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Copyright (c) 2026 Adel Hamad Ahmed Awaji, Khalid Hamoud Naji Sumayli, Ahlam Mohammed Ahmed Arishi, Abdullah Essa Magbool Oraybi, Abdullah Zain Abdullah Abbas, Ali Hassan Ali Oraybi, Faisal Hussain Magbol Muzaybi, Mohammed Bin Ibrahim Bin Mohsen Qumayr, Joawid Mohammed Ali Alshogairan, Essa Ali Ali Oraybi, Sultan Hamad Ahmed Awaji
This work is licensed under a Creative Commons Attribution 4.0 International License.
Laboratory Screening for Anemia: Hematological Assessment and Diagnostic Evaluation-An Updated Review
Corresponding Author(s) : Adel Hamad Ahmed Awaji
Saudi Journal of Medicine and Public Health, Vol. 3 No. 1 (2026)
Abstract
Background: Anemia is a common hematological condition characterized by reduced hemoglobin concentration or circulating red blood cell mass. It represents an important clinical and public health concern because it can impair tissue oxygenation, worsen underlying diseases, and indicate several nutritional, genetic, infectious, and systemic disorders. Early detection and accurate diagnosis are essential for appropriate management.
Aim: This review aims to provide an overview of anemia screening, focusing on its etiology, epidemiology, pathophysiology, diagnostic investigations, interpretation of laboratory findings, and laboratory quality and safety requirements.
Methods: A narrative review was conducted covering the principal mechanisms and causes of anemia, its distribution across different populations, the physiological regulation of erythropoiesis, and the laboratory approaches used for screening and diagnosis. Relevant investigations, transfusion considerations, quality assurance procedures, and laboratory safety practices were also discussed.
Results: Anemia develops primarily through decreased red blood cell production, increased red blood cell destruction, or blood loss. Its prevalence varies according to geographical, demographic, genetic, nutritional, and socioeconomic factors. Initial screening relies on complete blood count parameters, including hemoglobin, hematocrit, and red blood cell indices. Reticulocyte count, peripheral blood smear, iron profile, vitamin B12, folate, and targeted biochemical investigations support etiological classification. Additional immunological, genetic, imaging, and bone marrow investigations may be required in selected cases. Accurate results depend on appropriate specimen handling, internal and external quality control, and adherence to laboratory safety standards.
Conclusion: Systematic laboratory screening facilitates early anemia detection, identification of underlying causes, and appropriate clinical management.
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- 1. Karakochuk CD, Hess SY, Moorthy D, Namaste S, Parker ME, Rappaport AI, Wegmüller R, Dary O., HEmoglobin MEasurement (HEME) Working Group. Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review. Ann N Y Acad Sci. 2019 Aug;1450(1):126-146.
- 2. Lin TF, Huang JN, Cash HL. Investigation of Pediatric Anemia in the Commonwealth of the Northern Mariana Islands. Matern Child Health J. 2019 Mar;23(3):416-421.
- 3. Dhabangi A, Idro R, John CC, Dzik WH, Opoka R, Ssenyonga R, van Hensbroek MB. Risk factors for recurrent severe anemia among previously transfused children in Uganda: an age-matched case-control study. BMC Pediatr. 2019 Jan 18;19(1):27.
- 4. Lei MQ, Sun LF, Luo XS, Yang XY, Yu F, Chen XX, Wang ZM. Distinguishing iron deficiency anemia from thalassemia by the red blood cell lifespan with a simple CO breath test: a pilot study. J Breath Res. 2019 Mar 06;13(2):026007.
- 5. Skřenková J. Postmenarcheal irregularities in menstrual cycle in adolescent girls. Cas Lek Cesk. 2018 Dec 03;157(7):343-349.
- 6. Han SV, Park M, Kwon YM, Yoon HJ, Chang Y, Kim H, Lim YH, Kim SG, Ko A. Mild Anemia and Risk for All-Cause, Cardiovascular and Cancer Deaths in Apparently Healthy Elderly Koreans. Korean J Fam Med. 2019 May;40(3):151-158.
- 7. Garcia-Casal MN, Pasricha SR, Sharma AJ, Peña-Rosas JP. Use and interpretation of hemoglobin concentrations for assessing anemia status in individuals and populations: results from a WHO technical meeting. Ann N Y Acad Sci. 2019 Aug;1450(1):5-14.
- 8. Mengesha MB, Dadi GB. Prevalence of anemia among adults at Hawassa University referral hospital, Southern Ethiopia. BMC Hematol. 2019;19:1.
- 9. Rabindrakumar MSK, Pujitha Wickramasinghe V, Gooneratne L, Arambepola C, Senanayake H, Thoradeniya T. The role of haematological indices in predicting early iron deficiency among pregnant women in an urban area of Sri Lanka. BMC Hematol. 2018;18:37.
- 10. Thiagarajan P, Parker CJ, Prchal JT. How Do Red Blood Cells Die? Front Physiol. 2021;12:655393.
- 11. Baldwin C, Pandey J, Olarewaju O. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 24, 2023. Hemolytic Anemia.
- 12. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019 Aug;1450(1):15-31.
- 13. Deivita Y, Syafruddin S, Andi Nilawati U, Aminuddin A, Burhanuddin B, Zahir Z. Overview of Anemia; risk factors and solution offering. Gac Sanit. 2021;35 Suppl 2:S235-S241.
- 14. Zúñiga C P, Martínez G C, González R LM, Rendón C DS, Rojas R N, Barriga C F, Wietstruck P MA. [Sickle cell disease: A diagnosis to keep in mind]. Rev Chil Pediatr. 2018 Aug;89(4):525-529.
- 15. Mohandas N. Inherited hemolytic anemia: a possessive beginner's guide. Hematology Am Soc Hematol Educ Program. 2018 Nov 30;2018(1):377-381.
- 16. Bartels M, Bierings M. How I manage children with Diamond-Blackfan anaemia. Br J Haematol. 2019 Jan;184(2):123-133.
- 17. Rai D, Wilson AM, Moosavi L. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 19, 2023. Histology, Reticulocytes.
- 18. Bajwa H, Basit H. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Thalassemia.
- 19. Mast AE, Blinder MA, Dietzen DJ. Reticulocyte hemoglobin content. Am J Hematol. 2008 Apr;83(4):307-10.
- 20. Garzia M, Di Mario A, Ferraro E, Tazza L, Rossi E, Luciani G, Zini G. Reticulocyte hemoglobin equivalent: an indicator of reduced iron availability in chronic kidney diseases during erythropoietin therapy. Lab Hematol. 2007;13(1):6-11.
- 21. Portolés J, Martín L, Broseta JJ, Cases A. Anemia in Chronic Kidney Disease: From Pathophysiology and Current Treatments, to Future Agents. Front Med (Lausanne). 2021;8:642296.
- 22. Gordan R, Gwathmey JK, Xie LH. Autonomic and endocrine control of cardiovascular function. World J Cardiol. 2015 Apr 26;7(4):204-14.
- 23. Killeen RB, Kaur A, Afzal M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 26, 2025. Acute Anemia.
- 24. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Stahel PF, Vincent JL, Spahn DR., Task Force for Advanced Bleeding Care in Trauma. Management of bleeding following major trauma: an updated European guideline. Crit Care. 2010;14(2):R52.
- 25. DiGregorio AM, Alvey H. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 5, 2023. Gastrointestinal Bleeding.
- 26. Bonanno FG. Management of Hemorrhagic Shock: Physiology Approach, Timing and Strategies. J Clin Med. 2022 Dec 29;12(1)
- 27. Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015 Oct;52(4):261-9.
- 28. Ou CN, Rognerud CL. Diagnosis of hemoglobinopathies: electrophoresis vs. HPLC. Clin Chim Acta. 2001 Nov;313(1-2):187-94.
- 29. Carson JL, Stanworth SJ, Dennis JA, Trivella M, Roubinian N, Fergusson DA, Triulzi D, Dorée C, Hébert PC. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021 Dec 21;12(12):CD002042.
- 30. Carson JL, Stanworth SJ, Roubinian N, Fergusson DA, Triulzi D, Doree C, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2016 Oct 12;10(10):CD002042.
- 31. Theodorsson E. Quality Assurance in Clinical Chemistry: A Touch of Statistics and A Lot of Common Sense. J Med Biochem. 2016 Apr;35(2):103-112.
- 32. Ricós C, Fernandez-Calle P, Perich C, Westgard JO. Internal quality control - past, present and future trends. Adv Lab Med. 2022 Oct;3(3):243-262.
- 33. Gruber L, Hausch A, Mueller T. Internal Quality Controls in the Medical Laboratory: A Narrative Review of the Basic Principles of an Appropriate Quality Control Plan. Diagnostics (Basel). 2024 Oct 05;14(19)
- 34. Kinns H, Pitkin S, Housley D, Freedman DB. Internal quality control: best practice. J Clin Pathol. 2013 Dec;66(12):1027-32.
- 35. Blasutig IM, Wheeler SE, Bais R, Dabla PK, Lin J, Perret-Liaudet A, Thomas A, Cendejas KA, Giannoli JM, Vassault A, Amann E, Meng QH. External quality assessment practices in medical laboratories: an IFCC global survey of member societies. Clin Chem Lab Med. 2023 Jul 26;61(8):1404-1410.
- 36. Laudus N, Nijs L, Nauwelaers I, Dequeker EMC. The Significance of External Quality Assessment Schemes for Molecular Testing in Clinical Laboratories. Cancers (Basel). 2022 Jul 28;14(15)
- 37. Bayot ML, Zubair M, Limaiem F. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 19, 2025. Biosafety Guidelines.
- 38. Noble MA. ISO 15190:2003 Medical Laboratories - Requirements for Safety. EJIFCC. 2004 Dec;15(4):141-143.
References
1. Karakochuk CD, Hess SY, Moorthy D, Namaste S, Parker ME, Rappaport AI, Wegmüller R, Dary O., HEmoglobin MEasurement (HEME) Working Group. Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review. Ann N Y Acad Sci. 2019 Aug;1450(1):126-146.
2. Lin TF, Huang JN, Cash HL. Investigation of Pediatric Anemia in the Commonwealth of the Northern Mariana Islands. Matern Child Health J. 2019 Mar;23(3):416-421.
3. Dhabangi A, Idro R, John CC, Dzik WH, Opoka R, Ssenyonga R, van Hensbroek MB. Risk factors for recurrent severe anemia among previously transfused children in Uganda: an age-matched case-control study. BMC Pediatr. 2019 Jan 18;19(1):27.
4. Lei MQ, Sun LF, Luo XS, Yang XY, Yu F, Chen XX, Wang ZM. Distinguishing iron deficiency anemia from thalassemia by the red blood cell lifespan with a simple CO breath test: a pilot study. J Breath Res. 2019 Mar 06;13(2):026007.
5. Skřenková J. Postmenarcheal irregularities in menstrual cycle in adolescent girls. Cas Lek Cesk. 2018 Dec 03;157(7):343-349.
6. Han SV, Park M, Kwon YM, Yoon HJ, Chang Y, Kim H, Lim YH, Kim SG, Ko A. Mild Anemia and Risk for All-Cause, Cardiovascular and Cancer Deaths in Apparently Healthy Elderly Koreans. Korean J Fam Med. 2019 May;40(3):151-158.
7. Garcia-Casal MN, Pasricha SR, Sharma AJ, Peña-Rosas JP. Use and interpretation of hemoglobin concentrations for assessing anemia status in individuals and populations: results from a WHO technical meeting. Ann N Y Acad Sci. 2019 Aug;1450(1):5-14.
8. Mengesha MB, Dadi GB. Prevalence of anemia among adults at Hawassa University referral hospital, Southern Ethiopia. BMC Hematol. 2019;19:1.
9. Rabindrakumar MSK, Pujitha Wickramasinghe V, Gooneratne L, Arambepola C, Senanayake H, Thoradeniya T. The role of haematological indices in predicting early iron deficiency among pregnant women in an urban area of Sri Lanka. BMC Hematol. 2018;18:37.
10. Thiagarajan P, Parker CJ, Prchal JT. How Do Red Blood Cells Die? Front Physiol. 2021;12:655393.
11. Baldwin C, Pandey J, Olarewaju O. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 24, 2023. Hemolytic Anemia.
12. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019 Aug;1450(1):15-31.
13. Deivita Y, Syafruddin S, Andi Nilawati U, Aminuddin A, Burhanuddin B, Zahir Z. Overview of Anemia; risk factors and solution offering. Gac Sanit. 2021;35 Suppl 2:S235-S241.
14. Zúñiga C P, Martínez G C, González R LM, Rendón C DS, Rojas R N, Barriga C F, Wietstruck P MA. [Sickle cell disease: A diagnosis to keep in mind]. Rev Chil Pediatr. 2018 Aug;89(4):525-529.
15. Mohandas N. Inherited hemolytic anemia: a possessive beginner's guide. Hematology Am Soc Hematol Educ Program. 2018 Nov 30;2018(1):377-381.
16. Bartels M, Bierings M. How I manage children with Diamond-Blackfan anaemia. Br J Haematol. 2019 Jan;184(2):123-133.
17. Rai D, Wilson AM, Moosavi L. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 19, 2023. Histology, Reticulocytes.
18. Bajwa H, Basit H. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Thalassemia.
19. Mast AE, Blinder MA, Dietzen DJ. Reticulocyte hemoglobin content. Am J Hematol. 2008 Apr;83(4):307-10.
20. Garzia M, Di Mario A, Ferraro E, Tazza L, Rossi E, Luciani G, Zini G. Reticulocyte hemoglobin equivalent: an indicator of reduced iron availability in chronic kidney diseases during erythropoietin therapy. Lab Hematol. 2007;13(1):6-11.
21. Portolés J, Martín L, Broseta JJ, Cases A. Anemia in Chronic Kidney Disease: From Pathophysiology and Current Treatments, to Future Agents. Front Med (Lausanne). 2021;8:642296.
22. Gordan R, Gwathmey JK, Xie LH. Autonomic and endocrine control of cardiovascular function. World J Cardiol. 2015 Apr 26;7(4):204-14.
23. Killeen RB, Kaur A, Afzal M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 26, 2025. Acute Anemia.
24. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Stahel PF, Vincent JL, Spahn DR., Task Force for Advanced Bleeding Care in Trauma. Management of bleeding following major trauma: an updated European guideline. Crit Care. 2010;14(2):R52.
25. DiGregorio AM, Alvey H. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 5, 2023. Gastrointestinal Bleeding.
26. Bonanno FG. Management of Hemorrhagic Shock: Physiology Approach, Timing and Strategies. J Clin Med. 2022 Dec 29;12(1)
27. Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015 Oct;52(4):261-9.
28. Ou CN, Rognerud CL. Diagnosis of hemoglobinopathies: electrophoresis vs. HPLC. Clin Chim Acta. 2001 Nov;313(1-2):187-94.
29. Carson JL, Stanworth SJ, Dennis JA, Trivella M, Roubinian N, Fergusson DA, Triulzi D, Dorée C, Hébert PC. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021 Dec 21;12(12):CD002042.
30. Carson JL, Stanworth SJ, Roubinian N, Fergusson DA, Triulzi D, Doree C, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2016 Oct 12;10(10):CD002042.
31. Theodorsson E. Quality Assurance in Clinical Chemistry: A Touch of Statistics and A Lot of Common Sense. J Med Biochem. 2016 Apr;35(2):103-112.
32. Ricós C, Fernandez-Calle P, Perich C, Westgard JO. Internal quality control - past, present and future trends. Adv Lab Med. 2022 Oct;3(3):243-262.
33. Gruber L, Hausch A, Mueller T. Internal Quality Controls in the Medical Laboratory: A Narrative Review of the Basic Principles of an Appropriate Quality Control Plan. Diagnostics (Basel). 2024 Oct 05;14(19)
34. Kinns H, Pitkin S, Housley D, Freedman DB. Internal quality control: best practice. J Clin Pathol. 2013 Dec;66(12):1027-32.
35. Blasutig IM, Wheeler SE, Bais R, Dabla PK, Lin J, Perret-Liaudet A, Thomas A, Cendejas KA, Giannoli JM, Vassault A, Amann E, Meng QH. External quality assessment practices in medical laboratories: an IFCC global survey of member societies. Clin Chem Lab Med. 2023 Jul 26;61(8):1404-1410.
36. Laudus N, Nijs L, Nauwelaers I, Dequeker EMC. The Significance of External Quality Assessment Schemes for Molecular Testing in Clinical Laboratories. Cancers (Basel). 2022 Jul 28;14(15)
37. Bayot ML, Zubair M, Limaiem F. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 19, 2025. Biosafety Guidelines.
38. Noble MA. ISO 15190:2003 Medical Laboratories - Requirements for Safety. EJIFCC. 2004 Dec;15(4):141-143.