Question

Anemia Case Study

A routine admission CBC was analyzed on a 16 year old white male using an automated cell counter. The results were:

WBC:              8,200/ul

RBC:              4.85 x 10⁶/ul

Hb:                  20.0 g/dl

Hct:                 42.5%

MCV:              87.6fl

MCHC:           47.1 g/dl

1. Do the hemoglobin and hematocrit values match in this case? Explain your    answer.

2. Are all of the red cell indices above the usual reference range?

3. Do these abnormal results represent a laboratory error or a blood disorder? Why?

4. What can be done to verify accurate results for this patient?

5. What is the diagnosis for this patient?

Answer 1

Hemoglobin and Hematocrit mentioned in the case study does not match. Usually, hemoglobin and hematocrit go together. If one is high, the other one increases too. But, here the hematocrit is in normal range (38-48.6) and hemoglobin is higher than normal range(13-16.6g/dl).

Hematocrit measures the volume of red blood cells present in the total volume of the blood or plasma. RBC'S has a protein called hemoglobin(Hb). so if Hb and RBC'S increases then hematocrit will also be increased.

NO. Except Hb and MCHC, other cell indices are in normal range.

These results represent laboratory error because excess EDTA used in the blood sample can cause RBC to shrink leading to false rise in MCHC(mean corpuscular hemoglobin concentration). MCHC measures the average concentration of hemoglobin inside a red blood cell .So, when the size of the RBC becomes smaller , the concentration of Hb rises.

High MCHC can also occur in sickle cell anemia but in it, there will low hb and RBC count. In this case study RBC count is normal and Hb is higher , So it is less likely in this case study.

Ask the patient to drink adequate water and then repeat the test and perform the test immediately after collecting blood sample as the time gap between sample collection and performing the test can also affect the test results.

Based on the test results mentioned in the case study, the patient seems dehydrated otherwise normal, the two elevated indices of CBC might be a laboratory error.