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MLAB Hematology Keri Brophy-Martinez

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1 MLAB 1415- Hematology Keri Brophy-Martinez
Anemia Part One

2 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.

3 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

4 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

5 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

6 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


8 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

9 Laboratory Tests for Measurement of Anemia

10 Lab Tests Hemoglobin Reference values Hematocrit Reference values
Male: g/dl Female: g/dl Moderate anemia: 7-10 g/dl Severe anemia: <7 g/dl Reference values Male: % Female: 36-46%

11 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: 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

12 RBC Indices con’t MCH - mean cell hemoglobin weight
Normal: pg A measurement of the hemoglobin content in RBC’s Calculation: Hgb x 10 RBC MCHC - mean cell hemoglobin concentration Normal: % Used to classify RBCs as normochromic, or hypochromic A measure of the concentration of hemoglobin in the average RBC Calculation: Hgb x 100 Hct

13 Parameters of the CBC (complete blood count)
RDW -Red Cell Distribution Width Calculated index used to identify anisocytosis Normal: % Calculation: Standard deviation of MCV x100 Mean MCV

14 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%]

15 Reticulocyte maturation time in days RPI = corrected retic
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

16 Adult Reference Ranges
Red Blood Cells Male: x 106 /µl Female: x 106 /µl Hemoglobin Male: g/dl Female: g/dl Hematocrit Male: % Female: % MCV fL MCH 28-34 pg MCHC 32-36 % Reticulocyte % RDW %

17 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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