Abnormally shaped RBCs Spiculated

Abnormally shaped RBCs

Spiculated – Acanthocytes (abetalipoproteinemia, post – splenectomy, fulminating liver disease); Burr cells (stomach cancer, GI bleeding, uremia); Bite cells (hemolysis due to drugs); RBC fragmentation (cytotoxic chemotherapy, autoimmune hemolytic anemia, deficiency anemias, acute leukemia, inherited structural abnormality of RBC membrane protein spectrin).

Abnormally shaped RBCs Elongated

Abnormally shaped RBCs

Elongated – Elliptocytes (hereditary, microcytic anemia); ovalocytes (megaloblastic anemia); teardrop cells (spent polycythemia. myelofibrosis. Thalassemia); Sickle cells (sickle cell disorders); HbC crystalloids (HbC trait or disease). Acute alcoholism); Target cells (HbC disease or trait, HbD, HbE, HbS, thalassemia, iron deficiency anemia, liver disease, post – splenectomy).

Abnormally shaped RBCs Round

Abnormally shaped RBCs

Round – Macrocytes (increased erythropoiesis); round macrocytes (liver disease, hypothyroidism, alcoholism); macro – ovalocytes (megaloblastic anemia, cancer chemotherapy, myelodysplastic syndromes); microcytes (hypochromic anemias), spherocytes (hereditary spherocytosis, recent blood transfusion); stomatocytes (hereditary stomatocytosis, acute alcoholism); target cells (HBC disease or trait, HbD, HbE, HbS, thalassemia, iron deficiency anemia, liver disease, post splenectomy).

Peripheral Blood Smear (PS)

Peripheral Blood Smear(PS) - RBCs

Indications

Peripheral smear is done for typing anemia, to confirm red blood cells (RBC) indices or indicate leukemia or other conditions,

RBC inclusions

Basophilic or polychromatophilic macrocytes ( < 15 in healthy persons, increased in erythropoiesis due to hemorrhage or hemolysis); microcytes with stippling (thalassemia, lead poisoning); Cabot's rings (severe hemolytic anemias, pernicious anemia [ PA]); Howell – Jolly bodies(megaloblastic anemia, thalassemia, hyposplenism, splenectomy); Pappenheimer bodies (Sideroblastic anemia, thalassemia, lead poisoning, pyridoxine unresponsive or responsive anemias); Heinz bodies (congenital G – 6 PD deficiency, drug induced hemolytic anemias); Plasmodium trophozoites(malaria); reticulocyte.

Mean Corpuscular Hemoglobin Concentration (MCHC)

Mean Corpuscular Hemoglobin Concentration (MCHC)

Introduction

      MCHC is calculated as Hb divided by Hct.

      

      Normal Range

      32-38 %

      Indications

For laboratory quality control, chiefly because changes occur very late in the course of iron deficiency when anemia is severe and for instrument calibration.

Increased in

Hereditary spherocytosis (MCHC is > 36 gm/dL), infants and newborns, other causes due to automated cell counters are hemolysis, cold agglutinins, lipemia, rouleaux or RBC agglutinates.

Decreased in

Hypochromic anemia (Low MCHC may not occur in iron deficiency anemia when measured with automated instruments), marked leukocytosis (automated cell counter).

Mean Corpuscular Hemoglobin (MCH)

Mean Corpuscular Hemoglobin (MCH)

Introduction

MCH is calculated as Hb divided by total RBC count.

Normal range

            Adults – 27-31Pg
            New born – 33- 39Pg

Indications

Limited value in differential diagnosis of anemias; Used for instrument calibration.

Increased in

Macrocytic anemia, infants and newborns, marked leukocytosis( > 50,000/cu.mm),cold agglutinins, in vivo hemolysis, monoclonal proteins in blood, high heparin concentration, lipemia.

Decreased in

Microcytic and normocytic anemias.

Mean Corpuscular Volume (MCV)

Mean Corpuscular Volume (MCV)

Introduction

MCV is calculated as hematocrit (Hct) divided by RBC count with manual methods measured directly by automated instruments.

 

Normal range

Adults – 78-100Fl

Neonates- 102-115Fl.

Indications

Classification and differential diagnosis of anemia; useful screening test for occult alcoholism

Increased in (MCV > 95fL, Often > 110Fl)

All macrocytic anemias (megaloblastic anemias, Vit. B12’ folate deficiency, sprue, macrocytic anemia of pregnancy, megaloblastic anemia due to alcoholism, liver disease and hypothyroidism), infants and newborns.

 

Decrease in (MCV < 80FL)

Microcytic anemias

Usually hypo chromic (e.g. iron deficiency, pyridoxine – responsive thalassemia,   lead poisoning), chronic disease, abnormal HbC and HbE.

Total Erythrocyte Count (RBC Count)

Total Erythrocyte Count (RBC Count)

Normal range (x 106cumm)
Adult Males	Adult Females	Newborn
4.7- 6.0	4.2 –5.4	4.1-6.7

Hemoglobin Decreased in

All pathological causes of anemia; 

physiological in infants after 3 months of life (as infant is totally on milk feed, devoid of iron).

Hemoglobin Increased In

Hemoglobin Increased in

Chronic hypoxia of bone marrow due to exercise or any cardio respiratory disorder; 

polycythemia vera; 

physiological (normal) in newborn;

adults at high altitude.

Hemoglobin (Hb) Nomal Values

   Hemoglobin (Hb)

Normal range (g/dl)
Males	Females	Newborn	3Months	1Years
13.5-18	12.5-16	15-24	10.5	12.5

Complete Blood Count CBC

Tests included in CBC, Complete Blood Count

Hb,
TLC,
DLC,
RBC count
ESR
MCV
MCHC
MCH
Platelet Count
PCV
Peripheral Smear