Evaluation and management of anemia. Evaluation and management of anemia. Once the screening blood count demonstrates anemia, an evaluation is necessary and begins with an assessment of iron status. When ferritin (SF) and/or iron saturation levels (TSAT) indicate absolute iron deficiency, referral to a gastroenterologist or gynecologist to identify a specific source of chronic blood loss may be indicated. When ferritin and/or iron saturation values rule out absolute iron deficiency, and signs of inflammation are evident, AI is likely. Depending on ferritin, transferrin saturation, or values of markers suggesting concomitant true iron deficiency, diagnostic steps to identify the disease underlying AI and/or the reason for iron deficiency should be undertaken. A nephrologist may be consulted in the case of GFR reduction and evidence for chronic kidney disease. When ferritin and/or iron saturation values are indeterminant, further evaluation to rule out absolute iron deficiency vs inflammation/chronic disease is necessary. A successful therapeutic trial of iron would confirm absolute iron deficiency. No response to iron therapy would support the diagnosis of AI, suggesting that ESA therapy may be beneficial. Reprinted from Goodnough and Schrier⁸  with permission.