TEST DIRECTORY... | MIDx Labs

- PROFILE - ANEMIA STATUS

The Anemia Status Profile is a first-line evaluation of anemia that establishes both the morphologic character of the anemia and its underlying mechanism in a single draw. The complete blood count with automated differential defines the presence, severity, and red cell indices of the anemia, while the reticulocyte count indicates whether the marrow response is appropriate to the degree of anemia. Iron studies (serum iron, TIBC, calculated percent saturation) and ferritin characterize iron availability and storage; Vitamin B12 and Folate assess the substrates required for erythropoiesis; and LDH provides an initial marker of intravascular hemolysis and ineffective erythropoiesis.

Intended for adults presenting with a low hemoglobin or hematocrit, unexplained fatigue, pallor, or abnormal red cell indices on prior testing, as well as for periodic monitoring of patients with known iron, B12, or folate deficiency under active repletion.

Results should be interpreted alongside the patient's clinical history, transfusion history, medication list, and nutritional status. This profile characterizes anemia and narrows its differential; it does not identify a source of blood loss and does not replace evaluation for occult gastrointestinal bleeding, hemoglobinopathy testing, or bone marrow examination where clinically indicated.

LIS PROFILE CODE: (MID) Anemia Status Profile

INDIVIDUAL LIS TEST/PANEL CODES INCLUDED WITHIN PROFILE: (MID) Complete Blood Count with Automated Differential (CBCWD), (REF) RETIC, (MID) Iron Panel (IP), FERR, FOLATE, B12, LDH, MG

CPT CODE: 85025 (CBCWD) + 85045 (RETIC) + 83540 (IRON) + 83550 (TIBC) + 84466 (TRSFN) + 82728 (FERR) + 82746 (FOLATE) + 82607 (B12) + 83615 (LDH) + 83735 (MG)

NOTE: % Transferrin Saturation is a calculated result and is not separately billable. This is a MID-defined profile, not an AMA-recognized panel; components are billed individually and each must be supported by documented medical necessity for the individual patient.

ALIASES: Anemia Panel, Anemia Workup, Anemia Evaluation Profile, Iron Deficiency Workup

METHODOLOGIES: Spectrophotometry, Chemiluminescent Microparticle Immunoassay (CMIA), Hydrodynamic Impedance, Laser-Based Flow Cytometry, Fluorescence Flow Cytometry, Sodium Lauryl Sulfate (SLS) Hemoglobin

PATIENT PREPARATION: Iron studies should be collected in the morning, fasting. Serum iron demonstrates marked diurnal variation and rises following iron-containing meals. Oral iron supplements should be withheld for 24 hours prior to collection. Vitamin B12 and Folate supplements should be withheld the morning of collection. Patients taking high-dose biotin (>5 mg/day) should withhold supplementation for a minimum of 8 - 12 hours prior to collection. Iron studies and red cell indices are not interpretable within 72 hours of red blood cell transfusion; note recent transfusion on the requisition.

SPECIMEN:

- Type: Serum & Whole Blood

- Container: 1 Gold Top (SST) Vacutainer & 1 Lavender Top (K2/K3 EDTA) Vacutainer

- Minimum Volume Required: 2 mL for each container.

- Order of Draw: Gold Top (SST) before Lavender Top (K2/K3 EDTA) per CLSI GP41.

- Storage/Handling:

Gold Top (SST) Vacutainer - Allow 30 minutes for blood to clot, then centrifuge specimen at 3500 RPM for 10 minutes. Maintain specimen at room temperature or in the refrigerator until testing can be performed.

Lavender Top (K2/K3 EDTA) Vacutainer - Gently invert specimen 8 - 10 times immediately following blood collection to prevent clotting. Maintain specimen at room temperature or in the refrigerator until testing can be performed.

- Stability:

Room Temperature (20-25 °C): 1 day

Refrigerated (2-8 °C): 2 days (please note however that cellular degeneration can occur as soon as 24 hours post-collection)

Frozen (-20 °C or colder): Not Accepted

- Turnaround Time: 24 - 48 hours from receipt.

Special Instructions: Specimens meeting predefined criteria (e.g., flagged morphologic abnormalities, significant differential shifts, or critical count thresholds) will automatically reflex to a peripheral blood smear review by a medical laboratory scientist at no additional charge.

Depending on the findings identified on smear review, the specimen may be further escalated to pathologist for final interpretation, and any additional testing will be added to the original order.

The reticulocyte count is reported as an absolute count and is interpretable only in reference to the degree of anemia. A reticulocyte percentage is inflated in anemia by the reduced red cell denominator; a count within the reference interval in an anemic patient represents an inadequate marrow response, not a normal one. The reticulocyte response is additionally blunted within the first 3 - 5 days following acute blood loss, in ineffective erythropoiesis (megaloblastic anemia, myelodysplastic syndrome, thalassemia), and where concurrent nutritional deficiency, renal disease, or marrow infiltration limits the response. Conversely, the count may be elevated without hemolysis or blood loss during recovery from marrow suppression or in the weeks following repletion of iron, B12, or folate.

Hemolysis materially affects this profile. Red blood cells contain LDH, folate, and iron at concentrations far exceeding serum; even mild hemolysis produces falsely elevated LDH, folate, and serum iron results. Hemolyzed specimens will be rejected rather than reported with a disclaimer.

Ferritin is an acute-phase reactant. A normal or elevated ferritin does not exclude iron deficiency in the presence of infection, inflammation, malignancy, or chronic kidney disease. Concurrent CRP is recommended where inflammation is suspected.

Where hemolysis is clinically suspected, haptoglobin and total/indirect bilirubin should be ordered in addition to this profile; LDH alone is insufficient to establish a hemolytic process.

REJECTION REASONS: Clotted Specimen, QNS, Gross Hemolysis, Gross Lipemia, Contamination, Stability Violation, Expired Container, Incorrect Container

REFERENCE RANGES:

Please refer to individual test/panel directory pages for reference ranges for each test/panel included.