Red Cell Inclusions PDF

59 Red Cell Inclusions INCLUSION COMPOSED OF: STA...

59 Red Cell Inclusions INCLUSION COMPOSED OF: STAIN INDICATIONS Howell-Jolly Body DNA Wright Disturbed Erythropoiesis New Methylene Blue Hemolytic Anemias 0 Megaloblastic Anemia Post-Splenectomy Basophilic Stippling RNA Wright Thalassemia.......... New Methylene Blue Lead Poisoning. :·;:: : ~- :... ·: ·:t...... I · ♦ ♦ 0 Pappenheimer Bodies Iron Wright Sideroblastic Anemia Siderotic Granules (siderocyte) Confirm with Prussian Blue Hemoglobi nopath ies 0 Heinz Body Denatured Precipitated Supravital Stain G6PD Deficiency Hemoglobin such as Brilliant Cresyl Blue or Thalassemia 0 New Methylene Blue Unstable Hemoglobins (NOT seen with Wright stain) g Cabot Ring Remnants of Mitotic \.\/right Megaloblastic Anemia Spindle Parasites Malaria Wright Parasitic Infection Babesia Trypanosomes NOTE: ~ ,i. MCV, ,i. MCHC and t red cell count are associated w ith cold agglutinin disease; warm sample and rerun Correlate AbnontuullBC Shapes with Conditions Correlate-Abnormal RBG Inclusions with REMEMBER! HEME NO RMALS Conditions RULE OF THREE 9 d' Correlation of Hb, Hct and RBC Hb 14 ± 2 g/dl 16 ± 2 g/dL Hb x 3 = Hct ± 3% Hct 42 ± 5% 47 ± 5% RBC (in millions} X 3 = Hb ± 0.5 6 RBC 4.5 ± 0.7xl 0 /µL 5.3 ± 0.8x1 0'/µL If "Rule of Three" doesn't fit, consider: 7. Clotted sample WBC 5,000 - 10,000/µL 2. Cold agglutinin (warm sample and rerun) 3. Lipemic, icteric, or grossly hemolyzed sample Platelet 150,000 - 400,000/µL 4. Resisting hgb (SS, CC) 5. Abnormal red cells 60 RETICULOCYTE COUNT 1. Uses a supra vital stain which stains red cells in living state a. New methylene blue b. Brilliant cresyl blue Calgulate Red Cell Indices from Gfren Data 2. Monitors erythropoiesis 3. Calcula tions Obtain Accurate Results on a. % reticulocytes = Specimen witb Cold Agglutinin # reties in 1000 RBCs 10 b. Absolute retie=# RBCs x % reties ERYTHROCYTE SEDIMENTATION RATE c. Corrected retie count = 1. Principle - measures rate of fall of red cells through plasma % reties x patient hct 45 2. Reference ranges a. Female: 0-20 mm 4. Reference ranges - 0.5 - 1.5% b. Male: 0-15 mm 5. RPI (Reticulocyte Production Index = 3. Clinical correleation a. ,t. seen in presence of increased Corrected retie count plasma proteins, p rimarily fibrino- maturation time (usually use 2) gen and globulin (inflammation/infection) a. > 2 - adequate bone marrow (BM) response to anemia 4. Sources of error b. < 2 - inadequate BM response to a. Increase - tilting tube, standing too anemia long, ,t. temperature, excess EDTA b. Decrease - QNS specimen , 6. ,t.in hemolytic anemias, post-acute t temperature, excess EDTA blood loss, following therapy (e.g. , iror1, folate, B12) Reticulocyte Calculation Examples RBC = 3.0 x 106/µL; HCT = 25%; 36 reties counted in 1000 RBCs ❖ Retie count example: ❖ Corrected retie count example: 36 = 3.6% 3.6 X 25 = 2.0% 10 45 ❖ Absolute retie count example: ❖ RPI example: 3.0 x 10 / µL x.036 = 108 X 103 /µL or 6 2.0 = 1.0.108 X 106 /µL 2 Effect of Therapy on Reticulocyte Count in Anemia Relative vs. Absolute Values