Microcytic Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Microcytic and links to relevant pages within the course.
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| Wright's stained peripheral blood smear made from EDTA specimen.What RBC morphologies are present? | View Page |
| CBC Results WBC 6.1 X 10 9/L (Reference range 4.0 - 10.5 X 109/LRBC 4.84 X 1012/L (Reference range 3.50 - 5.50 X 1012/LHb 8.4 g/dL (Reference range 12.0 - 16.0 g/dL)Hct 28.8 % (Reference range 36.0 - 48.0%)MCV 59 fL (Reference range 80.0 - 100.0 fL)MCH 17.4 pg (Reference range 26.0 - 34.0 pg)MCHC 29.3 g/dL (Reference range 32.0 - 36.0 g/dL)RDW 19.5 % (Reference range 11.0 - 15.0 %)Plat 591 X 109/L (Reference range 150 - 400 X 109/L)Even though the RBC count is normal, it is increased for the amount of hemoglobin present. The concentration of hemoglobin in the RBCs is slightly decreased (hypochromic) and the cells are small (microcytic). The variation in RBC size is also slightly increased as are the platelets. | View Page |
| What is the classification of this patient's anemia, based on the CBC results? | View Page |
| Hematologic Findings For Various Types of Beta Thalassemia Beta Thalassemia Silent Carrier Beta Thalassemia Minor Beta Thalassemia Intermedia Beta Thalassemia Major Delta-Beta Thalassemia Anemia Absent Mild to absent Moderate Severe Mild Red blood cell (RBC) count Normal Increased Decreased to normal Decreased Decreased to normal Hemoglobin(Hb) Normal Decreased to normal (10 - 12 g/dL) Decreased (7 - 10 g/dL) Marked decrease (<7 g/dL) Decreased to normal (8 - 13 g/dL) Mean corpuscular volume (MCV) Slight to no decrease Marked decrease Marked decrease Marked decrease May be slightly decreased Mean corpuscular hemoglobin concentration (MCHC) Slight to no decrease Marked decrease Marked decrease Marked decrease May be slightly decreased Red blood cell distribution width (RDW) Normal Normal to slightly increased Increased Increased Normal RBC morphology Normal Marked hypochromia and microcytosis Codocytes (target cells) Possible basophilic stippling Nucleated RBCs are usually not present Marked hypochromia and microcytosis Codocytes (target cells) Possible basophilic stippling Nucleated RBCs are usually not present Marked hypochromia and microcytosis Codocytes (target cells) schistocytes ovalocytes basophilic stippling polychromasia nucleated RBCs Possible hypochromia and microcytosis Codocytes (target cells) Basophilic stippling Reticulocyte count Normal May be slightly increased Slightly increased (<5%) Mildly increased (5 - 10%) Mildly increased Hb electrophoresis Normal pattern Decreased amount of Hb A Variable amounts of Hb A2 and Hb F Decreased amount of Hb A Variable amount of Hb A2 Hb F is usually increased Severly decreased amount of Hb A Variable amount of Hb A2 Usually an increased amount of Hb F Decreased amount of Hb A and Hb A2 Increased amount of Hb F (15 - 20%) If red blood cells are normochromic and normocytic, the RBC, Hb, and Hematocrit (HCT) test values follow in three-fold progression (i.e., RBC x 3 = Hb and Hb x 3 = HCT). This is sometimes referred to as "the rule of threes." This rule will usually not apply in cases of beta thalassemia, particularly beta thalassemia minor where the RBCs are not normochromic and are microcytic, and where there is a disproportionate number of RBCs for the amount of hemoglobin that is present. | View Page |
| Laboratory Test Results Test Patient Result Reference Intervals (Adult female) White blood cell (WBC) count 3.7 x 109/L 4.4 - 11.3 x 109/L Red blood cell (RBC) count 5.6 x 1012/L 4.1 - 5.1 x 1012/L Hemoglobin (Hb) 10.5 g/dL 12.3 - 15.3 g/dL Hematocrit (HCT) 36.6% 35.9 - 44.6% MCV 65.8 fL 80.0 - 96.0 fL MCH 19.9 pg 27.5 - 33.2 pg MCHC 26.7% 33.4 - 35.5% RDW 14.0 <14.5 Platelets 249.0 x 109/L 100.0 - 450.0 x 109/L Total serum iron 165 µg/dL 60 - 150 µg/dL Iron-binding capacity 230 µg/dL 250 - 400 µg/dL The RBC count is increased for the amount of hemoglobin present. The concentration of hemoglobin in the RBCs is slightly decreased (hypochromic) and the cells are small (microcytic). The variation in RBC size (RDW) is within normal limits. | View Page |
| Why is it important to note that the red cell distribution width (RDW) in this case is normal ? | View Page |
| Case History Summary The laboratory findings in this case represent classic findings seen in beta thalassemia minor including: erythrocytosis, decreased hemoglobin, normal hematocrit, normal RDW, and the presence of codocytes (target cells). This patient does have a mild anemia, but some patients with beta thalassemia minor have no anemia. Hemoglobin electrophoresis confirms this diagnosis, showing an increased Hb A2 level and decreased Hb A.In addition, the slightly increased iron and slightly decreased TIBC contradict a suspicion of iron deficiency. These chemistry results are typical for beta thalassemia, even though the red blood cells are microcytic and hypochromic. | View Page |
| What is this patient's most likely diagnosis?Review of results:This patient has an increased RBC count with a decreased Hb and normal Hct. The MCV is microcytic and the RDW is within normal limits. Many codocytes are present on the peripheral smear. Serum iron is 165 µg/dL (normal = 60 -150 µg/dL), and the TIBC is 230 µg/dL (normal = 250 - 400 µg/dL). Consider also the findings on alkaline hemoglobin electrophoresis. | View Page |
| The abnormal RBCs seen in this illustration are indicative of: | View Page |
| The RBCs seen in this illustration are indicative of: | View Page |
| Which of the following would not be represented in the usual classification of anemia: | View Page |
| The reticulocyte count is used to assess which of the following: | View Page |
| Match the disease conditions on the left with appropriate red cell appearances on the right: | View Page |
| The condition most likely associated with the peripheral blood picture shown in the photograph is: | View Page |
| The condition most likely associated with the peripheral blood picture in the photograph is: | View Page |
| Dimorphic RBC population Illustrated in the photomicrograph of a peripheral smear are two populations of erythrocytes. Approximately 50% of the erythrocytes are normal size and contain a full complement of hemoglobin. The patient had received blood transfusions. The transfused red blood cells are the normocytic, normochromic red cells. Admixed are microcytic erythrocytes and larger erythrocytes, some faintly mottled or smudged, suggestive of reticulocytes. This picture represents a hemolytic process with a reticulocyte response. A similar dimorphic red cell population appears following erythropoietin therapy. It is important to recognize when a population of cells in the peripheral smear is not in context with anticipated laboratory findings and the clinical situation. | View Page |
| Iron Deficiency Absorption of iron is interrupted in the absence of the stomach. Microcytic, hypochromic red cells are not conspicuous in the previous slides to reflect this deficiency. However, multiple factors influencing red cell morphology are so diverse in this case and therapy so uncontrolled that iron deficiency is not perfectly expressed morphologically. | View Page |
| Which of the following terms best describes the cells in this field? | View Page |