Macrocytic Anemia

• Evaluate folic acid and vitamin B12 levels in the setting of an elevated MCV

• Further investigation by administering radiolabeled B12 (i.e., Schilling test) to determine if lack of intrinsic factor

• Consider obtaining homocysteine and methylmalonic acid levels Normocytic Anemia

• Evaluate reticulocytes and CBC

• High reticulocyte counts may indicate RBCs loss via acute blood loss, hemolysis, or splenic sequestration

• Low reticulocyte counts may indicate a diseased bone marrow (e.g., aplastic anemia, myelodysplasia, or leukemia), especially if the WBC and platelets are low

• High WBC/platelets may be from anemia of chronic disease, malignancy, or CKD

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