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Haematological problems
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
The diagnosis of α- or β-thalassaemia trait may be suspected by finding a low MCV (usually <70), a low MCH (<27 pg), often no anaemia and a normal MCHC (as distinct from iron deficiency when all the indices are reduced).
Megaloblastic Anemias
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
The hemoglobin values in megaloblastic anemia vary from normal to markedly decreased levels as low as 3 g/dL. Most patients have a macrocytosis with mean corpuscular volumes (MCV) ranging from 100 to as high as 160 fL. Macrocytosis may be present in a variety of disorders (see Table 3), but megaloblastic anemia should be strongly suspected if the MCV is greater than 110–120 fL. The MCV may be normal in megaloblastic anemia if concurrent iron deficiency, thalassemia, or anemia of chronic disease is present; it is occasionally normal in the absence of other disorders. The mean cell hemoglobin concentration (MCHC) in megaloblastic anemia is normal; the red cell distribution with (RDW) is increased. The reticulocyte count is low. Occasional patients exhibit neutropenia and/or thrombocytopenia.
Erythrocyte Deformability
Published in Gordon D. O. Lowe, Clinical Blood Rheology, 2019
Mean cell hemoglobin concentration (MCHC) is an important determinant of cytoplasmic viscosity which, as it rises, causes a loss of erythrocyte deformability. This is seen in congenital disorders such as hereditary xerocytosis35 and sickle cell disease.36 It is equally important to relate rheological measurements to MCHC in acquired disorders where there may be an increase in MCHC consequent upon loss of cell water. Electronic counters of the Coulter type, which use the measured MCV value to derive the MCHC, will tend to give false low MCHC values when these are above the upper limit of normal (35 g/dℓ), as in dehydrated erythrocytes,37 and in general do not give a valid measurement of the true MCHC.38 Spun hematocrit and hemoglobin measurements are a preferable method of deriving MCHC values for cells that are likely to give a high result. In studies of erythrocyte deformability using hypertonic media, it may be preferable to adjust the test cell suspensions to a standard erythrocyte count, rather than hematocrit, since the number of (shrunken) cells per unit volume of packed cells will increase as the MCHC decreases39 and thereby affect rheological measurements.
Clinical features of anemia in membranous nephropathy patients: a Chinese cohort study
Published in Renal Failure, 2023
Zhe Li, Weibo Le, Haitao Zhang, Dacheng Chen, Wencui Chen, Shuhua Zhu, Ke Zuo
The diagnostic criteria for anemia were defined as hemoglobin (Hb) <130 g/L in males and Hb <120 g/L in nonpregnant females [10]. The criteria for mild anemia were 110 g/L ≤ Hb < lower limit of the normal reference value, those for moderate anemia were 80 g/L ≤ Hb <110 g/L, and those for severe anemia were Hb <80 g/L [11]. Mean corpuscular volume (MCV) <80 fL, mean corpuscular hemoglobin (MCH) level <27 pg and mean corpuscular hemoglobin concentration (MCHC) <320 g/L were required for microcytic hypochromic anemia. The criteria for normocytic anemia were 80 fL ≤ MCV ≤100 fL, 27 pg ≤ MCH ≤34 pg, and 320 g/L ≤ MCHC ≤360 g/L [12]. The criteria for complete correction of anemia were Hb ≥130 g/L in males and 120 g/L in nonpregnant females after anemia treatment. The criteria for standard anemia treatment were 110 g/L ≤ follow-up Hb < lower limit of the normal reference value. The criterion for nonstandard anemia treatment was follow-up Hb <110 g/L [10]. The criteria for complete remission (CR) of MN were 24-h urine protein content <0.3 g, serum albumin (Alb) >35 g/L and stable serum creatinine (sCr) for more than 6 months. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the glomerular filtration rate (eGFR) [13]. Renal endpoint events were defined as eGFR reduction >30% within 2 years of follow-up or regular dialysis [14].
Mild erythrocytosis as a presenting manifestation of PIEZO1 associated erythrocyte volume disorders
Published in Pediatric Hematology and Oncology, 2019
Tristan Knight, Ahmar Urooj Zaidi, Shengnan Wu, Manisha Gadgeel, Steven Buck, Yaddanapudi Ravindranath
Case 3: Patient 3 was evaluated at age 17 years for unexplained icterus. He did not have any notable past medical history, nor was he taking any medications. His mother was known to have mild indirect hyperbilirubinemia, with a maximum reported value of 2.0mg/dL. The patient’s CBC was within normal limits (Table 1). However, MCHC was elevated in the context of a normal MCV, with mild reticulocytosis, and haptoglobin was below threshold of detection; plasma hemoglobin was not tested and Hb evaluation was not done. Serum erythropoietin was 24.4 mIU/mL (RR 4.3–29.0), giving a normalized value of +81.4. Peripheral blood smear (Figure 1H) showed numerous dense spherocytic cells, and Osmoscan was left-shifted (Figure 1I)—both consistent with Xerocytosis (HX/DHS); band-3 content was only minimally decreased, less than expected in spherocytosis.
Long term effect of sulfur mustard exposure on hematologic and respiratory status, a case control study
Published in Drug and Chemical Toxicology, 2019
Mohammad Reza Khazdair, Mohammad Hossein Boskabady
The results showed significant increase in hematological parameters including; hematocrit and MCV but MCHC was decreased in SM patients, but all these variables were within normal range. Leukocytosis is common within the first few days after exposure, while WBC counts then begin to drop on the third and fourth days after exposure. Although leukopenia, thrombocytopenia, and anemia are known to be the main acute hematological effects following SM poisoning (Willems 1989). Long term follow-up of SM patients revealed a significant increase in the total WBC and RBC counts but differential counts of lymphocytes, monocytes, and granulocytes revealed no significant difference between SM exposing patients and the control group (Mahmoudi et al.2005). Increased hematocrit found in the present study is also perhaps due to airway narrowing in chemical war victims leading to reduced oxygen delivery to the tissues. Although the results showed significant increase in hematocrit and MCV but significant decrease in MCHC, but all the three parameters was approximately seen in the normal range. In addition, only three patients suffered from relatively severe respiratory disease. All patients suffered from long term respiratory disorders due to SM exposure but did not need oxygen therapy (except one subject). In addition, no cases of cyanosis was detected in the studied subjects. The results also showed that the hemoglobin (14.67 g/dL) and hematocrit (45.28 ± 4.84) values in CWV were in the normal range. The PFT values of the studied CWV were not too low. All these evidences indicated that the patients were not in a deoxygenated state.