Haematological Examination

Anaemias can primarily originate from:

• Chronic diseases, e.g., neoplasias.
• Blood loss (mainly from the gastrointestinal tract).
• Poor nutrition – deficiency of hematopoietic elements (e.g., prolonged diets deficient in animal products).
• Dysplasia – aplasia of the bone marrow – haematological disorders (e.g., inherited hemoglobinopathies, such as thalassemia or "stigma," sickle cell anaemia, hereditary spherocytosis).
• Prolonged immobility.
• Renal insufficiency.
• Autoimmune diseases.
• Use of medications that suppress the bone marrow.

With a Complete Blood Count (CBC), we detect anaemia by directly measuring haematocrit (HCT) and haemoglobin (HGB), which in combination indicate the blood's content of red blood cells and their quality in terms of haemoglobin content. At the same time, we assess specific parameters to categorise the type of anaemia in its initial stage. Among the parameters checked are:

• Mean Corpuscular Volume (MCV) with indirect information on iron deficiency (-), deficiency of hematopoietic vitamins (+), dysplasia (+), thalassemia (-), etc.
• Mean Corpuscular Haemoglobin (MCH) and Mean Corpuscular Haemoglobin Concentration (MCHC), which primarily evaluate iron deficiencies.
• Red Cell Distribution Width (RDW-CV), which primarily assesses thalassemia, myelodysplastic syndromes, and the degree of red blood cell renewal.

Microscopic examination of blood: the morphology and quality of all blood cells (red, white, platelets) are examined under a microscope for further categorization of anaemia, while also checking for possible suspicion of haematological diseases or bone marrow dysplasia.

Erythrocyte Sedimentation Rate (ESR): we exclude the presence of chronic inflammatory diseases or serious bone marrow diseases or any other central disease that may have caused anaemia.

Reticulocyte Count (RETIC): it indicates the rate of red blood cell renewal, providing information about the marrow's productivity.

Iron (Fe) and its basic stores, ferritin (Ferr), and transferrin (Trf): they estimate the body's iron adequacy. Simple iron measurement is not sufficient, as iron exhibits significant fluctuations from day to day, even within a day. This is because iron, as a toxic metal, is found in small quantities in the blood for immediate organism needs, while the main bulk is stored mainly in ferritin and transferrin. Also, "falsely low" iron levels can appear for various reasons (fatigue – inflammation – fever, etc.), which are only revealed by simultaneous measurement of stores. Note that iron supplementation in individuals with "falsely low" iron results can be particularly burdensome.

C-Reactive Protein (CRP): its measurement is performed to exclude the presence of inflammation, which can give "false" values in iron, ferritin, and transferrin, complicating the evaluation of results.

Total Iron Binding Capacity (TIBC) and Transferrin Saturation (TfS): they provide information about the adequate transportation of iron within the body and its ability to absorb it.

Folic Acid and Vitamin B12: they are the most essential hematopoietic vitamins. They are often found at low levels in individuals with poor nutrition or in the elderly, who are undernourished or have difficulty absorbing them due to age or medication use.

Lactate Dehydrogenase (LDH) and Total Bilirubin (TBil): their measurement detects whether there is a physiological way of blood renewal and excludes haemolysis – blood destruction within the body.

Celiac Disease: it is a strongly inherited autoimmune disease characterized by gluten intolerance (protein found in wheat, barley, oats, and rye). This condition impedes iron absorption and can cause long-term iron deficiency anaemia. By measuring antibodies against gliadin IgG/IgA, tissue transglutaminase IgG/IgM, and endomysium IgG/IgM, we indirectly diagnose the disease without the need for gastroscopy. These tests are recommended in cases of undetermined long-term inability to maintain ferritin levels, following iron therapy.

Faecal Haemoglobin (HGBocc): it is recommended in cases of confirmed acute-phase iron deficiency and in individuals suspected of gastrointestinal bleeding.

No specific preparation or special diet is required for these analyses, and blood collection can be performed at any time of the day.

For stool collection:

- Collect a small stool sample in a specialized container.