TestIndicationsNormal ValuesAbnormal IncreaseAbnormal DecreaseInterfering Factors

Vitamin B12 Measurement of Vitamin B12 in blood May help identify a cause of megaloblastic anemia Used to evaluate malnourished patients Function: Conversion of inactive folate to active form; gastric acid detaches B12 from binding proteins; absorbed in small intestine aided by Intrinsic Factor (IF)

**Can contribute to neutropenia and thrombocytopenia160 950 pg/mL(as a general guideline)-Leukemia-Polycythemia vera-Severe liver disease-Myeloproliferative disease-Supplementation-Pernicious anemia-Peripheral neuropathy-Malabsorption syndrome-Atrophic gastritis-Pregnancy-Alcoholism-EtOH (alcohol)-Aspirin-Aminoglycoside antibiotics-Anticonvulsants-Colchicine-Oral contraceptives

Intrinsic Factor (IF) Antibody Used to diagnose pernicious anemia Function: Necessary for Vitamin B12 absorption in small intestineNegative

-Pernicious anemiaN/A-Injection of Vitamin B12 within 48 hrs

TestIndicationsNormal ValuesAbnormal IncreaseAbnormal DecreaseInterfering Factors

Anti-Parietal Cell Antibody Used to diagnose autoimmune cause of pernicious anemia Function: Located in proximal stomach, produce HCl and IF

Negative

-Pernicious anemia-Atrophic gastritis-Insulin-dependent diabetes mellitus (IDDM)-Thyroiditis-Myxedema-Addison disease-Iron-deficiency anemia-Juvenile diabetes

N/AN/A

Serum Folate (Folic Acid) Used to diagnose megaloblastic anemia Used for evaluation of malnutrition, especially in alcoholics Function: normal function of RBCs and WBCs, synthesis of certain purines and pyrimidines (precursors of DNA) as well as amino acids, fetal development5 25 ng/mL-Vegetarianism-Megaloblastic anemia-Hemolytic anemia-Pregnancy-Malnutrition-Liver disease-Sprue-Celiac disease-Chronic kidney disease (CKD)-Some anti-seizure meds, anti-malarials, EtOH, methotrexate

-Folate-deficient patient who has received a blood transfusion-Radionuclide administration should be avoided for at least 24 hrs

TestIndicationsNormal ValuesAbnormal IncreaseAbnormal DecreaseInterfering Factors

Total Serum Iron (Fe)(circulating iron) Measurement of the quantity of Fe bound to transferrin Evaluate iron deficiency Evaluate iron overload Evaluate iron poisoning Monitor iron replacement therapyMale: 80 180 mcg/dLFemale: 60 160 mcg/dL-Iron overload (hemochromatosis or hemosiderosis); causes deposits in brain, liver and heart dysfunction-Iron poisoning-Hemolytic anemia-Massive blood transfusions-Hepatitis or hepatic necrosis-Lead toxicity-Iron-deficiency anemia (insufficient intake, inadequate absorption, increased requirements, blood loss)-Chronic blood loss-Inadequate intestinal absorption of iron-Pregnancy (late)-Neoplasia-Recent blood transfusion-Recent ingestion of high iron content meal

Total Iron Binding Capacity (TIBC) Measurement of all proteins available for binding mobile iron Indirect yet accurate measure of transferrin More a reflection of liver function and nutrition than of iron metabolism

250 460 mcg/dL-Iron deficiency anemia (more availability for iron binding = lack of iron present)-Colon cancer-Pregnancy (late)-Polycythemia vera-Estrogen therapy-Hypoproteinemia-Malnutrition-Inflammatory diseases-Cirrhosis-Hemolytic anemia-Pernicious anemia-Sickle cell anemia-Fluorides and oral contraceptives (increased levels)-ACTH (adreno-corticotropic hormone) and chloramphenicol (decreased levels)

TestIndicationsNormal ValuesAbnormal IncreaseAbnormal DecreaseInterfering Factors

Transferrin Helps establish cause of abnormal Fe & TIBC

Male: 215 365 mg/dLFemale: 250 380 mg/dL

-Iron deficiency anemia (more availability for iron binding = lack of iron present)-Colon cancer-Pregnancy (late)-Polycythemia vera-Estrogen therapy-Iron overload-Malnutrition-Inflammatory diseases-Cirrhosis-Hemolytic anemia-Sideroblastic anemia-Megaloblastic anemia-MalignancyN/A

Transferrin Saturation Evaluate iron deficiency Evaluate iron overload Evaluate iron poisoning Monitor iron replacement therapyMale: 20 50%Female: 15 50%

**To calculate:Transferrin sat (%) = (serum iron level x 100%)/TIBC-Hemochromatosis-Hemosiderosis-Increased iron intake-Hemolytic anemias-Iron-deficiency anemia-Chronic illnesses (i.e. malignancy)N/A

Ferritin (stored iron over time) Most sensitive test to determine iron deficiency anemia The major iron-storage protein directly related to serum iron levels 30% of Fe stored in the form of ferritin/hemosiderin

Male: 12 300 ng/mLFemale: 10 150 ng/mL

Critical Value:Level below 10 mg/mL is diagnostic of Fe deficiency-Hemochromatosis-Hemosiderosis-Fe poisoning-Megaloblastic and hemolytic anemias-Alcoholic hepatobiliary disease, chronic hepatitis, cirrhosis-Inflammatory disease-Advanced cancers-Chronic illness leukemias, collagen vascular-Iron deficiency anemia-Severe protein deficiency-Hemodialysis-Recent transfusions-Recent ingestion of a high iron concentration meal-Recent administration of a radionucleide