mlab 1415- hematology keri brophy-martinez anemia part one
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MLAB 1415- Hematology
Keri Brophy-Martinez
Anemia
Part One
Anemia
Anemia is the inability of the blood to supply the tissue with adequate oxygen for proper metabolic function.
Clinically, anemia is defined as a decrease in the normal concentration of hemoglobin or erythrocytes.
Anemia is not a disease, but an expression of an underlying disorder or disease.
Development of Anemia
Anemia occurs if: Erythrocyte loss or destruction exceeds the
maximum capacity of bone marrow erythrocyte production OR
Bone marrow erythrocyte production is impaired or abnormal
Causes of anemia
Acute blood loss (hemorrhage) Accelerated destruction of RBC’s (immune or
non-immune) Nutritional deficiency (iron, folate or B12) Bone marrow replacement (e.g. cancer) Infection Toxicity Hematopoietic stem cell arrest or damage Hereditary or acquired defect
Anemia Classifications Functional
Uses absolute and corrected retic count, RPI, and serum iron for classification Types
Survival Defects(Increased Destruction) Proliferation Defects(Decreased production) Maturation Defects
Anemia Classifications Morphologic
Uses erythrocyte indices (MCV) for classification Types
Macrocytic, Normochromic Causes: Folate or B12 deficiency, liver disease, alcoholism
Normocytic, Normochromic Causes: bone marrow failure, hemolytic anemia, chronic renal failure,
leukemia, metastatic malignancy Microcytic,Hypochromic
Most common anemia Causes: iron deficiency, sideroblastic anemia, thalassemia, chronic
diseases
Diagnosis of anemia
Clinical history Physical signs such as pallor, fatigue, weakness and
shortness of breath Laboratory tests
CBC Examination of the blood smear Reticulocyte - measures effective erythropoiesis Bone marrow examination Iron studies - iron, total iron-binding capacity (TIBC), ferritin Vitamin B12 and folate Erythropoietin level
Laboratory Tests for Measurement of Anemia
Lab Tests Hemoglobin Reference values
Male: 14-17.4 g/dl Female: 12-16 g/dl
Moderate anemia: 7-10 g/dl
Severe anemia: <7 g/dl
Hematocrit Reference values
Male: 42-52% Female: 36-46%
Parameters of the CBC (complete blood count)
Red Blood Count or RBC Hemoglobin Hematocrit
Note: the approximate relationship of the hemoglobin to the hematocrit is 1:3. This may vary with the cause of the anemia and the effect on the RBC indices, especially the MCV.
RBC indices MCV - mean cell volume
Normal:80-100 fL (femtoliters) Measured directly on automated cell counters Used to classify RBCs as normocytic, microcytic or macrocytic Indicates the average volume of the red cells
Calculation: Hct x 10
RBC
RBC Indices con’t
MCH - mean cell hemoglobin weight Normal: 28-34 pg A measurement of the hemoglobin content in RBC’s
Calculation: Hgb x 10
RBC
MCHC - mean cell hemoglobin concentration Normal: 32-36 % Used to classify RBCs as normochromic, or hypochromic A measure of the concentration of hemoglobin in the average RBC
Calculation: Hgb x 100
Hct
Parameters of the CBC(complete blood count)
RDW -Red Cell Distribution Width Calculated index used to identify anisocytosis Normal: 11.5-14.5%
Calculation: Standard deviation of MCV x100
Mean MCV
Reticulocyte
Adult reference range: 0.5 - 2.5% Useful in determining the response to the anemia and the
potential of the bone marrow to manufacture RBC’s. Expressed as a percentage of the RBC’s.
When anemia is present, it is helpful to correct the retic using the patient’s hematocrit in order to assess appropriate bone marrow response
A supravital stain called New Methylene Blue is used to stain reticulocytes. On a Wright’s stained smear, reticulocytes appear as bluish red cells. The term used for retics on Wright’s stain is polychromasia.
Corrected retic% = retic % X Patient hct Normal hct* based on age and sex
[*Normal female hct = 42%][*Normal male hct = 45%]
Reticulocyte
Prematurely released retics remain in the blood and take from ½ to 1 ½ days longer to mature. This will cause even the “corrected” retic to be elevated, so a calculation must be performed to correct for this situation to obtain the reticulocyte production index (RPI). A maturation time table is used for this calculation.
Indicator of the adequacy of the bone marrow response in anemia RPI>2: good bone marrow response RPI<2: inadequate response
RPI = corrected retic
maturation time in days
Adult Reference Ranges
Red Blood Cells Male: 4.5-5.5 x 106 /µlFemale: 4.0-5.0 x 106 /µl
Hemoglobin Male: 14-17.4 g/dlFemale: 12-16 g/dl
Hematocrit Male: 42-52%Female: 36-46%
MCV 80-100 fL
MCH 28-34 pg
MCHC 32-36 %
Reticulocyte 0.5-2.5%
RDW 11.5-14.5%
References
Harmening, D. M. (2009). Clinical Hematology and Fundamentals of Hemostasis. Philadelphia: F.A Davis.
McKenzie, S. B., & Williams, J. L. (2010). Clinical Laboratory Hematology . Upper Saddle River: Pearson Education, Inc.