Many tests and tools are used to diagnose aplastic anemia. These help to confirm the diagnosis, look for its cause and find out how severe it is. They are also used to rule out other conditions that may cause similar symptoms.

Medical History

To understand what is causing your symptoms and low blood counts, your doctor will take a detailed medical history. Your doctor may ask you questions like the following:

  • What are your symptoms?
  • What medications or herbal supplements have you been taking?
  • Have you been exposed to harmful chemicals?
  • Did you have chemotherapy or radiation treatments in the past?
  • Is your urine dark or tea-colored in the morning?
  • Has your liver been inflamed recently?

Providing a detailed health history helps your doctor give you an accurate diagnosis.

Blood Tests

Doctors conduct several types of blood tests to help them understand your case of aplastic anemia and create a treatment plan. Blood test results and lab reports are something every patient should learn how to read.

Complete Blood Count (CBC)

One key test is a complete blood count (CBC). It uses a number of methods to measure how many of each blood cell type are in your blood sample. If the CBC shows a low number of red blood cells, white blood cells or platelets, your doctor may also do a blood smear test, which means examining your cells under a microscope. 

Getting a CBC on a regular basis is important for aplastic anemia patients. It allows doctors to monitor blood counts over time and compare them with previous results. Based on this record, doctors can determine a patient’s progress and refine treatment plans accordingly.  

Reticulocyte Count

A reticulocyte count measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate. People who have aplastic anemia have low reticulocyte levels.

EPO level

EPO, or erythropoietin, is a protein made by your kidneys. It is created in response to low oxygen levels in the body, typically caused by low red cell counts and anemia. EPO causes your bone marrow to make more red blood cells.

Your doctor will order an EPO level to see if a shortage could be causing your anemia. A low EPO level may indicate a problem other than aplastic anemia, or it may make anemia worse in people who have MDS. Your doctor may prescribe a pharmaceutical form of EPO if yours is low.

Iron level

If you have anemia, your doctor may also check the level of iron in your blood. If a shortage of iron is causing anemia, it can be easily treated with iron supplements.

In some cases, blood tests may show that you have too much iron in your body. This is called iron overload. It can be caused by genetic conditions, or from getting lots of red blood cell transfusions. There are a number of treatments that can remove iron from your body.

Vitamin B12 and folate levels

If you have red blood cells with an abnormal shape, size or look, your doctor will check your blood levels of vitamin B12 and folate (folic acid). A shortage of these vitamins can cause dysplasia, or cells that are not normal. These abnormal looking cells don’t work right, and this can lead to anemia.

Bone Marrow Tests

A bone marrow sample is usually a simple 30-minute procedure. The doctor removes some bone marrow aspirate (liquid bone marrow), typically from the pelvic or breast bone, with a hollow needle. A solid piece of bone marrow is also removed for a bone marrow biopsy.

The doctor will look at your liquid bone marrow under a microscope and send a sample of your bone marrow to a lab.

A bone marrow test is done for two main reasons:

  • To confirm a diagnosis of aplastic anemia
  • To understand how well or poorly your bone marrow is making blood cells

The bone marrow test shows:

  • The quantity (cellularity) of your bone marrow occupied by different cells
  • Exactly what types and amounts of cells your bone marrow is making
  • Increased, decreased, or normal levels of iron in your bone marrow
  • Chromosomal (DNA) abnormalities

Learn more about the process of getting a bone marrow test.