Investigation of Anaemia

Measurement of vitamin B12, folate, red cell folate, ferritin, gastric intrinsic factor antibodies (GIFAB) and erythropoietin are all routinely available.

View 2011 guidelines for the diagnosis and management of iron deficiency in pregnancy.

Sample requirements: B12 & folate - 4 mL SST (Gold capped) tube, Ferritin - 4 mL SST (Gold capped) tube, RBC Folate- 3ml EDTA (Purple capped) tube.  A separate sample for Chemistry is no longer required, we can do all the tests from the same sample providing the sample is adequately filled.


Reference Range


serum vitamin B12

211 - 911 ng/L

Subnormal levels are found in untreated Pernicious Anaemia. Low levels may be found in vegetarians and vegans.

serum folate

5.4 - 24 ug/L


red cell folate

280 - 791 ug/L

best index of body folate status


10 - 332 ug/L

may be unreliable during periods of acute illness, particularly liver disease, in which ferritin may rise as a marker of inflammation


3.0 - 18.0 mIU/ml

Discuss with lab

red cell volume

80-120% idealised normal men 30 ± 5 mL/kg women 25 ± 5 mL/kg

increased in "true" polycythaemia.  These tests are not performed at present.

plasma volume

80-120% idealised normal

reduced in "relative" polycythaemia.  These tests are not performed at present.

total blood volume

70 ± 10 mL/kg


red cell lifespan

120 ± 30 days


Reasons for referral for bone marrow investigation

  1. Diagnosis of haematological malignancy
  2. Staging of lymphomas and Hodgkin's disease
  3. Suspected marrow infiltration by cancer as suggested by a leucoerythroblastic blood film

Note that in all cases a marrow examination is part of a full clinical and laboratory appraisal and should be discussed with a clinical haematologist.

Page updated: 14/02/12 | Updated by: Michael 0'Sullivan

Investigation of Anaemia Links