Red blood indices

• Helpful in morphological classification of anaemias

1. Mean corpuscular volume : average volume of single RBC expressed in

femtoliters. Normal range: 74 – 95 fL
• < 74 = microcytic; 74 – 95 = normochromic; >95= macrocytic

2. Mean corpuscular hemoglobin: average weight of Hb in a single RBC.

Normal range: 27 – 32 picograms (pg)

3. Mean corpuscular hemoglobin concentration: average concentration of

Hb in RBC relative to the size of cell itself. Normal range: 30 – 38%
• < 30: hypochromic; 30 – 38: normochromic
Normocytic normochromic smear
MEGALOBLASTIC ANAEMIA
Cases on Anemia

Department of Physiology
Case no. 1
• A 35-year-old female comes to the doctor with a complaint of
breathlessness, loss of appetite and easy fatiguability for the past 5
months. She is 24 weeks pregnant with her 3rd child in 3 years and has
not seen any doctor during her pregnancies. She is not under any
medications & has no significant past history. She is a vegetarian,
does not smoke or drink.

• Her physical examination revealed pale conjunctiva, mild spooning of

nails, increased heart rate and systolic murmur
• Pulse: 100/min, regular; BP: 130/80 mm Hg
• Lab reports of this patient were as follows:
Test Name Result Reference range
Hb 6 gm% 12 – 16 gm% in females
PCV 30% 35 – 45%
RBC count 3 million/ cumm 4.0 – 5.5 million/ cumm
Mean corpuscular volume (MCV) 70 fL 80 – 100 fL
Mean corpuscular hemoglobin 19 pg 27 – 32 pg
(MCH)
Mean corpuscular hemoglobin 28% 30 – 38%
concentration (MCHC)

WBC count 5, 400 cells/ cumm 4,000 – 11,000 cells/cumm

Serum ferritin 9 nanogram/mL 13 – 150 ng/mL
Total iron binding capacity (TIBC) 450 μg/dL 150 – 350 μg/dL
• Stool examination: negative for occult blood; hookworm ova present
• Peripheral smear: RBCs are microcytic and hypochromic; mild
eosinophilia seen
Case no. 2
• A 6 yrs old boy comes to the doctor with history of recurrent attacks
of pain in bones and joints for last 5 months, easy fatiguability and
breathlessness for last 1 year.

• His physical examination revealed the following findings:

• Temperature: 100 oF
• Pulse: 120/min
• Respiratory rate: 30/min
• BP: 110/70 mm Hg
• Pallor present
• Icterus present
• Mild edema present
• Lungs clear
• CVS: heart sound normal with no murmur
• Abdomen: Hepatosplenomegaly present
• His lab report is given below:

Test name Result Reference Range

Hb 6.5 gm% 11 – 14.5 gm%
RBC count 2.5 million/ mm3 4 – 6 million/ mm3
Reticulocyte 12% 1 – 2%
count
WBC count 10000 cells/mm3 4000 – 11000 cells/mm3
ESR 1 mm at the end of 1 hr 3 – 5 mm at the end of 1 hr
by Westergren’s method
Hematocrit 25% 42 – 45%
Serum bilirubin 3 mg/ dL 0.2 – 0.8 mg/dL
• Peripheral smear: microcytic hypochromic anemia, poikilocytes,
target cells, fragmented RBCs, no hemoparasites
Case no. 3
• A 52 year old man comes to the doctor with complaints of loss of
appetite, loss of taste, muscle weakness, pain in lower limbs, easy
fatiguability, palpitation and repeated respiratory and urinary
infections. He has past history of being treated for depression. He is
an alcoholic for the past 10 years and has lost weight in the past one
year. His wife tells that the patient has slight memory impairment and
loss of balance.
His physical examination findings are as follows:
• Pulse: 110/ min
• BP: 140/90 mm Hg
• Temperature: 98oF
• Pallor present
• Face: glossitis, angular chelitis present
• CVS: systolic murmur present
• CNS: loss of sense of vibration, proprioception; reflexes diminished
• Lab reports of this patient were as follows:
Test Name Result Reference range
Hb 7.2 gm% 14 – 18 gm% in males
PCV 23% 38 – 50%
RBC count 2.63 million/ cumm 4.5 – 6 million/ cumm
Mean corpuscular volume (MCV) 144 fL 80 – 100 fL
Mean corpuscular hemoglobin 36 pg 27 – 32 pg
(MCH)
Mean corpuscular hemoglobin 35% 30 – 38%
concentration (MCHC)

WBC count 2,400 cells/ cumm 4,000 – 11,000 cells/cumm

Serum folate 1 nanogram/mL 3 – 16 ng/mL
Serum cobalamin 160 pg/mL 200 – 900 pg/mL
Intrinsic factor antibodies : Absent

His peripheral smear reveals large oval RBCS, hyper segmented

neutrophils
Case no. 4
• A 55 year old woman presents to her GP with weakness, “pins and
needles” sensation in her feet, and poor concentration. Her
symptoms have gradually worsened over two years. She had also
developed exertional dyspnoea and unsteadiness while walking. She
is a smoker and has a past history of repeated episodes of heartburn
and nausea.
• On examination,
• Pulse: 110/ min
• BP: 140/90 mm Hg
• Temperature: 98oF
• Pallor present
• Face: glossitis, bald tongue, angular chelitis present
• CVS: systolic murmur present
• CNS: decreased light touch and vibration sense in lower limbs;
reflexes diminished; mild atrophy of optic nerve
• Lab reports of this patient were as follows:
Test Name Result Reference range
Hb 9 gm% 12 - 16 gm% in females
RBC count 3.5 million/ cumm 4.0 – 5.5 million/ cumm
Mean corpuscular volume 110 fL 80 – 100 fL
(MCV)
WBC count 2,500 cells/ cumm 4,000 – 11,000 cells/cumm
Platelet count 1,30,000/ cumm 1,50,000 – 4,00,000/cumm
Peripheral smear: normocytic normochromic RBCs,
hypersegemented neutrophils seen
Serum folate 7.73 nanogram/mL 3 – 16 ng/mL
Serum cobalamin 160 pg/mL 200 – 900 pg/mL
Anti parietal cell Present
antibodies
Anti IF antibodies Present
Serum Gastrin Elevated
Homocysteine 17 μmol/L <12 μmol/L
Press the nail and note the color of nailbed after releasing the digital pressure.
Compare the color of palmar crease with that of the adjacent skin of
palm. Pallor is said to be present if both are of same color.
Smooth, red tongue of Vitamin B12 Pale tongue of iron deficiency
deficiency anaemia anaemia
Koilonychia of iron deficiency anaemia
Give reason

• Chronic renal failure patients are invariably anemic. Justify