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Forum Name: Hematology Topics

Question: 16 y/o F with High RBC HGB HCT and low MCH MCHC MPV


 chessgenome - Sat Aug 21, 2010 9:01 am

Hi,

Please help me interpret my recent CBC results. I am 16 yrs old. Female, I feel fine and do not get sick frequently. I was given this results by a med student who did not even look at the results and told me everything was withing range. However, I could see I have several out of range results and I was wondering whether I should take this to my primary care provider. The lab is reputable but the results are not interpreted by an actual physician because they draw samples from all prospective students at the university and I guess they don't have the time to see all the results. What can these abnormalities mean? Should I look further evaluation?

Thank you.

WBC 6.34 K/uL
NEU 3.35 53.8 %N
LYM 2.40 38.5 %L
MONO .396 6.35 %M
EOS .001 .018%E
BASO .086 1.39%B DFLT(NE)

RBC 6.77 M/uL
HGB 15.8 g/dL
HCT 55.2 %
MCV 81.6
MCH 23.3 pg
MCHC 28.6 g/dL
RDW 15.6 %

PLT 239. K/uL
MPV 5.05 fL

GLU 58 (L)
 Dr.M.Aroon kamath - Tue Aug 31, 2010 10:23 pm

User avatar Hi,
Your laboratory test results do show a raised RBC count and the RBC indices indicate a hypochromic microcytic picture with a normal RDW.

Generally, a suspicion of Iron deficiency anemia (as it is the commonest) often begins with the finding of ‘microcytosis’(smaller than normal sized RBCs) and 'hypochromia" (paler than normal RBCs) on a blood smear. In the not so distant past, microcytosis and anisocytosis were diagnosed based on stained peripheral blood smears. Nowadays, automated blood analysers provide parameters such as HgB, red cell indices, RDW as well as others.

Faced with a situation of microcytosis and hypochromia, often, the temptation to jump to a diagnosis of Iron deficiency. Thalassemia must always be excluded before a decision to prescribe iron is made.More so,in populations in which thalassemias are prevalent.

Differentiating iron deficiency anemia and thalassemias (with their very heterogeneous nature) can be challenging. Usually iron deficiency can be ruled out using free erythrocyte protoporphyrin (FEP), transferrin saturation or ferritin as a screening test. But diagnostic dilemmas do occur.

Efforts on to find ways of improving the sensitivity and specificity of tests to separate out iron deficiency from thalassemia traits. Various discrimination indices (such as Shine Lal index, Mentzer's index, England and Fraser idex and several others) have been used for this discrimination. Osmotic fragility test is one other test that may help in some cases.

All these still lack an ideal discrimination index. RDW is another index frequently available as part of the reports in the automated analysers.This index has further been refined as RDW- SD (stands for Standard Deviation) and RDW-CV (stands for Coefficient Variation).

α thalassemia trait: In this situation, the affected individuals are clinically normal but frequently have minimal anemia, reduced mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). The red blood cell count is usually increased to over 5.5 x 1012/L. Red cell distribution width (RDW) is usually increased.
Alpha thalassemia is common throughout parts of the world where malaria is endemic and is common in people of Asian, African, and Mediterranean heritage.

Beta thalassemia trait: In this, the affected individuals have minimal clinical manifestations, usually manifested as a borderline anemia with disproportionate microcytosis and a reciprocally high RBC count. They also have a normal (12.7-16.3%) or near normal (up to 17%) red cell distribution width.

The distinguishing finding in beta thalassemia is a hemoglobin electrophoresis with the finding of elevated minor hemoglobins Hgb A2 and F. Both will be increased in beta thalassemia trait without iron deficiency, and will be normal or decreased in alpha thalassemia and isolated iron deficiency anemia. However, it is good to remember that rarely some individuals with beta-thalassemia also have normal levels of Hb A2 and Hb F and if both alpha and beta thalassemia coexist, the changes in Hgb A2 and F may not be apparent.

It has also been observed that a high erythrocyte count is a common feature of iron deficiency anemia in infants and young children, more so in those with mild anemia. It appears that high erythrocyte counts cannot be regarded as a reliable preliminary parameter in differentiating iron deficiency from thalassemias in infants and children aged up to 48 months.

In your case, the laboratory values provided suggest what could be a beta-thalassemia trait. Firstly, consult your doctor and discuss these test results.It may not be a bad idea to have these tests repeated and include a reticulocyte count. If you happen to be from a thalassemia prevalent area, a hemoglobin electrophoresis is all the more appropriate.
Best wishes!

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