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Slide 22 of 25

We start with Hematocrit and Hemoglobin to get the the mean cell value (MCV). If MCV is high we do the reticulocyte count, serum B12 and serum folate. If MCV is low we do serum Fe, TIBC; if low we do ferritin and bone marrow, if normal we do Hb electrophoresis. If MCV is normal we do serum Fe, TIBC Reticulocyte count Haptoglobin Cooms' test and then peripheral smear examination for RBC morphology: 1- Combs' test and osmotic fragility to diagnosis Spherocytes. 2- DIC screen for fragmentation. 3- Hb electrophoresis for Sickle cells. 4- Bone marrow Hb electrophoresis for nucleated RBC.