mlab 1415: hematology keri brophy-martinez chapter 8: anemia part two
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MLAB 1415: HematologyMLAB 1415: HematologyKeri Brophy-MartinezKeri Brophy-Martinez
Chapter 8: AnemiaPart Two
The “Normal” RBCThe “Normal” RBCBiconcave disc
Area of central pallor
Approx. size 7 µm
RBC Size VariationsRBC Size VariationsAlterations in the size of the RBC
is called anisocytosis.
Correlate with MCV and RDW
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NormocyticNormocytic
MCV 80-100 fL
MacrocytesMacrocytes
8 μm or larger in diameter MCV of greater than 100 fL Evaluate macrocytic cells for:
◦ shape (round versus oval)◦ color (red versus blue)◦ pallor (if present)◦presence or absence of inclusions
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MacrocytesMacrocytes
Macrocytes arrive in peripheral circulation by three main ways:◦ Impaired DNA synthesis leading to decreased
number of cellular divisions, resulting in a larger cell Vitamin B12/Folate deficiency
◦ Accelerated erythropoiesis ending in a premature release of reticulocytes
◦Conditions in which membrane cholesterol and lecithin are increased obstructive liver disease 6
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MicrocytesMicrocytes
Diameter less than 7 μm MCV less than 80 fL. Any defect impairing
hemoglobin synthesis results in microcytic, hypochromic RBCs.
Decrease in hemoglobin synthesis results in increased cellular division and, consequently, small cells.
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MicrocytesMicrocytes
Causes◦Ineffective iron utilization, absorption, utilization, or release.
◦Decreased or ineffective globin synthesis.
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MicrocyteMicrocyte
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RBC Color VariationsRBC Color VariationsCorrelates with MCHCReference range for MCHC= 32-
36%
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NormochromicNormochromicNormal
hemoglobin content
MCHC 32-36 %
HypochromiaHypochromia
Any RBC having area of central pallor greater than 3 μm.
Direct relationship between amount of hemoglobin in red cell and appearance of red cell when stained.
Any problem with hemoglobin synthesis results in some degree of hypochromia.
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Hypochromia Hypochromia
MCHC <32Most frequently seen in iron deficiency
anemia. See in thalassemias, hemoglobinopathies, and sideroblastic anemias. May also see hypochromia in lead poisoning.
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HypochromiaHypochromia
Do NOT attempt to determine the presence of hypochromia based ONLY on RBC indices – must look at peripheral smear!
Hypochromia usually graded (1+ to 4+).
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Hypochromia GradingHypochromia Grading
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PolychromasiaPolychromasia
Occurs when immature RBCs are released into peripheral blood stream.
Blue-gray in color Larger than normal RBCs Basophilia is a result of
residual RNA fragments involved in hemoglobin synthesis.
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PolychromasiaPolychromasia
Cells are actually reticulocytes. Not uncommon to find a few
polychromatic cells on a normal peripheral blood smear.
Reticulocyte count should reflect the degree of polychromasia present.
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PolychromasiaPolychromasia
Causes of:◦ acute and chronic hemorrhage◦ hemolysis◦ regenerative red cell process◦newborns
Excellent indicator of therapeutic effectiveness for correcting iron deficiency anemia or vitamin therapy.
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Polychromasia GradingPolychromasia Grading
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HyperchromasiaHyperchromasia
Does not exist!!!!!!
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ReferencesReferencesHarmening, 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.
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