Anemia Package
- Complete blood count
- Iron
- Total iron-binding capacity (TIBC)
- Ferritin
- Vitamin B12
- Folate
What Is Anaemia?
Anaemia, commonly known as a low blood count, is a haemoglobin level in the blood below the expected threshold for a person's age, sex and pregnancy status. Haemoglobin is the protein in red blood cells that carries oxygen to tissues.
Anaemia can cause weakness, fatigue, paleness, dizziness, palpitations and shortness of breath on exertion. Mild anaemia may be detected during blood tests without causing any symptoms.
Not all anaemia is caused by iron deficiency. In addition to iron, B12 or folate deficiency, blood loss, chronic diseases, kidney diseases and inherited conditions such as thalassaemia can also cause anaemia. It is therefore important not only to identify anaemia but also to investigate its cause.
Which Tests Are Included in the Anaemia Package?
1. Haemogram — Complete Blood Count
A complete blood count assesses red blood cells, white blood cells and platelets. Haemoglobin (Hb) is the key parameter for determining whether anaemia is present.
MCV, which indicates the average size of red blood cells, provides information about the possible cause of anaemia. A low MCV may be seen in iron deficiency or thalassaemia carriers, while a high MCV may occur in B12 or folate deficiency. However, a normal MCV does not completely rule out these deficiencies.
2. Serum Iron
This measures the iron bound to a transport protein called transferrin in the blood. Iron is essential for haemoglobin production and oxygen transport.
Serum iron can be affected by the time of day, diet, iron supplements and infections. A low serum iron level alone does not establish a diagnosis of iron deficiency. It is assessed together with ferritin and iron-binding capacity.
3. Total Iron-Binding Capacity — TIBC
This indicates how much iron the proteins in the blood, particularly transferrin, can carry.
TIBC generally increases in iron deficiency. In chronic inflammation, liver diseases or nutritional disorders, it may be low or normal. A low TIBC therefore does not always indicate iron deficiency.
Transferrin saturation can also be calculated using serum iron and TIBC. This value indicates how much of the iron transport capacity is being used.
4. Ferritin
Ferritin is the primary test that provides information about the body's iron stores. Low ferritin indicates depleted iron stores. Iron deficiency can develop even before haemoglobin levels fall.
Ferritin is also a protein that can rise during infection and inflammation. Therefore, normal or high ferritin does not completely rule out iron deficiency, particularly in people with chronic diseases.
5. Vitamin B12
Vitamin B12 is essential for healthy blood cell production and normal nervous system function. In addition to anaemia, its deficiency can cause symptoms such as numbness and tingling in the hands and feet, balance problems or forgetfulness.
B12 deficiency can occur without anaemia or an elevated MCV. Borderline results may require further investigations depending on the symptoms.
6. Folate — Vitamin B9
Folate plays a role in DNA synthesis and the production of healthy blood cells. Deficiency may develop due to inadequate nutrition, malabsorption, certain medications or increased requirements.
Folate deficiency can cause a type of anaemia in which red blood cells become enlarged. Folate and B12 should be assessed together; taking folic acid alone without investigating B12 deficiency may correct the anaemia and mask the underlying B12 deficiency.
How Are Anaemia Test Values Interpreted?
Reference ranges may vary depending on the method used, age, sex and pregnancy status. The values below are for general information; the laboratory ranges on your results report should be used as the basis for interpretation.
Haemoglobin: Which Values Indicate Anaemia?
According to the WHO's 2024 guideline:
| Group | Haemoglobin level indicating anaemia |
|---|---|
| Non-pregnant women aged 15–65 | Below 12 g/dL |
| Men aged 15–65 | Below 13 g/dL |
| Pregnancy: first trimester | Below 11 g/dL |
| Pregnancy: second trimester | Below 10,5 g/dL |
| Pregnancy: third trimester | Below 11 g/dL |
These are the lower thresholds used to diagnose anaemia, not the full normal reference range. Age-specific thresholds are used for children.
Iron, TIBC and Ferritin Values
| Test | General range or interpretation | Meaning of a low / abnormal result |
|---|---|---|
| Serum iron | Example adult reference range: 50–150 µg/dL in men, 35–145 µg/dL in women | A result below the lower limit may be associated with iron deficiency or inflammation; it is not diagnostic on its own. |
| TIBC | Approximately 250–400 µg/dL; varies by laboratory | Usually increases in iron deficiency. A low level may be associated with inflammation or other diseases. |
| Ferritin: below 15 ng/mL | Markedly low | Strongly supports depletion of iron stores. |
| Ferritin: 15–29 ng/mL | Consistent with low iron stores | Iron deficiency may be present even if haemoglobin is normal. |
| Ferritin: 30 ng/mL and above | Interpreted in the clinical context | Does not rule out iron deficiency on its own; further evaluation is needed, particularly if inflammation is present. |
In people with anaemia, ferritin levels between 30–45 ng/mL may also be significant for iron deficiency. There is no single “ideal value” for ferritin; it is interpreted alongside the full blood count, symptoms and, when necessary, markers of inflammation.
Vitamin B12 Levels
The NICE guideline recommends the following interpretation for total B12. If the laboratory has validated, method-specific cut-off values, these should be used.
| Total vitamin B12 | General interpretation |
|---|---|
| Below 180 pg/mL | Consistent with B12 deficiency |
| 180–350 pg/mL | Borderline / possible deficiency; further evaluation may be needed |
| Above 350 pg/mL | B12 deficiency is less likely |
This classification is not a complete normal reference range. Symptoms, supplements taken and the measurement method may affect the result.
Folate Levels
| Serum folate | General interpretation |
|---|---|
| Below 4 ng/mL | Suggests folate deficiency |
| 4 ng/mL and above | Not low according to this threshold; interpreted alongside the laboratory range and clinical context |
Folate thresholds may vary by method. Recently consumed foods and vitamin supplements may affect serum folate levels.
Who May Be Recommended Anaemia Tests?
An assessment for anaemia may be performed in people with weakness, easy fatigability, pallor, palpitations, dizziness or shortness of breath. Heavy menstrual bleeding, pregnancy, inadequate or restrictive nutrition, malabsorption, chronic disease or a history of vitamin and iron deficiency may also require evaluation.
Tests are selected according to the person's symptoms and the doctor's assessment. This package helps investigate common deficiencies; it does not rule out all causes of anaemia on its own.
Is Fasting Required Before Anaemia Tests?
Fasting is generally not required for a full blood count and ferritin. However, as the package also includes serum iron and folate, you may be asked to provide your sample in the morning after following the laboratory's recommended fasting period. You may drink water.
Iron, B12, folic acid and other supplements may affect the results. Please inform our laboratory about the medicines and supplements you take; do not stop your prescribed treatment without your doctor's advice.
Where Can I Have Anaemia Tests in Northern Cyprus?
You can have your tests for anaemia assessment at the Wellcare Laboratories branches at Wellcare Health Clinic and Miracle Hospital in Nicosia and Medicalport Tunççevik Hospital in Kyrenia.
About Anaemia
Frequently Asked Questions
Are anaemia and iron deficiency the same thing?
No. Anaemia means a low haemoglobin level. Iron deficiency means a reduction in the body's iron stores. Iron deficiency can cause anaemia, but it may also be present before haemoglobin levels fall. In addition, not all anaemia is caused by iron deficiency.
What symptoms does anaemia cause?
Weakness, easy fatigability, pallor, dizziness, palpitations and shortness of breath on exertion may occur. However, these symptoms can also occur in other diseases. The diagnosis of anaemia is assessed through a blood test.
What haemoglobin level is considered to indicate anaemia?
According to WHO, in the 15–65 age group, haemoglobin levels below 12 g/dL in non-pregnant women and below 13 g/dL in men are considered to indicate anaemia. Different thresholds are used during pregnancy and in children.
What ferritin level suggests iron deficiency?
Ferritin below 15 ng/mL strongly supports depletion of iron stores. Values below 30 ng/mL are generally consistent with reduced iron stores. As iron deficiency may also be present at higher levels in the presence of anaemia or inflammation, the result should be assessed by a doctor.
Can iron deficiency be present when ferritin is normal?
Yes. Infection, inflammation and certain chronic diseases can raise ferritin levels. In these situations, ferritin may be normal or high despite the presence of iron deficiency. A full blood count, transferrin saturation and, when necessary, additional tests are used to help with assessment.
Is a low serum iron level sufficient on its own?
No. Serum iron can vary throughout the day and may be affected by infections. To assess iron deficiency, it should be interpreted alongside ferritin, TIBC and full blood count results.
Can B12 deficiency occur without anaemia?
Yes. B12 deficiency can cause nervous system symptoms such as numbness, tingling or balance problems, even when haemoglobin levels are normal. If results are borderline, your doctor may request additional tests, such as methylmalonic acid testing.
Should I start taking iron or vitamins immediately if anaemia is detected?
Treatment should be planned according to the type and cause of the deficiency. Unnecessary iron supplementation is not appropriate. When iron deficiency is detected, it is important not only to correct the deficiency but also to investigate causes such as heavy menstrual bleeding, blood loss from the digestive tract or malabsorption.
Why should iron deficiency be investigated in men and after menopause?
In these individuals, unexplained iron deficiency anaemia may be a sign of unnoticed blood loss from the digestive tract. The underlying cause therefore needs to be investigated through a medical assessment.
Do the tests in the anaemia package identify all causes of anaemia?
No. The package helps assess anaemia and common iron, B12 and folate deficiencies. Depending on the results, a peripheral blood smear, reticulocyte count, kidney function tests, haemoglobin analysis or other investigations may be needed.