Laboratory Evaluation of Anemia

Hemogram                           Male          Female

Hemoglobin (gm/dl)                 13.5 - 17.5   11.5 - 15.5

Hematocrit (%)		           40.0 - 52.0   36.0 - 48.0

Red cell Count (X 10 /12/L)        4.50 - 6.50   3.90 - 5.60

Mean Cell Hemoglobin (MCH)                  27.0 - 34.0

Mean Cell Volum (MCV) (fl)                  80.0 - 95.0
             
Mean Cell Hemoglobin Cocntration (MCHC)     30.0 - 35.0
            
White Blood Cell count (x 10/9/L)            4.0 - 11.0
            
Platelet Count (X10/9/10)                    105 - 450
  
Reticulocyte Count (5)                       0.5 - 1.5

As we can see only Hemoglobin, hematocrit and Red cell count have gender differences. The rest of the values ( what we call red cell indices) do not change with gender. Red cell indices give information about the average red cell volume (MCV) and red cell hemoglobin content (MCH) or concentration (MCHC). MCV is the most useful because it permits separation of microcytic anemia from normocytic and microcytic animas.

Cytomatic Classification of Anemia:

The cytomatic classification of the red blood cells will give us very important information for the first step in diagnosing the type of anemia we are investigating. It will lead us to which direction do we need to carry our laboratory screening for the exact causal diagnosis for anemia.

• Normochromic, Normocytic Anemia
  1- anemia of chronic disease
  2- hemolytic anemia
  3-anemia of acute hemorrhage

• Hypochromic, microcytic anemia
  1- iron deficiency anemia
  2- thalassemia

• Normochromic, Macrocytic anemia
  1- vitamin B12 deficiency
  2- folate deficiency

Laboratory evaluation:

• Peripheral Blood smear
• Red blood cell Count
• Red cell indices
• Hemoglobin
• Hematocrit
• Reticulocyte count
• Platelet count
• whit blood cell count
• blood in stool & urine
• Peripheral Blood smear

Laboratory Evaluation of anemia starts with the hemogram, that is the complete blood count, hemoglobin, hemotocrit and red cell indices plus the peripheral blood smear. In addition, initial evaluation should include a reticulocyte count, examination of the stool for occult blood, and urinalysis.

Screening Tests for Anemia

Hematocrit (Hct)       Cut point less than 36%-41%
	 
Hemoglobin (Hb)        Cut point less than 12-13 g/dl
	
Reticulacyte count     normal value 0.5 -1.5%
	 
Recommended in Infants Pregnant Women Other People at high
risk

We start with Hematocrit and Hemoglobin to get the mean cell value (MCV). If MCV is high we do the reticulocyte count, serum B12 and serum folate.

If MCV is low we do serum Fe, TIBC; if low we do ferritin and bone marrow, if normal we do Hb electrophoresis.

If MCV is normal we do serum Fe, TIBC Reticulocyte count Haptoglobin Cooms' test and then peripheral smear examination for RBC morphology:
1- Combs' test and osmotic fragility to diagnosis Spherocytes.
2- DIC screen for fragmentation.
3- Hb electrophoresis for Sickle cells.
4- Bone marrow Hb electrophoresis for nucleated RBC.

First Color Plate-upper

• A. Spherocytes in various hemolytic conditions
• B. Normal Cells for Comparison
• C. Autoimmune hemolytic anemia
• D. Hereditary sperocytosis
• E. Hereditary sperocytosis after splenomegaly; Note Howell-Jolly Bodies
• F. Extensive burns with anemia; Note severe fragmentation.

First Color Plate Lower

• A. elliptocytes in hereditary ovalocytosis
• B. Stomatocytes
• C. Heinz Bodies in G6PD Deficiency
• D. Acanthocytes in abetalipoproteinemia
• E. Acanthocytes and Howell-jolly bodies in liver diseas
• F. Autoagglutination in cold agglutinin disease

Second Color Plate upper

• A. B, Sickle cells
• C,D,E, Target cells in hemoglobin C disease.
• D, Hemoglobine C Crystals
• F, Hemoglobin C-thalassemia

Second Color Plate Lower

Schistocytes in patients with:

• A. Thrombotic thrombocytopenic Purpura,
• B. Disseminated intravascular Coagulation
• C. Aortic valve replacement
• D. Hemolyticuremic Syndrome