There is no single test that confirms pica. However, because pica can occur in people who have lower than normal nutrient levels and poor nutrition (malnutrition), the health care provider should test blood levels of iron and zinc.

Hemoglobin can also be checked to test for anemia. Lead levels should always be checked in children who may have eaten paint or objects covered in lead-paint dust. The health care provider should test for infection if the person has been eating contaminated soil or animal waste. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, posits four criteria that must be met for a person to be diagnosed with Pica:

In individuals with autism, schizophrenia, and certain physical disorders (such as Kleine-Levin syndrome), nonnutritive substances may be eaten. In such instances, pica should not be noted as an additional diagnosis.

Pagophagia is the compulsive consumption of ice or iced drinks.

It is a form of the disorder pica. It has been associated with iron deficiency anemia, and shown to respond to iron supplementation,

leading some investigators to postulate that some forms of pica may be the result of nutritional deficiency. Chewing ice may lessen pain in glossitis related to iron deficiency anemia. However, the American Dental Association recommends not chewing ice because it can crack teeth; instead ice should be allowed to melt in the mouth.

Folk wisdom (and some early investigators) maintained that pica reflected an appetite to compensate for nutritional deficiencies, such as low iron or zinc. Some forms of pica (as in pregnant women who are iron deficient) can be treated by supplementing the nutrient.

Later research has demonstrated that the substances ingested generally do not provide the mineral or nutrient in which patients are deficient. As the people start eating nonfoods, pica can also cause the nutritional deficiencies with which it is associated. In one case study, pagophagia was reported to "cause" iron deficiency anemia. At the same time, however, the researchers suggested that chewing ice may benefit stomatitis and glossitis. The nutrients obtained from nonfoods such as soil or ice will vary widely depending on geographic location. For example, ice made from hard water will contain more minerals, especially calcium and magnesium, but simply drinking the water will provide the same minerals.

The word derives from Greek: pagos, frost, + phagō, to eat.

As always, laboratory values have to be interpreted with the lab's reference values in mind and considering all aspects of the individual clinical situation.

Serum ferritin can be elevated in inflammatory conditions; so a normal serum ferritin may not always exclude iron deficiency, and the utility is improved by taking a concurrent C-reactive protein (CRP). The level of serum ferritin that is viewed as "high" depends on the condition. For example, in inflammatory bowel disease the threshold is 100, where as in chronic heart failure (CHF) the levels are 200.

A U.S. federal survey of food consumption determined that for women and men over the age of 19, average consumption from foods and beverages was 18.0 and 13.1 mg/day, respectively. For women, 16% in the age range 14–50 years consumed less than the Estimated Average Requirement (EAR), for men ages 19 and up, fewer than 3%. Consumption data were updated in a recently published government survey on food consumption reported that for men and women ages 20 and older the average iron intakes were, respectively, 16.6 and 12.6 mg/day. Consumption below the EAR continues to be rare for men (EAR=6.0 mg/day), whereas a significant minority for women presumed to be menstruating, i.e., ages 14 to 50 years (EAR 7.9 mg/day for teens and 8.1 mg/day for older women).

Anemia is often discovered by routine blood tests, which generally include a complete blood count (CBC). A sufficiently low hemoglobin (Hb) by definition makes the diagnosis of anemia, and a low hematocrit value is also characteristic of anemia. Further studies will be undertaken to determine the anemia's cause. If the anemia is due to iron deficiency, one of the first abnormal values to be noted on a CBC, as the body's iron stores begin to be depleted, will be a high red blood cell distribution width (RDW), reflecting an increased variability in the size of red blood cells (RBCs).

A low mean corpuscular volume (MCV) also appears during the course of body iron depletion. It indicates a high number of abnormally small red blood cells. A low MCV, a low mean corpuscular hemoglobin or mean corpuscular hemoglobin concentration, and the corresponding appearance of RBCs on visual examination of a peripheral blood smear narrows the problem to a microcytic anemia (literally, a "small red blood cell" anemia).

The blood smear of a person with iron-deficiency anemia shows many hypochromic (pale, relatively colorless) and small RBCs, and may also show poikilocytosis (variation in shape) and anisocytosis (variation in size). With more severe iron-deficiency anemia, the peripheral blood smear may show hypochromic, pencil-shaped cells and, occasionally, small numbers of nucleated red blood cells. The platelet count may be slightly above the high limit of normal in iron-deficiency anemia (termed a mild thrombocytosis), but severe cases can present with thrombocytopenia (low platelet count).

Iron-deficiency anemia is confirmed by tests that include serum ferritin, serum iron level, serum transferrin, and total iron binding capacity (TIBC). A low serum ferritin is most commonly found. However, serum ferritin can be elevated by any type of chronic inflammation and thus is not consistently decreased in iron-deficiency anemia. Serum iron levels may be measured, but serum iron concentration is not as reliable as the measurement of both serum iron and serum iron-binding protein levels (TIBC). The ratio of serum iron to TIBC (called iron saturation or transferrin saturation index or percent) is a value with defined parameters that can help to confirm the diagnosis of iron-deficiency anemia; however, other conditions must also be considered, including other types of anemia.

Further testing may be necessary to differentiate iron-deficiency anemia from other disorders, such as thalassemia minor. It is very important not to treat people with thalassemia with an iron supplement, as this can lead to hemochromatosis. A hemoglobin electrophoresis provides useful evidence for distinguishing these two conditions, along with iron studies.

The diagnosis of iron-deficiency anemia will be suggested by history that includes common causes of the condition, such as a menstruating woman or the presence of occult blood (i.e., hidden blood) in the stool. A travel history to areas in which hookworms and whipworms are endemic may be helpful in guiding certain stool tests for parasites or their eggs.

Although symptoms can play a role in identifying iron-deficiency anemia, these are often nonspecific symptoms, especially in mild cases, which may limit their contribution to determining the diagnosis.