Pre-auditory self-work materials.

3.1.Basic knowledge, skills, experiences, necessary for study the topic:

Subject	To know	To be able to
Pathophysiology	Main blood indexes norm	Interpret total blood and to tell about main mechanisms and probable reasons of the changes observed
Pediatry with Neonatology	Blood peculiarities in different-aged children in part about the first and the second crossings	Interpret total blood changes
Internal Diseases	Total blood main indexes norm	To tell about probable reasons of the changes observed in internal diseases clinics
Surgery	Total blood main indexes norm	To tell about probable reasons of the changes observed in surgical clinics
Dentistry	Total blood main indexes norm	To tell about probable reasons of the changes observed in stomatological patients

 

Topic content

 Color index characterizes erythrocytes satiation degree with haemoglobin. It is calculated on formula:

 

C.I.= (X haemoglob. x 5,0 x 1012/l) : (167 g/l x X erythroc.)

 

 where:

X haemoglob. – found haemoglobin amount (g/l);

X erythroc.- found erythrocytes amount in 1 l of blood.

The second formula: Hb (g/l) x 3 : RBC (3 first ziphras). It is evaluated in conditional units.

At English-speaking countries all these indexes are automatically determined practically in every clinic. Especially they are of great importance for anemias differentiated diagnostics.

 1. MCV (Mean Corpuscular Volume) – average erythrocytic volume. MCV=HCT (%) : RBC (x 10¹²/l) x 10, where: HCT- haematocrit; RBC- erythrocytic amount.

 

MCV (normocytes) - adults: 78-94 mcm³ or fl (femptolitres)

                                          new-borns: 95-105 mcm³;

                                          children: 76-90 mcm³.

MCV↑ (macrocytosis):

· pregnancy;

· megaloblastic anaemia;

· myelodysplastic syndrome;

· liver diseases;

· hypothyreoidism;

· alcoholism;

· treatment with estrogens;

· treatment with barbiturates et al.

MCV↓ (microcytosis):

1) anaemias:

· hereditary microspherocytic;

· iron-deficient;

· sideroblastic;

· chronic anaemias;

· thalassaemia (hereditary haemoglobinopathy);

2) hypohydration;

3) aluminium intoxication.

 

2. MCH (Mean Corpuscular Haemoglobine) – haemoglobine average content in erythrocytes.

MCH=Hb (g/l):RBC (x 10¹²/l)

MCH (erythrocytic normochromy)- adults: 27-33 pg (picogram)

                                                   children: 24-30 pg

MCH↑(hyperchromy):

· new-borns;

· megaloblastic anaemia;

· liver cirrhosis.

MCH↓ (hypochromy):

· iron-deficient anaemia;

· thalassaemia;

· sideroblastic anaemia.

 

3. MCHC – Mean Corpuscular Haemoglobine Concentration – Mean haemoglobine concentration in erythrocyte – Hb (g/decaliter): Ht or HCT (l/l) x 100

MCHC (norma): 32-36 g/dl (320-360 g/l).

MCHC↑:

· new-borns;

· hereditary spherocytosis;

· long-termed hypohydration.

MCHC↓ (absolute hypochromy):

· iron-deficient anaemia;

· thalassaemia;

· sideroblastic anaemia;

· hydraemia.

 

4. Reticulocytes amount in blood volume unit - Norm:

 adults and children: 0,2-2,0 % or 25-85 x 10⁹/l;

 new-borns : 2-6% or 85-250 x 10⁹/l.

Reticulocytosis (increasing):

· anaemias (haemolytic, acute posthaemorrhagic),

· in initial period (6-10^th days) of effective anaemias treatment, caused by iron and folic acid, cyancobalamine and pyridoxine insufficiency;

· in course of exit from bone marrow hypoplasy after therapy with cytostatics;

· after splenectomy;

· at malaria.

Reticulopenia (decreasing):

· hypo- and aplastic anaemias;

· megaloblastic anaemias;

· acute leukemias;

· radiation disease;

· in course of cytostatic therapy;

· pre-regenerative crisises at haemolytic anaemias;

· kidney diseases;

· radiation disease anaemia.

 

5. Reticulocytic index (RI)= R (%) x Ht (of patient) : Ht (normal). It is used for more adequate bone marrow erythropoietic activity assessment with the haematocrit taking into account.

Norm: 1%

RI ↑:

· haematocrit decreasing;

· haemolytic anaemias (due to erythropoiesis activation);

· initial stage of effective anaemias treatment (due to the same reason).

6. Reticulocytes formation index – RFI=RI:t (reticulocytes maturation time in perypheral blood) x 10.

RFI (norm)=1 cond. un.

RFI (at anaemia)>3 indicates to erythropoietic cells prolipheration and maturation activating.

RFI (at anaemia)<3 indicates to erythropoiesis inhibition.

 

7. RDW – erythrocytes distribution dispersion by volume – standard inclination correlation to MCV.

It is estimated by erythrocytometric curve (of Price-Jons’) variation co-efficient and is expressed in percentage.

Anisocytosis (this index increasing) – different-sized Er presence in one blood smear. It is characteristic for anemias (hemolytic, Fe-deficient, megaloblastic) as well as osteomyelofibrosis.

 

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