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Hemolytic Anemias: General Considerations
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
4. Reticulocytosis. There are several ways to utilize the reticulocyte count (typically expressed as the percentage of red cells which are reticulocytes) to evaluate red cell production by the marrow. The reticulocyte count may be expressed as an uncorrected percentage, or as the absolute reticulocyte count (percent reticulocytes multiplied by the red cell count per cubic millimeter), or as the corrected reticulocyte count (percent reticulocytes multiplied by patient’s hematocrit/45), or as the reticulocyte production index (corrected reticulocyte count multiplied by a factor which reflects the increased shift of less mature cells to the peripheral blood) (8). All of these modifications are efforts to remind the clinician that a reticulocyte count of 1%, which is perfectly adequate to maintain a hematocrit of 45%, is too low if the patient’s hematocrit is 25% (see Table 4 for normal values of reticulocyte evaluations). An elevated reticulocyte count is considered a hallmark of hemolytic anemia. However, as many as 37% of patients with autoimmune hemolytic anemia can present with reticulocytopenia (as defined by a reticulocyte production index <2%), and it is important to remember that absence of reticulocytosis does not rule out a hemolytic anemia (9, 10). Individuals with mild chronic hemolysis (particularly patients with hemoglobinopathies or thalassemia) often have a relatively normal hemoglobin concentration and hematocrit but have an elevated reticulocyte count: The shortened red cell survival requires extra marrow production in order to maintain a near-normal hematocrit/hemoglobin. The phenomenon of transient aplastic crises in chronic hemolysis due to B19 parvovirus infection will be discussed elsewhere.
A case of Sβ+ sickle cell disease diagnosed in adulthood following acute stroke: it’s 2021, are we there yet?
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Ava Runge, Danielle Brazel, Zahra Pakbaz
Initial laboratory workup in the ED revealed Coombs negative severe hemolytic anemia with hemoglobin 6.8 g/dL, absolute reticulocytes 0.05 tril/L, reticulocyte production index 0.79%, hematocrit 19.2%, MCV 76.5 fL, and severe thrombocytopenia with platelets 24 bil/L, for which she received packed red blood cells (PRBC) and platelet transfusions. Peripheral blood smear showed few spherocytes, few target cells, and few tear cells without schistocytes. Additional laboratory analysis revealed LDH and lactate elevated to 4385 U/L and 6.0 mMol/L, respectively, total bilirubin 1.7 mg/dL, AST 236 U/L, ALT 80 U/L, and D-dimer >21.0 mcg/mL with elevated fibrinogen. Urine drug screen was positive for amphetamines (later she denied using amphetamine but reported that she might have had passive exposure) and marijuana, which she was consuming for chronic pain of unknown etiology.
Adherence to iron prophylactic therapy during pregnancy in an urban regional hospital in South Africa
Published in South African Family Practice, 2019
Princess Z Mkhize, T Naicker, OA Onyangunga, J Moodley
The haematological, reticulocyte profiling and SF levels taken at antenatal visits across the study population are shown in Table 2. Haemoglobin levels were below the normal reference range for pregnancy in the HIV-uninfected ≤ 33 weeks (52%), HIV-infected ≤ 34 weeks (58%), HIV-uninfected 34–36 weeks (50%) and HIV-infected 34–36 weeks (56%). The ≥ 37 weeks groups (both HIV uninfected and infected) displayed lower haemoglobin levels (18%, 33%) respectively. Based on HIV status, SF levels were similar across all groups. In the HIV-uninfected ≤ 34 weeks, the reticulocyte percentage (RC) was 6% above the normal range compared with other groups (p = 0.44). The reticulocyte production index (RPI) was significantly higher and within the reference range for the HIV-uninfected ≥ 37 weeks(1 ± 0.34) compared with the other groups (p = 0.0001; Table 2). Maternal haemoglobin levels at delivery were significantly different between groups (p = 0.006; Table 2).
Hepcidin and diabetes are independently related with soluble transferrin receptor levels in chronic dialysis patients
Published in Renal Failure, 2019
Luís Belo, Susana Rocha, Maria João Valente, Susana Coimbra, Cristina Catarino, Elsa Bronze-da-Rocha, Petronila Rocha-Pereira, Maria do Sameiro-Faria, José Gerardo Oliveira, José Madureira, João Carlos Fernandes, Vasco Miranda, Alice Santos-Silva
Leukocyte, platelet and erythrocyte counts, hematocrit, hemoglobin concentration, and hematimetric indices [mean cell volume (MCV), mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC)] were measured by using an automatic blood cell counter (Sysmex K1000; Sysmex, Hamburg, Germany). Reticulocytes were quantified by microscopic counting on blood smears, after vital staining with New methylene blue (Reticulocyte stain; Sigma-Aldrich Co. LLC. St. Louis, MO, USA). The reticulocyte production index (RPI), an appropriate way to measure the effective red blood cell (RBC) production, was calculated by the formula: [(reticulocyte %/maturation time of RBC)*(hematocrit/0.45)], where the maturation time of RBC (days of circulating blood reticulocytes released from the bone marrow) was 1 for hematocrit values between 36% and 45%, 1.5 for hematocrit values between 26% and 35%, 2 for values between 16% and 25%, and 2.5 for values lower than 15% [13].