ADVIA 120 CASE STUDIES RBC CASES

   Macrocytosis   Case #1 The RBC in this sample are Macrocytic from unknown etiology. The MCV is124 fl. T The RBC Vol histogram show a population skewed to the right. The RBC V/HC cytogram show a macro population. The%Macro is 52.2 The morphology flags show Macro = +++ Macrocytosis

Macrocytosis Macrocytes Normal Lymphocyte Show Macrocytes. Note: A normal RBC is approximately the size of the nucleus of a normal small lymphocyte. This slice show a normal small lymphocyte for comparison Macrocytosis

Microcytic Hypochromic RBCs Case #2         The RBC in this sample are Microcytic from unknown etiology. The MCV is60.2 fl. The MCHC is 27. 4 The RBC Vol histogram show a population skewed to the left. The HC histogram shows a population skewed to the left The RBC V/HC cytogram show a micro-hypo population. The morphology flags show Micro = +++ and Hypo = +++ This is an excellent time to discuss the Three Times Rule that applies only to Normal RBC’s. These are abnormal RBC’s and the 7.6 Hgb if cells were normal would render a 22.8 HCT. Cells are definitely abnormal and the MCH and MCHC reflects that. Note the agreement of the MCHC and CHCM, which further validates these results and demonstrates the three times rule does not apply to abnormal cells. Microcytic Hypochromic RBCs

Microcytic Hypochromic RBCs Red Blood Cells Normal Lymphocyte Slide shows normal small lymphocyte for comparison to RBC’s. Normal RBC is the same size as the nucleus of a small lymphocyte. This slice shows the microcytic hypochromic cells in this patient sample. Microcytic Hypochromic RBCs

Cold Agglutinin (Pre-Warming) Case #8    Not in this cold agglutinin, the agglutinated RBC’s present as a totally separate population in the RBC V/HC cytogram. The agglutinated RBC’s are also evident in the RBC Vol histogram. As the clumped RBC’s pass the laser, the cells are incorrectly sized. Cold Agglutinin (Pre-Warming)

Cold Agglutinin (Pre-Warming) Agglutination of RBC’s 50 X and 100 X magnification showing the agglutinated Red Blood Cells caused by the cold agglutinin, Cold Agglutinin (Pre-Warming)

Cold Agglutinin (Warmed) Case #8 Pre Warmed After warming the sample, the RBC agglutinin is not longer causing the RBC’s to clump. Cold Agglutinin (Warmed)

Hgb SS - Sickle Cell Anemia Case #9  The macrocytosis seen in this sample is probably due to the increased ertyhropoietic rate.  Hgb SS - Sickle Cell Anemia

Hgb SS - Sickle Cell Anemia Sickled Cells Slice of sample showing sickled cells in the peripheral blood smear. Hgb SS - Sickle Cell Anemia

Case #10     MCHC showing hypochromic cells. The flagging exhibits this. This is a perfect time to go into the 3 X Rule since these cells are abnormal and the rule does not apply. 3 x Hgb = HCT + 3 Hgb = 15 15 x 3 = 45 + 3 HCT = 48.6 Rule does not apply because cells are not Normal. Low MCHC

Low MCHC Hypochromic Red Blood Cell Normochromic Red Blood Cell Show the normocytic normochromic population then compare the hypochromia on the left that coincides with the MCHC. This is a perfect time to discuss the 3 x Rule of H & H. The following slide will help drive the point home further. Low MCHC

 High MCHC  Case #11 Hyperchromic cells indicated by high MCHC. + Case #11   Hyperchromic cells indicated by high MCHC. 3 x Rule does not apply because cells are not normal 3 x 18.2 = 54.6 Hct = 49.8 High MCHC

High MCHC Hyperchromic Red Blood Cells Normochromic Red Blood Cell Comparison of normochromic cells to cells with high MCHC. Yes you can say the word Hyperchromic. Not all hyperchromic cells must be spherocytes. The cells can be called hyperchromic if they do not demonstrate the central pallor. High MCHC