Laboratory Evaluation
- Tests to perform
- Hemoglobin level and hematocrit
- RBC morphology (see Differential Diagnosis)
- MCV
- Reticulocyte count
- Elevated count implies bone marrow compensation for chronic blood loss or hemolysis.
- Low count may suggest impaired RBC production or acute blood loss.
- Stool guaiac tests for occult blood should be performed at several different times to capture intermittent bleeding.
- The following tests are not necessary in initial diagnosis but help identify cause.
- Iron studies
- Erythrocyte sedimentation rate
- Serum bilirubin
- Serum lactate dehydrogenase
- Normal values for hemoglobin (g/dL)/hematocrit (%)/MCV (fL), by age
- Cord blood: 15.3/49/112
- 1 day: 19.0/61/119
- 1 week: 17.9/56/119
- 1 month: 17.3/54/112
- 2 months: 10.7/33/100
- 3 months: 11.3/33/88
- 6 months–2 years: 12.5/37/77
- 2–4 years: 12.5/38/79
- 5–7 years: 13/39/81
- 8–11 years: 13.5/40/83
- 12–14 years
- Girls: 13.5/41/85
- Boys: 14/43/84
- 15–17 years
- Girls: 14/41/87
- Boys: 15/46/86
- Black children on average have normal hemoglobin values that are approximately 0.5 g/dL lower than those in white and Asian children.
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