T4 - RBC Disorders (RBC Variations)

• Reticulocyte Count

ANEMIA EVALUATION:

• Indicates bone marrow response (effective or ineffective)

• Peripheral Blood Smear

ANEMIA EVALUATION:

• classify anemia by RBC morphology (micro/macrocytic, normo/hyper/hypochromic)

MEAN CELL VOLUME

LABORATORY DIAGNOSIS FOR ANEMIA:

• Most important

• Key in the morphologic classifications of anemia

Red Cell Distribution Width (RDW)

LABORATORY DIAGNOSIS FOR ANEMIA:

• Index of vartiations of cell volume in a red blood cell population

• The coefficient of variations of RBC volume expressed in percentage

• Peripheral Blood Film —quality control

• Bone Marrow Biopsy —cause of anemia

• Iron Studies —microcytic

• Serum Vit B12 and Folate assays —macrocytic

• Direct Antiglobulin Test (DAT) —autoimmune hemolytic

LABORATORY DIAGNOSIS FOR ANEMIA:

• Serves as quality control to verify the result produced by automated analyzers

• Peripheral Blood Film —quality control

• Bone Marrow Biopsy —cause of anemia

• Iron Studies —microcytic

• Serum Vit B12 and Folate assays —macrocytic

• Direct Antiglobulin Test (DAT) —autoimmune hemolytic

LABORATORY DIAGNOSIS FOR ANEMIA:

• May help in establishing the cause of anemia

• Peripheral Blood Film —quality control

• Bone Marrow Biopsy —cause of anemia

• Iron Studies —microcytic

• Serum Vit B12 and Folate assays —macrocytic

• Direct Antiglobulin Test (DAT) —autoimmune hemolytic

LABORATORY DIAGNOSIS FOR ANEMIA:

• Valuable if an inappropriately low reticulocyte count and a microcytic anemia are present

• Peripheral Blood Film —quality control

• Bone Marrow Biopsy —cause of anemia

• Iron Studies —microcytic

• Serum Vit B12 and Folate assays —macrocytic

• Direct Antiglobulin Test (DAT) —autoimmune hemolytic

LABORATORY DIAGNOSIS FOR ANEMIA:

• Helpful in investigating a macrocytic anemia with a low reticulocyte count

• Peripheral Blood Film —quality control

• Bone Marrow Biopsy —cause of anemia

• Iron Studies —microcytic

• Serum Vit B12 and Folate assays —macrocytic

• Direct Antiglobulin Test (DAT) —autoimmune hemolytic

LABORATORY DIAGNOSIS FOR ANEMIA:

• Can differentiate autoimmune hemolytic anemias from hemolytic anemias due to other causes

• Ineffective Erythropoiesis —defective

• Insufficient Erythropoiesis —↓ precursor

• Effective Erythropoiesis —adequate, ↑Reticulocyte

MECHANISM OF ANEMIA:

• Production of defective precursor erythroid cells

  • # of precursor cells are normal

  • Defective in function

• Ineffective Erythropoiesis —defective

• Insufficient Erythropoiesis —↓ precursor

• Effective Erythropoiesis —adequate, ↑Reticulocyte

MECHANISM OF ANEMIA:

• Decrease number of erythroid precursor cells

• Ineffective Erythropoiesis —defective

• Insufficient Erythropoiesis —↓ precursor

• Effective Erythropoiesis —adequate, ↑Reticulocyte

MECHANISM OF ANEMIA:

• Adequate bone marrow response

• Reticulocyte count is eleveated due to increased RBC production

Normochromia

QUALITATIVE RBC ABNORMALITIES:

• Central pallor is 1/3 of RBC diameter

Hypochromia (1+)

QUALITATIVE RBC ABNORMALITIES:

• Central pallor is >1/3 of RBC diameter

Hypochromia (2+)

QUALITATIVE RBC ABNORMALITIES:

• Central pallor is >2/3 of RBC diameter

Hypochromia (3+)

QUALITATIVE RBC ABNORMALITIES:

• Central pallor is 3/4 of RBC diameter

Hypochromia (4+)

QUALITATIVE RBC ABNORMALITIES:

• Thin rim of hemoglobin is left

Hyperchromia

QUALITATIVE RBC ABNORMALITIES:

• Decreased or absent central pallor

Slight

RETICULOCYTE GRADE:

• 1%

1+

RETICULOCYTE GRADE:

• 3%

2+

RETICULOCYTE GRADE:

• 5%

3+

RETICULOCYTE GRADE:

• 10%

4+

RETICULOCYTE GRADE:

• 11%

• Microcytic anemia

  • MCV = less 80 fL

  • RBC size = less 6um

ANICOCYTOSIS (Type of Anemia)

• result in reduced hemoglobin synthesis

  • Defective hemoglobin synthesis

  • Defective globin synthesis

• Normocytic Anemia

  • MCV = 80-100 fL

ANICOCYTOSIS (Type of Anemia)

• Develops due to premature destruction and shortened survival of RBCs

  • Intrinsic causes

  • Extrinsic causes

• Macrocytic Anemia

  • MCV = more 100fL

  • RBC Size = greater 8um

ANICOCYTOSIS (Type of Anemia)

• result in megaloblastic and non-megaloblastic cell development

  • Megaloblastic Anemia

  • Non-Megaloblastic Anemia

• Microcytic Anemia + Defective Hemoglobin synthesis

ANICOCYTOSIS (Type of Anemia)

• Iron-Deficiency Anemia

• Chrocnic inflammatory state

• Sideroblastic anemia

• LEAD POISIONING

• Microcytic Anemia + Defective Globin synthesis

ANICOCYTOSIS (Type of Anemia)

• Thalasemmia

• Hb E disease

• Normocytic Anemia + Intrinsic cause

ANICOCYTOSIS (Type of Anemia)

• Membrane defect

• Hemoglobinopathies

• Enzyme deficiencies

• Normocytic Anemia + Extrinsic cause

ANICOCYTOSIS (Type of Anemia)

• Immune and nonimmune RBC injury

• Macrocytic Anemia + Megaloblastic Anemia

ANICOCYTOSIS (Type of Anemia)

• Caused by impair synthesis of DNA

• Nuclear maturation lags behind cytoplasmic development

• Macrocytic Anemia + NonMegaloblastic Anemia

ANICOCYTOSIS (Type of Anemia)

• Are related to membrane changes owing to disruption of cholesterol-phospholipid ratio