Anemia; Low hemoglobin, low hematocrit, low red cell count - Cancer Therapy Advisor
The hematocrit test is used to check for anemia as well as to screen for, With a test for hemoglobin or as part of a complete blood count (CBC). Anemia; Low hemoglobin, low hematocrit, low red cell count .. "The erythropoietin/hematocrit relationship in normal and polycythemic man: Implications of. There is a practice to assess hydration status through hemoglobin-hematocrit relationship. The hematocrit must always be three times the value of hemoglobin .
MCV values can be elevated in the setting of brisk reticulocytosis reticulocytes are larger than mature erythrocytes or as an artifact resulting from red cell agglutination. Normal values for MCV can result from coincident microcytic and macrocytic conditions; this state can be deduced from a particularly large RDW, as well as from microscopic examination of the peripheral smear.
Relationship between haemoglobin and haematocrit in the definition of anaemia.
Isolated increases in mean corpuscular hemoglobin concentration MCHC value with normal MCV values are commonly observed in hereditary spherocytosis. The diagnostic utility of the MCV is reduced or even eliminated in patients who have received one or more transfusions.
Anemias can also be categorized by whether they are a congenital e. The patient's medical records provide an invaluable resource for differentiating congenital from acquired etiologies. In all conditions, the risks associated with anemia are separate from the risks associated with the underlying medical condition e.
Signs and symptoms Signs: Key management points 1. If so, the patient may benefit from transfusion with packed red blood cells. The risks of standard red cell transfusions may be elevated under some conditions, including hyperhemolysis an unusual complication of sickle-cell diseaseiron-overload conditions, post-transfusion purpura, cardiopulmonary failure or other volume-overload states, religious objection, unavailability of ABO- and crossmatch-compatible product.
A few circumstances may require special preparation of donor red cells by the blood bank: Identify chief cause of anemia blood loss, red cell destruction, marrow failureits origin acute vs. Perform physical exam to investigate obvious sites of bleeding, as well as occult gastrointestinal, third-spacing hemorrhage.
Send samples for diagnostic work-up see below. Hematological subspecialists will typically request some or all of the following at initial consult: CBC with platelets and leukocyte counts, coagulation studies prothrombin time, PT and activated partial thromboplastin time, aPTTperipheral blood smear, reticulocyte count, and markers of hemolysis [lactate dehydrogenase, LDH, haptoglobin, bilirubin direct and indirect ]; and, less commonly, iron studies iron, transferrin, ferritinnutritional studies folate, vitamin B12and tests for red-blood cell antibodies Coombs' direct and indirect.
Emergency Management For all anemias: Identify the pathophysiology hemorrhage, destruction, marrow failure. The benefits of transfusion for patients with erythrocyte loss hemorrhage or destruction hemolysis will be temporary unless the underlying defect is corrected. Send patient samples to blood bank for typing and crossmatch analyses. Identify the site s of hemorrhage. Determine tempo of anemia with serial CBCs and measures of physiological compensation reticulocytosis.
Platelets and coagulation factors should be replaced to levels that permit normal hemostasis. Red-cell transfusions may be helpful in stabilizing the patient. Assess tempo of anemia.
Repeat CBCs should be obtained at appropriate intervals until the patient's Hct and Hb values are stabilized at a level that is compatible with physiological demands. Diagnosis Diagnostic tests For all anemias: Because many therapies--especially erythrocyte transfusions--can interfere with the diagnostic workup, it is generally recommended that, if possible, relevant studies of whole blood, plasma, and serum are obtained prior to initiating therapy.
Minimal initial evaluation for clinically significant anemias includes CBC with red cell indices, and enumeration of both platelets and leukocyte; coagulation studies PT and aPTT ; peripheral blood smear examination; and reticulocyte count.
As a practical matter, iron studies iron, transferrin, ferritinnutritional studies folate, vitamin B12and markers of hemolysis [LDH, haptoglobin, bilirubin direct and indirect ] are commonly obtained at the same time.
Tests for markers of hemolysis [LDH, haptoglobin, bilirubin indirect and direct ]. Fibrinogen, D-Dimer or fibrin split products.
Red cell enzymes G6PD. Nutritional studies [iron serum iron, transferrin, ferritinfolate, vitamin B12]. Blood tests for renal and liver function. Reticulocyte levels can provide clues to the temporal evolution of the anemia, as well as the adequacy of the marrow response. Uncomplicated, sub-acute and chronic anemias will display a variable elevation in the reticulocyte count; the absence of a reticulocytosis in this setting should prompt a search for a coincident reticulocytopenic condition.
As a measure of compensatory marrow erythropoiesis, reticulocyte levels must be corrected for the degree of anemia. This is done by multiplying the observed reticulocyte count by the ratio of the patient's hematocrit to a normal hematocrit.
The resulting number is known as the reticulocyte index RI. Burr cells are commonly observed as an artifact of peripheral smear preparation. Red cell inclusion bodies: Howell-Jolly bodies spherical basophilic bodies comprising nuclear remnants occur in hyposplenic states including post-splenectomy and sickle-cell disease, and less commonly in hemolytic anemias and megaloblastic anemias. Basophilic stippling persistent RNA is associated with lead intoxication, thalassemia, and conditions characterized by defective heme synthesis.
Confirming the diagnosis Low and high values for hemoglobin or hematocrit should be confirmed by repeat analysis. There are specific situations in which spurious values for Hb or Hct can be observed, including: If possible, samples should be re-drawn by direct venipuncture.
A similar artifact can arise when samples are drawn from a site that is proximal to an intravenous access site. In this case the clinical laboratory should report a "spun hematocrit" or "packed-cell volume". In many cases agglutination can be reversed by warming the blood sample prior to analysis. Cold agglutinins do not affect accuracy of spun hematocrit measurements.
Abnormal proteins myeloma, cryofibrinogens can interfere with RBC analyses; spun hematocrit measurements are reliable under these conditions. Consider complicating factors [fluid overload, cardiopulmonary compromise, religious objection, immune dysregulatory state hyperhemolysis, post-transfusion purpura ].
Always fill at least three tubes. For hematocrits obtained by venipuncture, draw a sample of blood into the tube containing anticoagulant and mix well.Iron Deficiency Anemia: Causes, Symptoms, & Treatment
Dip the hematocrit tube into the blood and allow the blood to rise to the desired two-thirds to three-quarters level. Because blood cells naturally sediment, a prior thorough mixing of the blood in the tube is necessary to ensure accurate reading.
After cleaning the outside of the hematocrit tubes of excess blood, invert the tube slowly so that the blood migrates just short of the bottom end of the tube.
Relationship between haemoglobin and haematocrit in the definition of anaemia.
Seal the bottom of the tube with sealant. Make certain that little or no air is interspersed in the column of blood. If the seal is incomplete, leakage will occur during centrifugation and false readings will be obtained. Place the tubes in a microhematocrit centrifuge and spin for 3 to 5 minutes at high speed. A shorter spin will not allow for complete sedimentation. Using either a hematocrit reader or any ruled apparatus, measure the length of the column of the packed red cells and divide it by the length of the whole column of blood cells and plasmaas in Figure Average all readings obtained from the different microhematocrit tubes.
The hematocrit is a ratio of the packed cells to total volume. Hemoglobin Hemoglobin determinations will usually be performed by an automated cell counter from a tube of well-mixed EDTA-anticoagulated blood filled to a predetermined level. In this assay, all forms of hemoglobins are converted to the colored protein cyanomethemoglobin and measured by a colorimeter. An inadequate sample, whether due to insufficient volume or inadequate anticoagulation, may give false readings.
If it is necessary to determine the level of anemia quickly, the hematocrit is an easier, more convenient test.
Hemoglobin Electrophoresis Hemoglobin electrophoresis measures the mobility of hemoglobin in an electric field; it can therefore detect only those abnormalities in hemoglobin that alter the charge. Electrophoretic mobilities are affected by pH and by the medium in which the test is conducted.
Anemia; Low hemoglobin, low hematocrit, low red cell count
Screening tests typically use a hemolysate of anticoagulated blood electrophoresed on cellulose acetate at pH 8. If necessary, a further electrophoresis in starch gel at pH 6. At that stage, the work will usually be performed by a specialized laboratory. Hemoglobin electrophoresis will not readily assess situations where there are neutral amino acid substitutions or where the hemoglobin is normal but the constituent chains are not produced in equal numbers thalassemias.
The diagnosis of alpha thalassemia of a mild to moderate degree cannot be made by hemoglobin electrophoresis; the diagnosis of beta thalassemia may be made by inference from an increase in the Hb A2. A standard electrophoresis would look like Figure A standard hemoglobin electrophoresis cellulose acetate, pH 8. Basic Science The molecular weight of hemoglobin is approximately 64, daltons.