The doctor’s visit
No instance of anaemia should ever be treated based on assumption. If you experience any symptoms common with the condition, you must seek medical assessment.
Due to the nature of anaemic symptoms, there is often an underlying medical condition which will, more often than not, require testing. If this is the case, the illness cause will require careful treatment. Anaemia will be resolved in the process.
A general practitioner (GP or family physician) will want to begin by making a compete assessment of your medical history (including your family medical history) and perform a physical exam.
Your doctor will typically ask you a series of specific questions. These can include:
- When did you start experiencing symptoms?
- Have you ever experienced anaemia before?
- Has anyone in your family had, and been treated for anaemia?
- Are you taking any medications or supplements?
- Have you noticed any changes to the nature or colour of your stool or urine?
- Have you noticed any bleeding issues?
- What is your occupation?
- Do your social habits involve a lot of alcohol consumption?
Your doctor will then move on to performing a physical examination to check various things associated with your overall symptoms. Your doctor will assess your overall appearance and look for signs of fatigue, a paleness to your skin (perhaps even jaundice) and examine the nail beds. Your doctor will also physically assess you for signs of an enlarged spleen or liver, listen to your heart (assessing your heart rhythm and sounds) as well as check your lymph nodes.
Testing for anaemia
Once a discussion and a physical exam have been completed, it is more than likely that your doctor will recommend a series of tests to help determine an underlying cause of your anaemia and make a final diagnosis.
Depending on the nature of your symptoms, your physical exam and your medical history discussion, your doctor will recommend tests most appropriate to either help confirm a diagnosis or rule out potential health conditions. The severity of anaemia is also taken into account before tests are recommended as some causes may need to be determined immediately for emergency treatment.
Common tests include:
- CBC (complete blood count) and Peripheral blood smear: Your doctor can assess the type of anaemia and the severity of the condition using these laboratory blood tests based on the size of your RBCs, shape, appearance and the number being produced to replenish the body. Your doctor will also look at your white blood cells and platelets, as well as measure your haemoglobin (Hgb). All of these factors will help to accurately determine an anaemic condition.
- Reticulocyte count: This blood test measures the amount of new RBCs being produced in the body’s marrow.
- Liver and kidney function tests: A portion of your blood sample will be looked at to assess how well your liver or kidneys are functioning. These tests will help your doctor to determine whether your liver function is having any impact on your anaemic condition, or if you have an underlying kidney dysfunction. The kidney test will measure levels of urea, creatinine and dissolved salts in your system which form from the breakdown of proteins in the body before being passed as waste.
- Bone marrow biopsy: If necessary your doctor may request a sample of your bone marrow to evaluate the production of RBCs. This will generally only be requested when your doctor strongly suspects a problem with your bone marrow.
- Serum iron level: This test enables your doctor to assess whether your underlying cause may be related to an iron deficiency. This test is typically done in conjunction with others that measure the body’s iron stores such as a transferrin level test (looks at the proteins that carry iron in the body) and a ferritin level test (measures the total iron capacity that is available in the body).
- Vitamin B-12 and folate: Your doctor will look at your vitamin levels to assess whether there is a deficiency or not, so as to establish or rule out an underlying cause.
- Bilirubin test: Your doctor may request this test (from a blood sample) to assess the amount of this yellow pigment (chemical compound) in your blood. The purpose is to determine any signs of haemolytic anaemia (RBCs are being destroyed at a faster rate than they are being replenished and flushed from the body’s system). Bilirubin is found in bile and is produced by the liver. It will be elevated when the breakdown products of RBCs in the blood are elevated.
- Stool haemoglobin test, faecal occult blood test and urine tests: Your doctor may request a sample of your stool (faeces) to look for any signs of bleeding. Other tests related to this include a stool occult blood test or a stool Guaiac test. If there are signs of blood in your sample it will indicate that there is a bleed occurring somewhere in the gastrointestinal tract (between the mouth and the rectum) and could point to a cause, such as colon cancer, stomach ulcers or ulcerative colitis. If necessary, your doctor may recommend other tests to help determine a diagnosis. Additional tests could be an upper GI endoscopy (gastroscopy), colonoscopy, barium enema, chest X-ray or CT scan. Your doctor may also wish to evaluate a sample of your urine for the same purpose.
- Lead level test: This test may be recommended to assess the potential for lead toxicity levels.
- Haemoglobin electrophoresis: If it is determined in the initial evaluation that there is a possibility of a family history of anaemia, this test may be recommended to determine or rule out a possible inherited condition.