RED CELL INDICES

ANAEMIA: OVERVIEW & CLASSIFICATION

DR. CROSDALE O. PUGHIKUMO

MBBS, PGDM, FMCPath (Haem), MSc.

DEPT. OF HAEMATOLOGY/IMMUNOLOGY
FACULTY OF BASIC MEDICAL SCIENCES
COLLEGE OF HEALTH SCIENCES
NIGER DELTA UNIVERSITY.
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 RED CELL INDICES

• They are measures of the size and haemoglobin content of RBCs.

• 3 parameters are employed in their calculation:
• These are: The haemoglobin concentration (Hb)
The packed cell volume (PCV) and,
The red cell count.
• There are 3 main red cell indices: MCV, MCH & MCHC.
• A recent addition is the red cell distribution width (RDW).
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 MEAN CELL VOLUME (MCV)
• It indicates the average volume of individual red cells.
• MCV = PCV in L/L
Red cell count/L
E.g. for a PCV of 0.45L/L and red cell count of 5 x 10 12 /L
MCV = 0.45L/L
5.0 X 10 12 /L = 90.0 X 10 -15 L or fL
Normocytic red cells, MCV, 80-96fL.
Microcytic “ “ “ < 80fL
Macrocytic “ “ “ > 96fL.
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 MEAN CELL HAEMOGLOBIN (MCH)
• Indicates the average weight of Haemoglobin (Hb) in individual red cells.
• MCH = Hb in g/L
Red cell count/L
E.g. for Hb of 15.0g/dL (150g/L) and a red cell count of 5 x 10 12 /L
MCH = 150g/L
5 x 10 12 /L = 30.0 x 10 -12 g = 30.0pg.
Reference range is 27-32pg.
Small cells usually contain less Hb.
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 MEAN CELL HAEMOGLOBIN
CONCENTRATION(MCHC)
• Indicates the average concentration of haemoglobin in a litre of red cells.
• MCHC = Hb in g/L
PCV in L/L
E.g. for Hb of 150g/L and PCV of 0.45L/L,
MCHC = 150g/L
0.45 = 330g/L or 33g/dL.
Reference range is 32-36g/dL (normochromia).

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 ANAEMIA

Introduction
• Functionally, anaemia is a decrease in the O2 carrying capacity of blood
leading to tissue hypoxia.

• Definition: Anaemia is defined as haemoglobin concentration (Hb) below

the lower limit of normal for age, sex, and altitude.

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 Reference values

• Newborn: 15.0-21g/dL(14-20g/dL in blacks). It decreases to about 10g/dL by 2 months.

• 3 months –puberty: 10.5-15.5g/dL.
• Adult male: 13.5-17.5g/dL.
• Adult female: 11.5-15.5g/dL.
• Pregnant women: 10.0-15.0g/dL.
• Hb in blacks is generally 0.5g/dL lower compared to caucasians.
• Diurnal variation: Hb, PCV and RBC count are highest in the mornings.

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 RED CELL TURN-OVER

• A healthy adult, loses about 20mls of red cells to senescence daily.

• The bone marrow produces about the same quantity daily.
• The bone marrow can increase production 10ce normal to compensate for
loss.
• So red cell life span may fall to about 18 days before anaemia develops.

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 CLINICAL PRESENTATION OF ANAEMIA

They are in 2 groups:

:
• those related to the etiology of anaemia.
• those related to reduced O2 carrying capacity.

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 Severity of anaemia:

• WHO grading:
• Mild anaemia: Hb > 9.0g/dL to lower limit of normal.
• Moderate anaemia: 6-8.9g/dL.
• Severe anaemia: < 6.0g/dL.

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 Factors influencing clinical severity of anaemia

●Speed of onset: rapid, progressive anaemia is more symptomatic, because there is

less time to adapt.
● Severity: Mild anaemia is usually asymptomatic, unlike moderate and severe forms.
● Age: Anaemia is better tolerated by young people because of better tolerance to
tissue hypoxia.
● Hb-O2 dissociation curve: Red cell 2,3DPG increases in anaemia, shifting the curve
to the right giving up O2 more readily to the tissues.
E.g. 2,3 DPG increases in Pyruvate Kinase Deficiency (PKD), and HbSS.
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 SYMPTOMS OF ANAEMIA

• Lethargy
• Palpitations
• Headaches
• General weakness of the body
• Syncopy
• Dyspnoea: Dyspnoea on exertion (DOE), Dyspnoea at rest (DAR).
• Visual disturbances.
• Amenorrhoea, menorrhagia.
• In the elderly: Clinical features of Heart Failure (HF), angina pectoris, intermittent claudication.
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 SIGNS OF ANAEMIA

Are general & specific:

● General:
□ Pallor of mucous membranes.
□ Hyperdynamic circulation: Tachycardia, Tachypnoea, cardiomegaly &
pansystolic murmur loudest at the apex.
□ Occasionally retinal haemorrhage.

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 SPECIFIC SIGNS

• Iron deficiency anaemia (IDA): Koilonychia.

• Haemolytic or megaloblastic anaemia: Jaundice, fever.
• Haemoglobinopathies: leg ulcers, skeletal deformities, cholelithiasis.
• Bone marrow failure (BMF): clinical features of septicaemia
(neutropaenia), spontaneous bruising (thrombocytopaenia).

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 CLASSIFICATION OF ANAEMIA

• There are 3 main classification:

• Etiopathogenetic.
• Morphologic.
• Reticulocyte production index (RPI).

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 ETIOPATHOGENETIC CLASSIFICATION

A . Decreased red cell production:

1. Impaired proliferation/differentiation of stem cells.
Anaemia associated with infection.
“ “ “ Renal failure (R.F).
“ “ “ Chronic liver disease (CLD).
“ “ “ malignancy.
“ “ “ collagen disease. SLE, Rheumatoid Arthritis.
“ “ “ endocrine disease; hypopituitarism, myxoedema.
Sideroblastic anaemias.
Congenital dyserythropoietic anaemias (CDAs).
Aplastic anaemia.

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 2. Impaired marrow function due to deficiency of essential
nutrients.

• Iron deficiency anaemia (IDA).

• Megaloblastic anaemias: Vitamin B12 and Folate.
• Anaemias associated with vitamin C def. (scurvy).
• “ “ “ other nutritional deficiencies.

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 B. Increased red cell destruction.

1. Due to intracorpuscular defects.

a. Membrane.
b. Metabolic/enzyme.
c. Haemoglobinopathies.
2. Due to extracorpuscular defects.
a. Immune.
b. Non-immune.
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 C. Haemorrhhage (Blood loss)

• Acute: Road traffic accidents (RTA), Obstetric complications, firearms,

Weapons of mass (WMD).
• Chronic: Helminthiasis, Peptic ulcer disease (PUD), malignancy,
menstrual abnormalities.

• D. Maldistribution: splenic sequestration.

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 MORPHOLOGIC CLASSIFICATION

Determined by 2 main red cell indices, MCV & MCHC.

1. Normocytic, normochromic anaemias: Normal MCV (80-96fL) & MCHC (31-36g/dL).
E.g. most Haemolytic anaemias
Some cases of anaemia of chronic disorders (AOCD).
Acute blood loss,
Chronic kidney disease (CKD)
Bone marrow failure (BMF)
Mixed nutritional deficiency,
Malignancy.
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 2. Hypochromic, microcytic anaemias.

• MCV < 80fL, MCH < 31g/dL.

• E.g. IDA,
• Thalassaemias,
• some cases of anaemia of chronic disorders (AOCDs),
• Lead (Pb) poisoning,
• some cases of sideroblastic anaemias.

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 3. Macrocytic anaemias

• MCV > 96fL.

• E.g. megaloblastic anaemia due to B12 or FA deficiency.
• non-megaloblastic macrocytic anaemias,
• Chronic liver disease (CLD)
• Myelodysplastic syndrome (MDS)
• Aplastic anaemia.

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 THANKS FOR RAPT ATTENTION!

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