Lab Interpretation Guide
Anemia Blood Markers — Complete Guide
Hemoglobin · MCV · Ferritin · Iron · B12 · Folate · Reticulocytes
Quick Answer
Anemia diagnosis starts with hemoglobin level. MCV differentiates microcytic (iron deficiency, thalassemia) from normocytic (chronic disease, bleeding) and macrocytic (B12/folate deficiency). Ferritin, iron studies, and B12 confirm the etiology. Always check for masked iron deficiency in inflammation.
Hemoglobin Reference Ranges
Men (adult)
Normal130–170 g/L
Mild110–129
Moderate80–109
Severe< 80
Women (adult)
Normal120–155 g/L
Mild105–119
Moderate80–104
Severe< 80
Pregnancy
Normal110–150 g/L
Mild100–109
Moderate70–99
Severe< 70
MCV-Based Diagnosis
MCV < 80 fL — Microcytic
- –Iron deficiency anemia (most common)
- –Thalassemia (alpha or beta)
- –Anemia of chronic disease (sometimes)
- –Sideroblastic anemia (rare)
→ Check ferritin, serum iron, TIBC, transferrin saturation, peripheral smear
MCV 80–100 fL — Normocytic
- –Anemia of chronic disease (most common)
- –Acute blood loss
- –Hemolytic anemia
- –Mixed deficiency (B12 + iron)
- –Early iron or B12 deficiency
→ Check reticulocytes, LDH, haptoglobin, direct Coombs, ferritin, B12
MCV > 100 fL — Macrocytic
- –B12 deficiency (most common)
- –Folate deficiency
- –Liver disease or alcohol excess
- –Hypothyroidism
- –Medications (methotrexate, hydroxyurea)
→ Check B12, folate, homocysteine, methylmalonic acid, thyroid function, LFTs
Iron Studies — Pattern Interpretation
Condition
Ferritin
Serum Iron
Transferrin Sat.
Iron Deficiency Anemia
↓ < 15 ng/mL
↓ Low
↓ < 20%
Anemia of Chronic Disease
Normal or ↑
↓ Low
Low or normal
Iron + Inflammation (masked)
Normal (falsely)
↓ Low
↓ < 20%
Iron Overload / Hemochromatosis
↑↑ Very high
↑ High
> 45%
Normal
15–300 ng/mL
9–30 µmol/L
20–45%
Iron Deficiency Anemia
Ferritin↓ < 15 ng/mL
Serum Iron↓ Low
Transferrin Sat.↓ < 20%
Anemia of Chronic Disease
FerritinNormal or ↑
Serum Iron↓ Low
Transferrin Sat.Low or normal
Iron + Inflammation (masked)
FerritinNormal (falsely)
Serum Iron↓ Low
Transferrin Sat.↓ < 20%
Iron Overload / Hemochromatosis
Ferritin↑↑ Very high
Serum Iron↑ High
Transferrin Sat.> 45%
Normal
Ferritin15–300 ng/mL
Serum Iron9–30 µmol/L
Transferrin Sat.20–45%
Key Clinical Points
- •Ferritin is an acute-phase reactant — may be falsely normal in iron deficiency with concurrent infection or inflammation
- •Iron masked by inflammation: low serum iron + elevated CRP + normal ferritin = likely iron deficiency despite normal ferritin
- •B12 deficiency causes both megaloblastic anemia AND irreversible neurological damage — treat promptly
- •Elevated homocysteine + MCV > 100 = strong indicator of B12 or folate deficiency even if B12 is borderline
- •RDW > 15% with low hemoglobin suggests mixed etiology or early iron deficiency before MCV drops
- •Reticulocytopenia in anemia suggests bone marrow failure or aplasia — urgent hematology referral
- •In pregnancy, iron deficiency is the most common cause of anemia — ferritin < 30 ng/mL warrants supplementation
Identifying anemia type automatically from blood test?
STRUCTA MED automatically identifies iron deficiency, B12/folate, and anemia of chronic disease patterns — including iron masked by inflammation — with sex and pregnancy-adjusted thresholds.
Analyze Anemia Markers Free →