The document discusses a presentation on the complete hemogram and peripheral blood smear. It covers the indices and definitions used to evaluate red blood cells, normal reference values, classifications of anemia, and morphological features seen on peripheral blood smears and their interpretations. The presentation analyzes quantitative and qualitative parameters of red blood cells and how they are impacted by different pathological conditions.

1. PRESENTATION ON COMPLETE HEMOGRAM AND PERIPHERAL BLOOD SMEAR. Presenter: Dr.Tanoy Bose Moderator: Prof.R.K.Kotokey Department of Medicine, AMCH

2. To be discussed under following points: INTRODUCTION THE INDICES AND DEFINITIONS DISCUSSIONS NORMAL VALUES CLASSIFICATION OF ANEMIA RBC MORPHOLOGY IN PBS & INTERPRETATION CONCLUSION

3. INTRODUCTION The cellular and the fluid component of blood exist in a homeostasis which is readily altered by any pathological process that interferes with the maintenance of the homeostasis and the changes there of can be evaluated and interpreted to reach to the etiological diagnosis.

4. Introduction contd……. The red cell population is defined by some quantitaive parameters and qualitative parameters. 1.Quantitative parameters: # Volume of packed cells i.e. the hematocrit # Hemoglobin concentration # Red cell concentration per unit volume. 2.Qualitative parameters: # Mean corpuscular volume # Mean corpuscular hemoglobin # Mean corpuscular hemoglobin concentration. N.B: all are calculated by automated analysers.

5. INDICES AND DEFINITION Hematocrit ( Packed cell volume): It is the proportion of the volume of blood sample that is occupied by RBCs. Hematocrit = Red Cell Number [ L/L ] Red Cell Volume Hemoglobin Concentration: It is the amount of hemoglobin per unit volume of blood. Estimated by colorimetric method. [ Gms/dL ] Red Cell Count: Total number of Red Cells per unit volume of blood sample. Estimated by automated cell counter. [ No.of RBC/ cu.mm ]

6. Contd…. Mean Corpuscular Volume: It is the average volume a RBC. MCV = Hematocrit X 1000 / RBC count [ fL ] Mean Corpuscular Hemoglobin: It is the average hemoglobin content per RBC. MCH = Hemoglobin conc./ RBC count [ pg ] Mean Corpuscular Hemoglobin Concentration: It is the average concentration of hemoglobin in a given Red Cell Volume. MCHC = Hemoglobin conc./ Hematocrit [Gms/ dL ]

7. Some additional parameters … Red Cell distribution Width: This parameter quantitates the Red Cell Volume heterogeneity or reflects the range of Red Cell sizes measured in a sample. Retticulocyte Count: It is the number of retticulocytes (immatured nonnucleated Red Cells) in peripheral blood.

8. DISCUSSIONS The calculation of hematocrit is often misinterpreted in cases of volume depletion, shock and in cases where plasma is trapped by RBCs and is shown false high due to hemoconcentration. The presence of improperly lysed RBCs ,leucocytosis, increased lipids and proteins alters the estimation of hemoglobin. In cold agglutinin disease and high blood sugar levels MCV is estimated false high due osmotic swelling of the RBCs. MCH is the reflection of hemoglobin mass and is decreased in situations where hemoglobin synthesis is defective. Usually MCHC values do not increase more than 37 g/dL as level above this will result in crystallisation of hemoglobin. RDW is important in early classification of anemia because it is affected earlier in nutritional anemia before any other red cell indices. Retticulocyte count assesses the functional capacity of the bone marrow to synthesise and release retticulocyte in response to a challenge.

9. NORMAL VALUES Hemoglobin 15 +/- 2 g/dL in males 14 +/- 2 g/dL in females RBC count 5.0 +/- 0.5 million/cu.mm in males 4.3 +/- 0.5 million/cu.mm in females PCV 45 +/- 5 % in males 41 +/- 4 % in females MCV 92 +/- 10 fL MCH 29.5 +/- 2.5 pg MCHC 33.0 +/- 1.5 Gm/dL Retticulocyte count 0.5 – 2.0 %

10. CLASSIFICATION OF ANEMIA HYPOCHROMIC MICROCYTIC : Genetic: Thalassemia Sideroblastic anemia Acquired: Iron deficiency anemia Sideroblastic anemia Anemia of chronic disease NORMOCHROMIC MACROCYTIC : With megaloblastic marrow: Vit-B12/Folate deficiency With normoblastic marrow: Alcohol Mylodysplasia POLYCHROMATOPHILIC MACROCYTIC: Hemolysis NORMOCHROMIC NORMOCYTIC : Chronic disorders Infection, Malignancy Collagen disease, RA Renal failure Hypothyroidism, Hypopitutarism Aplastic anemia or PRCA Primary diseases of bone marrow Leukemia, Myelosclerosis Bone marrow infiltration with other tumors LEUKOERYTHROBLASTIC : Myelosclerosis Leukemia Metastatic carcinoma

11. PERIPHERAL BLOOD SMEAR Microangiopathic hemolytic anemia e.g. Severe burns DIC,TTP,Prosthetic valves Mechanical distortion Distended & fragmnted RBC Schistocyte Fe deficiency, Thalassemia RBC < 7.0 microns Microcyte Megaloblastic anemia (oval ) Liver disease (round ) Alcoholism Some Aplastic anemias MDS, Hydroxyurea Rx Young RBC Abnormal maturation RBC > 8.5 microns Well filled with Hb Macrocyte Fe def. anemia Thalassemia Sideroblastic Decreased hemoglobin synthesis Prominent central pallor Hypochromia Pb toxicity Thalassemia 5’ nucleotidase deficiency Precipitated ribosomes (RNA) Punctate basophilic inclusion Basophilic stippling Abetalipoproteinimia Parenchymal liver disease Post splenectomy. d/t altered membrane lipids Spiculated with dense core Acanthocytes

12. Contd………………. Myelopthesis Myelofibrosis Distorted , drop shaped cells Tear drop cells Liver disease,Post splenectomy, Thalassemia, Hemoglobinopathy Increased membrane redundancy Target like appearance, often hypochromic Target cells Hered. Spherocytosis Immunohemolytic anemia cl.Perfringiens toxin Decreased membrane redundancy Sperical c dense appearance & absent central pallor,usually of decreased diameter Spherocyte HbS disease ( not including trait) Molecular aggregation of HbS Bipolar,spiculated,pointed at both ends Sickle cell

13. CONCLUSION The red cells and it’s content are vulnerable to both intrinsic and extrinsic insults and the quantitaive,qualitative and morphologic parameters vary accordingly, reflecting changes which can be evaluated and interpreted in reaching a proper etioogical diagnosis.

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