deficiency anemia, Hemolytic anemia, Sickle cell disease, Thalassemia, Aplastic anemia, Anemia of chronic disease, Multiple myeloma, Hypothyroidism, Chronic kidney disease, Liver cirrhosis, Heavy metal poisoning (lead, arsenic, cadmium, mercury toxicity)
  • Follow-up Tests
    • Abnormal Hemoglobin: If ferritin or iron studies abnormal, recommend iron supplementation trial with repeat testing in 4-6 weeks; consider endoscopy if iron deficiency with ongoing blood loss
    • Vitamin B12 Deficiency (<200 pg/mL): Follow with methylmalonic acid and homocysteine levels for confirmation; consider intrinsic factor antibodies and parietal cell antibodies to diagnose pernicious anemia; anti-tissue transglutaminase (TTG) if celiac disease suspected
    • Folic Acid Deficiency (<2.7 ng/mL): Check methylmalonic acid (normal in folate deficiency, elevated in B12 deficiency); assess dietary intake; consider celiac serologies (TTG-IgA, total IgA)
    • Microcytic Anemia (MCV <80): If iron deficiency excluded, test for hemoglobin electrophoresis or genetic testing for thalassemia; lead level if occupational exposure present
    • Hemoglobinopathies Detected: Refer to hematologist for genetic counseling; perform DNA sequencing for specific mutations; arrange family screening and prenatal counseling if applicable
    • Macrocytic Anemia (MCV >100): Order reticulocyte count (elevated in hemolysis, low in bone marrow suppression); peripheral blood smear to visualize ovalocytes and hypersegmented neutrophils
    • Hemolytic Anemia Suspected (elevated LDH, indirect bilirubin, low haptoglobin): Direct antiglobulin test (Coombs test) for autoimmune hemolytic anemia; LDH isoenzymes if hemolysis confirmed
    • Elevated TSH (>4.0 mIU/L): Confirm hypothyroidism with free T4; initiate levothyroxine replacement; monitor anemia improvement after 6-8 weeks of thyroid supplementation
    • Elevated Creatinine (>1.3 mg/dL males, >1.1 mg/dL females): Calculate glomerular filtration rate (GFR); referral to nephrology if GFR <60 mL/min/1.73m²; measure serum erythropoietin levels
    • Abnormal Liver Function: Perform abdominal ultrasound to assess liver size and cirrhosis; measure prothrombin time (PT/INR) for synthetic function; esophageal varices screening if cirrhosis suspected
    • M Band on Protein Electrophoresis: Serum protein immunofixation electrophoresis for monoclonal protein characterization; bone marrow biopsy if multiple myeloma suspected; skeletal survey for lytic lesions
    • HbA1c ≥6.5% (Diabetes Mellitus): Initiate glycemic control measures; measure fasting glucose and glucose tolerance test; monitor for diabetic complications affecting anemia
    • Vitamin D Deficiency (<30 ng/mL): Initiate vitamin D2 or D3 supplementation (1000-4000 IU daily); repeat 25-OH Vitamin D in 8-12 weeks; assess calcium absorption with albumin-corrected serum calcium
    • Heavy Metal Toxicity Detected: Urine heavy metal testing for confirmation and assessment of renal elimination; chelation therapy consideration for significant lead or arsenic exposure; repeat blood levels after treatment
    • Pancytopenia (low RBC, WBC, platelets): Bone marrow aspiration and biopsy to evaluate for aplastic anemia, infiltration, or malignancy; assess cytotoxic medication exposure
    • Elevated Uric Acid (>7.2 mg/dL males, >6.0 mg/dL females): Screen for gout and kidney stone risk; if hemolysis confirmed, allopurinol prophylaxis may be indicated; monitor for hyperuricemia complications
    • Abnormal Lipid Profile: Calculate cardiovascular risk score; lifestyle modifications and potential statin therapy; anemia increases cardiovascular risk independent of lipid levels
    • Recommended monitoring frequency: Mild anemia - every 3-6 months; Moderate anemia - monthly initially then quarterly; Severe anemia - weekly to monthly depending on etiology and treatment; After treatment initiation - 4-6 weeks then quarterly
    • Complementary tests: Peripheral blood smear microscopy for red blood cell morphology; reticulocyte count for bone marrow response assessment; serum haptoglobin for hemolysis confirmation; lactate dehydrogenase isoenzymes
    • Iron overload assessment: Transferrin saturation >45% requires liver MRI (R2* or T2*) to measure hepatic iron; cardiac MRI if cardiomyopathy suspected from iron deposits
    • Gastrointestinal bleeding workup: Upper endoscopy if unexplained iron deficiency in males or postmenopausal females; colonoscopy if blood loss source not found; fecal occult blood test
  • Fasting Required?
    • Yes - Fasting is required for 8-12 hours before blood collection for this comprehensive anemia profile
    • Fasting requirement rationale: Iron Studies (Serum Iron fluctuates with food intake and diurnal variation), Lipid Profile (Triglycerides significantly affected by recent food consumption), Liver Function Tests (some parameters affected by postprandial state), Glucose/HbA1c component (baseline glucose affects interpretation)
    • Patient preparation: NPO (nothing by mouth) from midnight before morning collection; water intake is permitted; collect blood between 7-9 AM to minimize diurnal variation effects on iron levels
    • Medications to avoid or discuss with physician: Iron supplements (take 1-2 weeks after collection if possible, as exogenous iron affects serum iron interpretation); certain antibiotics affecting B12 absorption; metformin (hold on collection day if possible); herbal supplements containing iron or B vitamins
    • Dietary restrictions: Avoid iron-rich foods 24 hours before testing (red meat, spinach, fortified cereals); avoid calcium supplements 12 hours before as they interfere with iron absorption and testing interpretation; avoid excessive coffee or tea (interferes with iron absorption measurement)
    • Specific timing: Menstruating women should have blood drawn if possible when not actively menstruating to reduce baseline anemia from blood loss
    • Patient instructions: Nothing to eat or drink after 10 PM evening before test (except water); wear comfortable clothing with accessible veins in forearms; arrive 15 minutes early to complete intake forms; continue all chronic medications unless specifically instructed otherwise
    • Medications to continue during fasting: All cardiovascular medications (antihypertensives, statins, anticoagulants); thyroid replacement (levothyroxine); immunosuppressive medications; diabetes medications should be discussed - some require food intake
    • Additional preparations: Avoid strenuous exercise 24 hours before testing (affects hemoglobin levels and white blood cell count); ensure adequate hydration with water (dehydration artificially elevates hemoglobin and hematocrit); avoid smoking 30 minutes before blood draw (affects CBC values)
    • Stress reduction: Psychological stress affects cortisol and immune markers; recommend relaxation 15 minutes before collection; anxiety increases white blood cell count
    • Sample collection tube requirements: EDTA (purple-top) tube for CBC and hemoglobin studies; SST (gold-top) serum separator tube for chemistry panels including iron studies, lipids, liver function; collect multiple tubes to prevent hemoconcentration affecting results
    • Post-collection: Food and drink may resume immediately after blood draw; continue all medications as prescribed; maintain hydration; results typically available in 24-48 hours depending on laboratory processing

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