Aspek Laboratorium Anemia

The Three Basic Measures

Measurement Normal
Range
A. RBC count 5 million 4 to 6
B. Hemoglobin 15 g% 12 to 17
C. Hematocrit 45 38 to 50
 Definition of Anaemia

Decrease in the number of circulating red

blood cell mass and there by O2 carrying
capacity
As such, critical for all practitioners to know
how to evaluate / determine its cause / treat
 Symptoms of Anemia

Normal or High Hemoglobin/Hematocrit

Check other
Causes of symptoms
e.g. Cardiac Low
Pulmonary RBC indices

MCV < 80 MCV=80-9 MCV > 98

MCHC < 32 6
History of acute blood loss
Auto immune Hemolytic anemia
B12 and folate
Serum iron and Total
Iron binding capacity Anemia of chronic Diseases levels
of Ferritin Anemia of infection

Low Iron Normal High Iron Low B12 Low folate High or Normal

IDA, chronic Hb BM exam PA, GI Folate MPD

diseases, Renal electrophoresis For problems malnutrition Liver Disease
diseases for Thala. Sideroblastic Severe GI problems
anemia malnutrition. Liver disease
 Classification of anemia

Functional classification:
Hypoproliferative destruction (infective hematopoiesis).
Clinical classification:
Causes of anemia (blood loss, IDA, hemolysis).
Quantitative classification:
Hematocrit
Hemoglobin
Blood cell indices (MCV, MCH, MCHC).
Reticulocytes count.
 Red cell indices

MCV (mean corpuscular volume)

The average volume of RBC
Hct
= 10 (fl)
RBC count (m/L)
e.g. Hct= 40%
RBC=5.0 (m /L)
MCV= 40/5.0 10 = 80 fl
NR= 80-96 fl
 MCH (mean corpuscular hemoglobin)
The average content of Hb in average RBC.
It is directly proportional to the amount of Hb and RBC size.

Hb
MCH = 10 (pg)
RBC count (m/L)

e.g. Hb = 14 g/dl
RBC = 4 (m/L)

MCH= 14/4 10
= 35 pg

NR= 27-32 pg
 MCHC (mean corpuscular hemoglobin
concentration)
Express the average concentration of hemoglobin per unit
volume of RBC.
It defined as the ratio of the weight of hemoglobin to volume
of RBC.

Hb (g/dl)
MCHC= 100 (%)
Hct (%)

e.g. Hb = 14 g/dl
Hct = 45 %

MCHC 14/45 100 = 31%

NR= 32-36%
 Anaemia

Hb% < 12, Hct < 38%

Hypoproliferative Hemolytic

Retics < 2 Retics > 2

 Mean Cell Volume (MCV)

RBC volume (rather) is measured by

The Mean Cell Volume or MCV and RDW

MCV

Microcytic Normocytic Macrocytic

< 80 fl 80 -100 fl > 100 fl

< 6.5 6.5 - 9 >9

 Anaemia Workup - MCV
MCV

Microcytic Normocytic Macrocytic

Iron Deficiency IDA Chronic disease Megaloblastic anemias
Chronic Infections Early IDA Liver disease/alcohol
Thalassemias Hemoglobinopathies Hemoglobinopathies
Hemoglobinopathies Primary marrow disorders Metabolic disorders
Sideroblastic Anemia Combined deficiencies Marrow disorders
Increased destruction Increased destruction
Classification of Anemias Using MCV and RDW

Low MCV Normal MCV High MCV

(Microcytic) (Normocytic) (Macrocytic)

Low RDW
Thalassemia minor
(low variability)

Anemia of chronic
Thalassemia minor Aplastic anemia
disease
Normal RDW Anemia of chronic Myelodysplastic
Hereditary
disease syndrome
spherocytosis

Early deficiency of B12 or folate

High RDW iron, B12, or folate deficiency
Iron deficiency
(high variability)
Sickle cell anemia Hemolytic anemia
Types of Anaemia
Screening Tests Anaemia
Clinical Signs and symptoms of Anaemia
Look for bleeding all possible sites
Look for the causes for anemia
Routine Hemoglobin examination
Cut off marks for Hb
US < 13.5 g WHO < 12.5 g
Subcontinent Less than 12 g%
 Iron

Serum Iron TIBC Ferritin

Iron Deficiency Low Elevated Low

Sideroblastic Elevated Nml Elevated

Thalassemia Elevated Nml Elevated

Anemia of Chronic Low Low Elevated

Disease
IDA -CBC
Microcytic Hypochromic - IDA
Iron related tests Normal IDA
Serum Ferritin (pmo/L) 33-270 < 33
TIBC (g/dL) 300-340 > 400
Serum Iron (g/dL) 50-150 < 30
Saturation % 30-50 < 10
Bone marrow Iron ++ Absent
 Microcytic Anaemias

Serum
MCV < 80 fl TIBC BM Perls stain
Iron
Iron Def. Anemia 0
Chronic Infection ++
Thalassemia N ++++
Hemoglobinopathy N N ++
Lead poisoning N N ++
Sideroblastic N ++++
 Macrocytic Anaemias

A. Megaloblastic Macrocytic B12 and Folate

B. Non Megaloblastic Macrocytic Anaemias
1. Liver disease/alcohol
2. Hemoglobinopathies
3. Metabolic disorders, Hypothyroidism
4. Myelodystrophy, BM infiltration
5. Accelerated Erythropoesis - destruction
6. Drugs (cytotoxics, immunosuppressants, AZT,
anticonvulsants)
MBA
Macrocytosis -MBA
HSN - MBA
 Dimorphic Anaemia

Folate & Fe deficiency (pregnancy, alcoholism)

B12 & Fe deficiency (PA with atrophic gastritis)
Thalassemia minor & B12 or folate deficiency
Fe deficiency & hemolysis (prosthetic valve)
Folate deficiency & hemolysis (Hb SS disease)
Peripheral smear exam is critical to assess these

RDW is increased very much

 Hct
(In the Diagnosis of Anemia)

Is packed RBC volume

Is ratio of RBC volume to volume of whole
blood
Usually expressed in percentage (42%) or as
decimal fraction (.42)
Venous and arterial hematocrits closely agree
Specimen of choice is EDTA
(ethylenediaminetetra acetic acid), oxalate or
heparin
 Hct
(In the Diagnosis of Anemia)

Measurement done by centrifugation or through

calculations performed on many automated
measurements.
Calculated hematocrit is product of MCV and RBC
count.
Normal ranges are 42-52% in men and 37-47% in
women.
Normal ranges also vary among age groups,
institutions, and geographic locations.
 Reticulocyte Count
(In the Diagnosis of Anemia)

Useful in determining response and potential of

bone marrow.
Reticulocytes are non-nucleated RBCs that still
contain RNA.
Visualized by staining with supravital dyes,
including new methylene blue or brilliant cresyl
blue; RNA is precipitated as dye-protein complex.
Normal range is 0.5-2.0% of all erythrocytes.
If bone marrow responding to anemia, should see
increases in retic count.
Newborns have higher retic count than adults until
second or third week of life.
 Bone Marrow
(In the Diagnosis of Anemia)

Bone marrow aspiration and biopsy are

important diagnostic tools in the determination
of anemia.
 Other Tests
(In the Diagnosis of Anemia)

Hemoglobin Electrophoresis
Antiglobulin Testing
Osmotic Fragility
Sugar Water Test
Hams Test
RBC Enzymes
B12, Fe, TIBC, Folate Levels
TERIMA KASIH