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Test Code LAB9895 ANEMIA CASCADE

Important Note

This test is intended for patients over 18 years old with unexplained anemia.  For outpatient use only.

The cascade begins with a complete blood count (CBC), differential, and reticulocyte battery. If the patient’s hemoglobin is below the reference interval, additional testing will be performed as determined by the mean corpuscular volume (MCV). See the table below for a description of the additional testing that may be performed on the sample based on the MCV and other parameters.

Microcytic Normocytic Macrocytic

If Reticulocyte Hemoglobin is not decreased: Creatinine will be reflexed.

If Reticulocyte Hemoglobin is decreased:  Iron Saturation and Ferritin will be reflexed.

If Ferritin is not decreased: Creatinine will be reflexed.

 

If reticulocyte count is not increased and the Reticulocyte Hemoglobin is not decreased: Creatinine will be reflexed.

If reticulocyte count is not increased and the Reticulocyte Hemoglobin is decreased: Iron Saturation and Ferritin will be reflexed.

If reticulocyte count is increased: LDH and haptoglobin will be reflexed.

If LDH is increased and the haptoglobin is decreased: DAT will reflex.
 

If reticulocyte count is not elevated: Vitamin B12 will be reflexed.

If B12 is not decreased: TSH, ALT, AST will be reflexed.

If reticulocyte count is increased: LDH and haptoglobin will be reflexed.

If LDH is increased and the haptoglobin is decreased: DAT will reflex.
 

Additional Codes

Orderable Codes:

Epic Code Atlas Code Mayo Access ID Order LOINC Legacy Code
LAB9895 LAB9895 N/A N/A ANECAS

Testing included in this panel:

Blood Count with Differential, Complete (LAB293)

Reticulocyte Battery (LAB17561)

Specimen Information

Both a SST and a Lav Top (EDTA) are REQUIRED for this testing.

Container Specimen Temperature Collect Vol Submit Vol Min Vol
SST Serum Refrigerate 8 mL 3 mL 3 mL
*Lav Top (EDTA) Whole Blood Refrigerate 3.5 mL 3.5 mL 3.5 mL

*Invert tube gently 10 times.

 

Test Schedule / Analytical Time / Test Priority

Daily / Up to 3 days depending on the reflexed testing /  Not available STAT

Performing Location

University of Vermont Medical Center

Is the UVMMC lab NY State Certified to perform this testing?  Yes/No

Yes

Potential Reflex-Only Testing:

Test Name Epic Code (not orderable)
Differential, Manual LAB9871
Differential, Automated Manual LAB11520
Anemia Cascade Iron Saturation and Ferritin LAB9899
Anemia Cascade Iron Saturation LAB17608
Anemia Cascade Ferritin LAB17605
Anemia Cascade LDH and Haptoglobin LAB9900
Anemia Cascade LDH LAB17609
Anemia Cascade Haptoglobin LAB17607
Anemia Cascade Vitamin B12 LAB9901
Anemia Cascade DAT LAB9902
DAT C3 LAB285
DAT IgG LAB283
Anemia Cascade TSH, AST, ALT LAB9903
Anemia Cascade Creatinine LAB9904