Evaluation of laboratory findings of anemia

Tests in the diagnosis of anemia

1. Hemoglobin
There are 3 methods for measuring hemoglobin:
- Cyanmethemoglobin method
- Oxyhemoglobin method
- Iron content measurement method
2. Hematocrit
Hematocrite is the ratio of the volume of RBCs to the volume of whole blood, it is
usually expressed as percentage (%).
Measurement of the hematocrite may be done by centrifugation or through
calculations performed on many automated hematology instruments.
Adult reference range for hematocrite:
- In men : (42-52)%
- In women : (37-47)%
3. RBC indices
The RBC indices are the mean corpuscular volume (MCV), mean cell hemoglobin
(MCH), and mean cell hemoglobin concentration (MCHC).
a) MCV
- MCV is used as an estimation of the average size of the RBC

(%) 10
=
( )

b) MCH
- MCH is the content of hemoglobin in the average RBC.
- It is calculated from hemoglobin concentration and the RBC count.
- Both MCH and MCHC values are used to determine the content of hemoglobin in
RBCs.

() 10
=
( )

c) MCHC
- MCHC is the average concentration of hemoglobin in a volume of packed red blood
cells.
- It is calculated from the hemoglobin concentration and the hematocrit.

() 100
=
(%)
4. Peripheral blood smear
The size and shape of RBCs can be noted by peripheral blood smear.Alteration in
size of the RBCs results in anisocytosis; alterations in their shape results in
poikilocytosis.
The hemoglobin (chromatic) content of the RBC also can be inspected visually. In
addition, cytologic details on the peripheral smear may provide clues to the etiology
of the anemia, the bone marrow response, or both.
E.g: basophilic stippling in the RBCs may suggest the presence of increased bone
marrow production and reticulocytosis.
5. Reticulocyte count
Reticulocytes are non-nucleated RBC, that still contain RNA.
Reticulocytes may be visualized after incubation with a variety of suprevital dyes,
including crystal violet or brilliant cresyl blue.
The referemce values for reticulocyte: 0.5%-2%

% %
% =
(45)

6. Bone marrow smear and biopsy

Factors to be evaluated in the interpretation of a bone marrow aspirate smear and
biopsy include:
- mauration of the red and white cell series
- presence of megakaryocytes
- ratio of myeloid to erythroid cells
- abundance of iron stores
- presence or absemce of granulomas, tumor cells, and overall estimate bone marrow
cellularity
Interpretation of the bone marrow requires a differential count of the myeloid,
lympoid, and erythroid series, an iron stain, and other appropriate technique, such
as immunohistochemical stains.
WBC Evaluation

Test FUll Name examples of causes of a low examples of causes of a high

count count
WBC White Blood Cell Count Known as leukopenia Known as leukocytosis

Bone marrow disorders Infection, most

or damage commonly bacterial
Autoimmune conditions or viral
Severe infections Inflammation
(sepsis) Leukemia,
Lymphoma or other myeloproliferative
cancer that spread to disorders
the bone marrow Allergies, asthma
Diseases of immune Tissue death
system (e.g., HIV) (trauma, burns,
heart attack)
Intense exercise or
severe stress

Diff White Blood Cell

Differential

(Not always performed;

may be done as part of or
in follow up to CBC)
Neu, Absolute neutrophil count, Known as neutropenia Known as neutrophilia
PMN, % neutrophils
polys Severe, overwhelming Acute bacterial
infection (sepsis) infections
Autoimmune disorders Inflammation
Reaction to drugs, Tissue death
chemotherapy (necrosis) caused by
Immunodeficiency trauma, heart attack,
Myelodysplasia burns
Bone marrow damage Physiological (stress,
(e.g., chemotherapy, rigorous exercise)
radiation therapy) Certain leukemias
Cancer that spreads to (e.g., chronic
the bone marrow myeloid leukemia)

Lymph Absolute lymphocyte count, Known as lymphocytopenia Known as lymphocytosis

% lymphocytes
Autoimmune disorders Acute viral infections
(e.g., lupus, rheumatoid (e.g., chicken pox,
arthritis) cytomegalovirus
Infections (e.g., HIV, (CMV), Epstein-Barr
 viral hepatitis, typhoid virus (EBV), herpes,
fever, influenza) rubella)
Bone marrow damage Certain bacterial
(e.g., chemotherapy, infections (e.g.,
radiation therapy) pertussis (whooping
Corticosteroids cough), tuberculosis
(TB))
Toxoplasmosis
Chronic
inflammatory
disorder (e.g.,
ulcerative colitis)
Lymphocytic
leukemia, lymphoma
Stress (acute)

Mono Absolute monocyte count, Usually, one low count is not Chronic infections
% monocytes medically significant. (e.g., tuberculosis,
fungal infection)
Repeated low counts can Infection within the
indicate: heart (bacterial
endocarditis)
Bone marrow damage Collagen vascular
or failure diseases (e.g., lupus,
Hairy cell leukemia scleroderma,
rheumatoid arthritis,
vasculitis)
Monocytic or
myelomonocytic
leukemia (acute or
chronic)

Eos Absolute eosinophil count, Numbers are normally low in Asthma, allergies
% eosinophils the blood. One or an occasional such as hay fever
low number is usually not Drug reactions
medically significant Parasitic infections
Inflammatory
disorders (celiac
disease,
inflammatory bowel
disease)
Some cancers,
leukemias or
lymphomas

Baso Absolute basophil count, % As with eosinophils, numbers Rare allergic

basophils are normally low in the blood; reactions (hives,
 usually not medically significant food allergy)
Inflammation
(rheumatoid
arthritis, ulcerative
colitis)
Some leukemias

RBC Evaluation

Test Full Name examples of causes of low examples of causes of high result
result
RBC Red Blood Cell Known as anemia Known as polycythemia
Count
Acute or chronic Dehydration
bleeding Lung (pulmonary) disease
RBC destruction (e.g., Kidney or other tumor that
hemolytic anemia, produces excess
etc.) erythropoietin
Nutritional deficiency Smoking
(e.g., iron deficiency, Genetic causes (altered
vitamin B12 or folate oxygen sensing, abnormality
deficiency) in hemoglobin oxygen
Bone marrow release)
disorders or damage Polycythemia veraa rare
Chronic inflammatory disease
disease
Kidney failure

Hb Hemoglobin Usually mirrors RBC results, Usually mirrors RBC results

provides added information
Hct Hematocrit Usually mirrors RBC results Usually mirrors RBC results; most
common cause is dehydration
RBC indices
MCV Mean Indicates RBCs are smaller Indicates RBCs are larger than
Corpuscular than normal (microcytic); normal (macrocytic), for example in
Volume caused by iron deficiency anemia caused by vitamin B12 or
anemia or thalassemias, for folate deficiency
example.
MCH Mean Mirrors MCV results; small red Mirrors MCV results; macrocytic
Corpuscular cells would have a lower value. RBCs are large so tend to have a
Hemoglobin higher MCH.
MCHC Mean May be low when MCV is low; Increased MCHC values
Corpuscular decreased MCHC values (hyperchromia) are seen in
Hemoglobin (hypochromia) are seen in conditions where the hemoglobin is
Concentration conditions such as iron more concentrated inside the red
 deficiency anemia and cells, such as autoimmune hemolytic
thalassemia. anemia, in burn patients, and
hereditary spherocytosis, a rare
congenital disorder.
RDW (Not RBC Low value indicates uniformity Indicates mixed population of small
always Distribution in size of RBCs and large RBCs; immature RBCs tend
reported) Width to be larger. For example, in iron
deficiency anemia or pernicious
anemia, there is high variation
(anisocytosis) in RBC size (along with
variation in shape poikilocytosis),
causing an increase in the RDW.
Reticulocyte Reticulocytes In the setting of anemia, a low In the setting of anemia, a high
Count (Not (absolute count reticulocyte count indicates a reticulocyte count generally
always done) or %) condition is affecting the indicates peripheral cause, such as
production of red blood cells, bleeding or hemolysis, or response
such as bone marrow disorder to treatment (e.g., iron
or damage, or a nutritional supplementation for iron deficiency
deficiency (iron, B12 or folate) anemia)