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MLAB 1415: Hematology Keri Brophy -Martinez

MLAB 1415: Hematology Keri Brophy -Martinez. Chapter 8: Anemia Part Two. The “Normal” RBC. Biconcave disc Area of central pallor Approx. size 7 µm. RBC Size Variations. Alterations in the size of the RBC is called anisocytosis . Correlate with MCV and RDW. Normocytic. MCV 80-100 fL.

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MLAB 1415: Hematology Keri Brophy -Martinez

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  1. MLAB 1415: HematologyKeri Brophy-Martinez Chapter 8: Anemia Part Two

  2. The “Normal” RBC • Biconcave disc • Area of central pallor • Approx. size 7 µm

  3. RBC Size Variations • Alterations in the size of the RBC is called anisocytosis. • Correlate with MCV and RDW

  4. Normocytic • MCV 80-100 fL

  5. Macrocytes • 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

  6. Macrocytes • 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

  7. Microcytes • 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.

  8. Microcytes • Causes • Ineffective iron utilization, absorption, utilization, or release. • Decreased or ineffective globin synthesis.

  9. Microcyte

  10. RBC Color Variations • Correlates with MCHC • Reference range for MCHC= 32-36%

  11. Normochromic • Normal hemoglobin content • MCHC 32-36 %

  12. Hypochromia • 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.

  13. Hypochromia • MCHC <32 • Most frequently seen in iron deficiency anemia.  See in thalassemias, hemoglobinopathies, and sideroblastic anemias.  May also see hypochromia in lead poisoning.

  14. Hypochromia • 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+).

  15. Hypochromia Grading

  16. Polychromasia • 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.

  17. Polychromasia • 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.

  18. Polychromasia • 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.

  19. Polychromasia Grading

  20. Hyperchromasia • Does not exist!!!!!!

  21. 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.

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