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Investigations

Authoring team

  • blood film:
    • hypersegmented polymorphs (vitamin B12 deficiency)
    • target cells (liver disease)
  • ESR - raised in malignancy
  • serum B12
  • red cell folate (more reliable than serum folate)
  • liver function tests - including gamma GT
  • bone marrow biopsy - only indicated if one of the above does not reveal cause of macrocytic anaemia

If tests indicate vitamin B12 deficiency then proceed to perform a Schilling test in order to help identify cause of deficiency.

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