PowerPoint: Anemia: Part Two
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MLAB 1415: Hematology
Keri Brophy-Martinez
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
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Normocytic
MCV 80-100 fL
Macrocytes
8 μm or larger in diameter
MCV of greater than 100 fL
Evaluate macrocytic cells for:
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shape (round versus oval)
color (red versus blue)
pallor (if present)
presence or absence of inclusions
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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
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Microcytes
Diameter less than 7 μm
MCV less than 80 fL.
Any defect impairing hemoglobin,
heme, or globin synthesis results in
microcytic, hypochromic RBCs.
Decrease in hemoglobin synthesis
results in increased cellular division
and, consequently, small cells.
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Microcyte
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RBC Color Variations
Correlates with MCHC
Reference range for MCHC= 32-36%
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Normochromic
Normal hemoglobin
content
MCHC 32-36 %
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.
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Hypochromia
MCHC <32
Most frequently seen in iron deficiency
anemia. See in thalassemias,
hemoglobinopathies, and sideroblastic
anemias. May also see hypochromia in lead
poisoning.
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Hypochromia Grading
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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.
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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.
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Polychromasia
Causes of:
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◦
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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 Grading
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Hyperchromasia
Does not exist!!!!!!
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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.