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![Page 1: Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.](https://reader035.fdocuments.us/reader035/viewer/2022081506/5697bfe91a28abf838cb69ce/html5/thumbnails/1.jpg)
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Laboratory evaluation of erythrocyte
RBCHaemoglobin
Packed cell volume
MCVMCH
MCHC
RDW
Reticulocyte
Blood film
Quantitative description of erythropoiesisAnaemia, polycythaemia
Qualitative description of erythropoiesisMicro-, normo-, nacrocytosis;Hypo-, normo-, hyperchromia
Reflects anisocytosis
Reflects bone marrow erythropoietic activityhypoproliferative, hyperproliferative
Final assessment of the disorderabnormal RBC (fragments)
![Page 3: Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.](https://reader035.fdocuments.us/reader035/viewer/2022081506/5697bfe91a28abf838cb69ce/html5/thumbnails/3.jpg)
![Page 4: Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.](https://reader035.fdocuments.us/reader035/viewer/2022081506/5697bfe91a28abf838cb69ce/html5/thumbnails/4.jpg)
Laboratory evaluation of erythrocyte
RBCHaemoglobin
Packed cell volume
MCVMCH
MCHC
RDW
Reticulocyte
Blood film
Quantitative description of erythropoiesisAnaemia, polycythaemia
Qualitative description of erythropoiesisMicro-, normo-, nacrocytosis;Hypo-, normo-, hyperchromia
Reflects anisocytosis
Reflects bone marrow erythropoietic activityhypoproliferative, hyperproliferative
Final assessment of the disorderabnormal RBC (fragments)
![Page 5: Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.](https://reader035.fdocuments.us/reader035/viewer/2022081506/5697bfe91a28abf838cb69ce/html5/thumbnails/5.jpg)
![Page 6: Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.](https://reader035.fdocuments.us/reader035/viewer/2022081506/5697bfe91a28abf838cb69ce/html5/thumbnails/6.jpg)
MCV
• HCT/RBC• RBC 5.000.000/microliter• Hematocrit 50%• The volume of RBC in 1 microliter• 0,0000001 microliter• 0,0001 nanoliter• 0,1 picoliter• 100 femtoliter [fL]
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MCV (Mean Corpuscular Volume)
• microcytic anemia
• normocytic anemia
• macrocytic anemia
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MCHC
• hypochromia
• normochromia
• hyperchromia
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Laboratory evaluation of erythrocyte
RBCHaemoglobin
Packed cell volume
MCVMCH
MCHC
RDW
Reticulocyte
Blood film
Quantitative description of erythropoiesisAnaemia, polycythaemia
Qualitative description of erythropoiesisMicro-, normo-, nacrocytosis;Hypo-, normo-, hyperchromia
Reflects anisocytosis
Reflects bone marrow erythropoietic activityhypoproliferative, hyperproliferative
Final assessment of the disorderabnormal RBC (fragments)
![Page 10: Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.](https://reader035.fdocuments.us/reader035/viewer/2022081506/5697bfe91a28abf838cb69ce/html5/thumbnails/10.jpg)
RDWMCV: 86 flRDW: 10,5 % (Normal)
MCV: 86 flRDW: 19,0 % (Abnormal)
red cell populations with higher than normal RDW are termed heterogenousthose with normal RDW are homogeneousanisocytosis is a general term reflecting increased variation in the size of red blood cells. The MCV will be within normal limits, but RDW will be increased.
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Laboratory evaluation of erythrocyte
RBCHaemoglobin
Packed cell volume
MCVMCH
MCHC
RDW
Reticulocyte
Blood film
Quantitative description of erythropoiesisAnaemia, polycythaemia
Qualitative description of erythropoiesisMicro-, normo-, nacrocytosis;Hypo-, normo-, hyperchromia
Reflects anisocytosis
Reflects bone marrow erythropoietic activityhypoproliferative, hyperproliferative
Final assessment of the disorderabnormal RBC (fragments)
![Page 12: Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.](https://reader035.fdocuments.us/reader035/viewer/2022081506/5697bfe91a28abf838cb69ce/html5/thumbnails/12.jpg)
Reticulocyte
Variation usually affects a continuum of red cell sizes, but occasionally two distinct red cell populations can be observed– sideroblastic anemia– red cell transfusion
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Reticulocyte count • the number of reticulocytes is reported as a percentage
of the total red cells – 0.5-2.5%• when the red cell count is low, the percentage of
reticulocytes is inaccurately high, suggesting that more reticulocytes are present than there are in reality.
For instance: – A normal person with an rbc count of 5,000,000 /microliter and an
absolute reticulocyte count of 50,000 /microliter would have a relative retic count of 1.0%.
– An anemic person with 2,000,000 rbc's/microliter and the same 50,000 retics/microliter would have an apparently "abnormal" relative retic count of 2.5 % and could be misdiagnosed
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Reticulocyte index (RI)
• A value of 45 is usually used as a normal hematocrit.• Hematocrit (%)......Retic survival (days)/maturation correction
36-45 1.0 26-35 1.5
16-25 2.0 15 and below 2.5
• So in a person whose reticulocyte count is 5%, hemoglobin 7.5 g/dL, hematocrit 25%, the RI would be:
5 x (25/45) /2 = 1.4• RI 1.0 – 2.0 for a healthy individual. • RI < 2 with anemia indicates decreased production
of reticulocytes and RBC• RI > 2 with anemia indicates hemolysis
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Hypoproliferative Anemia• Microcytic
– iron deficiency anemia
– thalassemia (decreased globin chain synthesis)
– sideroblastic anemia (decreased porphyrin synthesis)
– anemia of chronic disease
• Macrocytic
– megaloblastic anemia (B12, folate deficiency)
Hemolytic Anemia
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Increased RBC turnover• RI• Serum unconjugated bilirubin
• Haptoglobin concentration• Serum LDH
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Hemolysis• Hereditary disorders include erythrocyte membrane and enzymatic defects and
hemoglobin abnormalities. Some hereditary disorders include the following:– G-6-PD deficiency
– Hereditary spherocytosis
– Sickle cell anemia
• Acquired hemolytic conditions can be due to immune disorders, toxic chemicals and drugs, antiviral agents (eg, ribavirin), physical damage, and infections. They can include the following:
– autoimmune hemolytic anemia (AIHA)
– disseminated intravascular coagulation (DIC)
– hemolytic uremic syndrome (HUS)
– thrombotic thrombocytopenic purpura (TTP)
– defective prosthetic cardiac valves
• Autoimmune hemolytic anemia and hereditary spherocytosis are classified as examples of extravascular hemolysis because the RBCs are destroyed in the spleen and other reticuloendothelial organs (RES).
• Intravascular hemolysis occurs in hemolytic anemia due to prosthetic cardiac valves, G-6-PD deficiency, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation
• Fragmented erythrocytes (schistocytes)
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Laboratory evaluation of erythrocyte
RBCHaemoglobin
Packed cell volume
MCVMCH
MCHC
RDW
Reticulocyte
Blood film
Quantitative description of erythropoiesisAnaemia, polycythaemia
Qualitative description of erythropoiesisMicro-, normo-, nacrocytosis;Hypo-, normo-, hyperchromia
Reflects anisocytosis
Reflects bone marrow erythropoietic activityhypoproliferative, hyperproliferative
Final assessment of the disorderabnormal RBC (fragments)
![Page 19: Laboratory evaluation of erythrocyte RBC Haemoglobin Packed cell volume MCV MCH MCHC RDW Reticulocyte Blood film Quantitative description of erythropoiesis.](https://reader035.fdocuments.us/reader035/viewer/2022081506/5697bfe91a28abf838cb69ce/html5/thumbnails/19.jpg)
Variation in shape• poikilocytosis
– poikilocyte is pear-shaped and so also called a teardrop cell
• poikilocytosis can refer to an increase in abnormal red blood cells of any shape where they make up 10% or more of the total population.
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IDA
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Megaloblastic anemias• macrocytic anemia with thrombocytopenia and a decreased reticulocyte
count– MCV can range from 100-150 fL or greater
• hypersegmented neutrophils can be observed on the peripheral smear – Hypersegmented neutrophils contain 5 or more lobes, while normal
neutrophils contain 3-4 lobes
• macrocytes are oval and have been called macroovalocytes. – In persons with severe anemia, macrocytes with nuclear remnants and
erythrocytes with megaloblastic nuclei can be present in the peripheral blood
– Macrocytes can be found in the peripheral blood in patients with liver disease or hemolytic anemia and usually do not have oval features
• increased LDH and indirect bilirubin levels along with a decreased reticulocyte count suggest ineffective hemopoiesis in which intramedullary hemolysis is occurring.– LDH level is an excellent indication of response to or failure of therapy
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