Analysis of Mean Corpuscular Volume and Red Cell Distribution Width in Patients with Aplastic Anemia
Lingling LiuQiuhao FuDanfeng ZhangDandan ChenFang WangRong GuoXinsheng XieZhongxing JiangJifeng YuYingmei Li
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To explore the characteristics of hemogram in patients with aplastic anemia (AA), especially mean corpuscular volume (MCV) and red cell distribution width (RDW). We examined the blood routine of 180 new-onset AA patients and used 166 patients with myelodysplastic syndrome (MDS) as controls. Among the 180 AA patients, 105 (58.3%) were diagnosed with severe AA (SAA), while 75 (41.7%) were diagnosed with non-severe AA (NSAA). Compared to MDS, patients with SAA generally had unfavorable hemogram, including significantly lower white blood cell (WBC), absolute neutrophil count (ANC), hemoglobin (Hb), platelet (PLT) and reticulocyte counts (RET). However, WBC, ANC and lymphocyte counts were higher in the NSAA group than in the MDS group; Hb and Ret were comparable between the two groups. 8.5% of SAA patients and 58.1% of NSAA patients presented with macrocytic anemia, whereas 25.7% of SAA and 64.0% of NSAA had a high RDW. In the MDS group, 54.7% of patients presented with macrocytic anemia, and 84.7% had increased RDW. WBC, ANC, PLT, and Ret in a high-RDW group (25.7% of SAA) were significantly higher than in a normal-RDW group (74.3% of SAA). Overall, most SAA patients exhibited normocytic–normochromic anemia, and their hemograms decreased more significantly; more than half of NSAA patients showed macrocytic-heterogeneous anemia, and their hemograms were similar to those of MDS. Patients with elevated RDW may have better residual bone marrow hematopoietic function than those with normal RDW but with more severe anemia.Keywords:
Macrocytic anemia
Aplastic anemia
Mean corpuscular hemoglobin
White blood cell
Macrocytosis
Complete blood count
Erythrocyte mean corpuscular volume and mean corpuscular hemoglobin levels were higher in children with Down syndrome than in normal control subjects. Reference values for mean corpuscular volume and mean corpuscular hemoglobin level derived from normal populations may be inappropriate for children with Down syndrome. These findings may have important implications for the diagnosis of iron deficiency in these children. Erythrocyte mean corpuscular volume and mean corpuscular hemoglobin levels were higher in children with Down syndrome than in normal control subjects. Reference values for mean corpuscular volume and mean corpuscular hemoglobin level derived from normal populations may be inappropriate for children with Down syndrome. These findings may have important implications for the diagnosis of iron deficiency in these children.
Macrocytosis
Mean corpuscular hemoglobin
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Background: Febrile seizures (FS) are the most common type of convulsion in young children. The predisposing factors are still under investigation; however, iron insufficiency might play a role in this regard. Objectives: Our objective was to determine the association between iron status and febrile seizure. Patients and Methods: This prospective case-control study was conducted among 109 children aged 6 months to 6 years and hospitalized for the first episode of FS. The case group was compared to a group of 70 age- and sex-matched controls admitted to the same ward with the same diagnosis of infection. The control and case groups were matched based on family history of FS, age, sex, temperature, cause of illness, erythrocyte sedimentation rate (ESR), white blood cells (WBC), and platelets. Venous blood samples were examined for complete blood count (CBC), serum iron, serum ferritin, and total iron-binding capacity. The CBC included measurements of red blood cell (RBC), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), WBC, and platelets. Results: There were no significant differences between the study groups in terms of temperature, ESR, WBC, and platelets. The mean Hb, HCT, ferritin, iron, and MCH were significantly lower in the case group than in the control group. The mean level of MCV in the FS group was lower than the mean level of MCV in the control group, but the difference was not significant. Conclusions: Low levels of serum ferritin and iron might play a role in the pathogenesis of simple febrile seizure. Further longitudinal studies are clearly needed to confirm our findings.
Mean corpuscular hemoglobin
Complete blood count
White blood cell
Venous blood
Erythrocyte sedimentation rate
Mean platelet volume
Febrile seizure
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Abstract Background Biological variation studies have shown that the complete blood count (CBC) has narrow within-individual variation and wide group variation, indicating that the use of reference intervals (RIs) is challenging. The aim of this study was to examine differences in CBC RIs according to race/ethnicity in a multiethnic population at a hospital in San Francisco in hopes of improving the medical utility of CBC testing. Methods Subject data were obtained by screening CBC results from the medical records of outpatients meeting certain criteria who visited Zuckerberg San Francisco General Hospital from April 2017 to January 2018. From these records, sex- and race/ethnicity-specific CBC RIs were calculated as the 2.5th to 97.5th percentiles. Results From a total of 552 subjects, 47.9% were male (65 White, 50 Black, 71 Hispanic and 54 Asian) and 52.1% were female (51 White, 39 Black, 122 Hispanic and 72 Asian). The RIs of neutrophil, lymphocyte and eosinophil counts; and hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) showed significant differences (p<0.05) among the four racial/ethnic groups: neutrophil, lymphocyte and eosinophil counts; and MCHC in males, and hemoglobin, MCV, MCH and MCHC in females. Conclusions Race/ethnicity-specific CBC RIs should be taken into consideration in a multiethnic population to better interpret patient status and make progress toward precision medicine.
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Asparaginase, an effective drug in the treatment of childhood acute lymphoblastic leukemia (ALL), has become an important component of most childhood ALL regimens during the remission induction or intensification phases of treatment. The incidence range of asparaginase-associated lipid abnormalities that are seen in children is 67–72%. Lipemia causes erroneous results, which uses photometric methods to analyze blood samples. We describe a case of l-asparaginase-associated severe hyperlipidemia with complete blood count abnormalities. Complete blood count analysis was performed with Beckman COULTER® GEN·S™ system, which uses the Coulter Volume, Conductivity, Scatter technology to probe hydrodynamically focused cells. Although an expected significant inaccuracy in hemoglobin determination occurred starting from a lipid value of 3450 mg/dl, we observed that triglyceride level was 1466 mg/dl. Complete blood count analysis revealed that exceptionally high hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration levels vs. discordant with red blood cell count, mean corpuscular volume, and hematocrit levels. Total leukocyte count altered spontaneously in a wide range, and was checked with blood smear. Platelet count was in expected range (Table 1). Thus, we thought it was a laboratory error, and the patient’s follow-up especially for red cell parameters was made by red blood cell and hematocrit values. Table 1. Patient’s complete blood count analysis according to the days of induction Day of induction Hb (g/dl) Hct (%) MCV (fl) MCH (pg) MCHC (g/dl) RDW (%) RBC (× 106/μl) WBC (× 10³/μl) Plt (× 10³/μl) 26 11.2 30.8 92 34 36.5 18 3.3 1.2 124 30 14.1 31 93 42 45 17.6 3.4 10.1 156 33 16.8 27 92 57 62 17 2.9 2.3 113 36 18.9 29 97 63 65 18.9 3.01 13.5 182 37 13.6 28.5 98 47 47 20 2.8 6.7 151 38 8.9 26.3 98 33 33 22 2.6 2.7 117 Hb, hemoglobin; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin; Hct, hematocrit; RBC, red blood cell count; RDW, red cell distribution width; WBC, white blood cell count; Plt, platelet count.
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A complete blood cell count (CBC) is one of most common test requested by a doctor that gives information about the cells in a patient`s blood. These days, counting the cells in a patient`s blood is generally automated by use of an automated analyzer. Because an automated cell counter samples and counts so many cells, the results are very precise. In addition to counting, automated analyzers also measure the amount of hemoglobin in the blood and red blood cell indices including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red blood cell distribution width (RDW). These informations are very helpful to a physician who is trying to identify the cause of a patient`s disease. If the red cells are smaller or larger than normal, or if there`s a lot of variation in the size of the red cells, these data can help guide the direction of further testing and expedite the diagnostic process so patients can get the treatment they need quickly. Therefore, we need to pay more attention to the interpretation of CBC results. (Korean J Med 78:531-539, 2010)
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An electronic cell sizing and counting system was employed for the first time to study developmental changes in the peripheral blood picture of neonatal mice. Among the parameters studied were erythrocyte volume and number, hemoglobin level, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. The system used determined several of these blood values simultaneously and permitted much more rapid and accurate measurements than have previously been obtained using standard hemocytometric techniques. The erythrocytes of the neonatal period were macrocytic and hypo??chromic. The mean volume and mean corpuscular hemoglobin decreased after birth, while the erythrocyte count, hemoglobin content and mean corpuscular hemoglobin concentration rose. Adult values for each of these parameters were reached by the 41st day after birth. The eryth??rocyte population gradually became more homogeneous as the largest cells were eliminated with time, when supplemental iron was administered to female mice during or just before pregnancy,the erythrocyte distributions of the offspring were the same as in normal newborn mice, but the erythrocyte number was higher. On the basis of evidence reported in this study together with that obtained by other investigators, a model for the production of hypochromic macrocytes in neonatal mice is described. It is suggested that the immediate cause of the macrocytosis is the skipping of cell divisions during erythrocyte production.
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Macrocytic anemia
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Brittin and associates reported that the spurious macrocytosis caused by antibody-coated erythrocytes did not occur when this parameter was measured by the Coulter counter model S. We have encountered at least two definite cases in which spurious macrocytosis as well as spurious mean corpuscular hemoglobin concentration and mean corpuscular hemoglobin values were obtained using this instrument. These were due to cold agglutinins. The clue to each of these cases was a mean corpuscular hemoglobin concentration of more than 36%. The combination of this finding with elevated mean corpuscular volume and mean corpuscular hemoglobin values should prompt a search for cold agglutinins.
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Background: Febrile seizures (FS) are the most common type of convulsion in young children. The predisposing factors are still under investigation; however, iron insufficiency might play a role in this regard. Objectives: Our objective was to determine the association between iron status and febrile seizure. Patients and Methods: This prospective case-control study was conducted among 109 children aged 6 months to 6 years and hospitalized for the first episode of FS. The case group was compared to a group of 70 age- and sex-matched controls admitted to the same ward with the same diagnosis of infection. The control and case groups were matched based on family history of FS, age, sex, temperature, cause of illness, erythrocyte sedimentation rate (ESR), white blood cells (WBC), and platelets. Venous blood samples were examined for complete blood count (CBC), serum iron, serum ferritin, and total iron-binding capacity. The CBC included measurements of red blood cell (RBC), hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), WBC, and platelets. Results: There were no significant differences between the study groups in terms of temperature, ESR, WBC, and platelets. The mean Hb, HCT, ferritin, iron, and MCH were significantly lower in the case group than in the control group. The mean level of MCV in the FS group was lower than the mean level of MCV in the control group, but the difference was not significant. Conclusions: Low levels of serum ferritin and iron might play a role in the pathogenesis of simple febrile seizure. Further longitudinal studies are clearly needed to confirm our findings.
Mean corpuscular hemoglobin
Complete blood count
White blood cell
Erythrocyte sedimentation rate
Venous blood
Mean platelet volume
Febrile seizure
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