Spotlight on Anemia: Identifying and Addressing Root-Cause Anemias

In our latest article, "Spotlight on Anemia," we explore how to utilize Functional Blood Chemistry Analysis to identify the underlying causes of low hemoglobin, fatigue, poor oxygenation, and impaired erythropoiesis.

Introduction

Anemia is one of the most commonly encountered clinical conditions, yet its underlying causes are often oversimplified or missed entirely in conventional practice. The diagnosis may end with a hemoglobin result, but in Functional Medicine, that’s only the beginning.

By evaluating a full suite of blood biomarkers, Functional Blood Chemistry Analysis allows practitioners to differentiate between iron-deficiency anemia, B12 or folate-related megaloblastic anemia, anemia of chronic disease, and hemolytic patterns. More importantly, it reveals early dysfunction in erythropoiesis, the production of red blood cells, before full-blown anemia develops.

This Spotlight article provides a comprehensive guide for assessing anemia through a Functional Medicine lens. You'll learn how to spot patterns of impaired oxygen transport, nutrient deficiency, bone marrow suppression, and inflammation-driven dysfunction using a combination of CBC, iron studies, nutrient markers, and supporting labs.

Why Functional Evaluation of Anemia Matters

Red blood cells are essential for oxygen delivery, carbon dioxide removal, and metabolic regulation. When oxygen-carrying capacity declines, whether through cell loss, destruction, or nutrient-related underproduction, fatigue, weakness, cognitive dysfunction, and systemic stress can follow.

Yet anemia is not a singular diagnosis; it's a symptom of an underlying problem. Functional analysis helps uncover:

• Early-stage erythropoietic stress before overt anemia
• Subclinical nutrient insufficiencies
• Inflammatory blocks in iron metabolism
• Hidden hemolysis or marrow suppression
• Incomplete recovery from prior anemia

Core Biomarkers to Evaluate

1. Complete Blood Count (CBC) with Differential and Platelets

Foundational to anemia assessment. Functional ranges help fine-tune interpretation:

• Hemoglobin (Hb) and Hematocrit (Hct): Assess total oxygen-carrying capacity
• Red Blood Cell Count (RBC): May be low in iron, B12, or folate deficiency
• Mean Corpuscular Volume (MCV):
  • < 82 fL: Microcytic
  • 82–90 fL: Normocytic
  • > 90 fL: Macrocytic
• Mean Corpuscular Hemoglobin (MCH) and MCH Concentration (MCHC): Low in iron deficiency
• Red Cell Distribution Width (RDW): High in early or mixed-pattern anemias
• Platelets: Often elevated in iron deficiency, decreased in B12 or folate deficiency

2. Iron Studies

• Serum Iron: Low in both iron deficiency and chronic disease
• TIBC: High in deficiency, low in chronic inflammation
• Ferritin: Functional deficiency below 45 ng/mL
• Transferrin: Elevated in deficiency, reduced in malnutrition

3. Nutrient Markers

• Vitamin B12: Suboptimal if < 545 pg/mL
• Folate, Serum: Ideal > 15 ng/mL

4. Reticulocyte Count

Assesses bone marrow response to anemia. Low indicates underproduction, high indicates compensation.

5. BUN/Creatinine Ratio

Elevated in GI bleeding or protein catabolism, low in liver dysfunction.

6. C-Reactive Protein (CRP)

Elevated CRP supports a diagnosis of anemia of chronic disease or inflammation-driven suppression of erythropoiesis.

7. Erythropoietin

Helps assess renal contribution to anemia.

8. Bilirubin and Haptoglobin

• Elevated Bilirubin: May signal hemolysis
• Low Haptoglobin: Confirms hemolysis or destruction of RBCs

Recognizing Functional Patterns

Iron-Deficiency Anemia

• Low Hb, Hct, MCV, MCH
• High RDW
• Low Iron, Ferritin, Transferrin Saturation
• High TIBC, Transferrin

B12 or Folate Deficiency

• MCV trending upward from 90 fL
• High RDW
• Low B12 or Folate
• May have pancytopenia or leukopenia

Anemia of Chronic Disease

• Low Hb, normocytic or microcytic
• Normal or high ferritin
• Low TIBC
• High CRP

Hemolytic Anemia

• High Reticulocytes
• Elevated Bilirubin
• Low Haptoglobin

Functional Approach to Treatment

1. Nutritional Supplementation

• Iron bisglycinate for confirmed deficiency
• Methylated B vitamins
• Vitamin C to enhance absorption

2. Gut and Absorption Support

• Correct low stomach acid
• Address dysbiosis and inflammation

3. Inflammatory Root Cause Resolution

• Address autoimmunity and infections
• Modulate stress response

Monitoring Progress

• Retest every 8–12 weeks
• Expect 1 g/dL hemoglobin rise every 2–3 weeks if responding
• Track RDW, MCV, Ferritin, and CRP

Conclusion

Anemia is a signal, not a singular condition. Functional Blood Chemistry Analysis helps reveal the root causes, allowing you to intervene early, monitor precisely, and restore optimal vitality in your patients.

How Optimal DX Can Help

With Optimal DX, you can:

• Interpret CBC and nutrient patterns functionally
• Visualize trends in biomarker recovery
• Auto-score iron, B12, and folate sufficiency
• Create targeted intervention plans

Join Optimal DX and bring clarity and depth to your anemia assessments.