1. ADVIA 120
CASE STUDIES
RBC CASES

2.    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

3. 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

4. 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

5. 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

6. 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)

7. 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)

8. 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)

9. 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

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

11. 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 =
HCT = 48.6
Rule does not apply because cells are not Normal.
Low MCHC

12. 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

13.  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

14. 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