RBC Count
Hemoglobin Concentration
Hematocrit
RBC Indices
Red Cell Distribution Width
→ As Medical Technologists, our work is to assist the doctors. The doctors will order laboratory
tests in order to evaluate the RBCs in particular in terms of assessing anemia.
→ What are the RBC parameters used that the doctors look into when assessing or evaluating
anemia?
✓ They request for the Complete Blood Count (CBC).
✓ The CBC panel contains the panel for RBCs, WBCs and for platelets. But for anemia, our
primary concern are the RBC panel or parameters.
→ A lot of physicians actually do not pay so much attention to the RBC count because what’s
important with RBC is not on how many they are but on how much oxygen they can carry.
✓ Reiteration: The count or the concentration of the RBC is not that important because what
is important with the RBC is how much oxygen it can carry and deliver to the tissues.
→ There are instances that the RBC count is normal but the anemia is existing so that is why, doctors
look to the next parameter which is hemoglobin. This is because our hemoglobin are the ones
responsible for the oxygen-carrying capacity of our RBCs. So, when there is an abnormality in the
hemoglobin, surely the function of the RBC is affected.
→ Hematocrit may also be assessed by the physicians as well as the RBC Indices and Red Cell
Distribution Width.
✓ The RBC Indices are the MCH, MCV and MCHC.
✓ Red Cell Distribution Width is used in order to assess for anisocytosis.
→ In the laboratory or in the clinical setting, we can define anemia as a decrease in the RBC parameter
when compared to the reference range of the population of healthy individuals.
This is an example of a CBC result of a 2-year-old.
→ The hemoglobin is very low, the RBC count is quite low and then the MCH is normal, the MCV
is normal but the MCHC is lower than normal.
→ The doctor may initially look into this as the patient having an anemic episode.
, Aside from the CBC panel, doctors may also evaluate for reticulocytes. Reticulocytes are released in
the circulation normally but when there is the existence of anemia, there will be release of more
reticulocytes into the circulation.
Last immature non nucleated erythrocytic stage
Contains remnants of RNA that becomes visible when stained with supravital stain (refer to red
box below)
The red box shows how the remnants of RNA looks
like when stained with supravital stain. The blue
ones here are aggregates of RNA stained by
supravital stain.
→ It is called supravital stain because the cells
are stained while they are still alive so that the stain
or the dye will be taken up by the cell. After
absorbing the dye, the cytoplasm will be colored (refer to the blue box above). This is how the
reticulocytes will look like under the microscope when stained by supravital stain.
Can we observe this appearance of reticulocytes
when stained with Romanowsky stain?
→ No. You can only observe for this
appearance of the reticulocytes when you
are using supravital stain.
Normally, stays in the bone marrow for 2-3 days and 1 day in the peripheral blood then they become
mature RBC
→ Normal release of reticulocytes in the circulation
Why is reticulocyte included in the assessment of anemia?
→ This is because reticulocytes are indirect assessment of the bone marrow erythropoietic
status.
✓ Reticulocytes are actually a parameter that assesses the function of the bone marrow. In
a normal scenario, when anemia is existing, your body will compensate for the anemia,
including the bone marrow: producing more RBCs, increasing the rate of erythropoiesis,
including increasing the rate of production or release of reticulocyte.
✓ So, if your bone marrow is normally functioning and there is anemia existing, you can expect
that reticulocyte will increase. But, if there is evident anemia, but there is a very little
number of reticulocytes in the circulation, that gives the doctor an idea that something
must be wrong in the bone marrow. So, the doctor may order tests to evaluate the bone
marrow activity or function.
Assessment of bone marrow
Differentiation if anemia is due to:
a. Inadequate erythropoiesis (↓ reticulocyte count, ↓ RPI)
b. Premature destruction as in hemolytic (↑ reticulocyte count, ↑ RPI) – bone marrow is able to
compensate
Inadequate erythropoiesis is called as hypoproliferative because in here, there is impairment in the
erythropoiesis thus, we can expect that there would be decrease in the number of reticulocytes
and other reticulocytes tests.
Hemoglobin Concentration
Hematocrit
RBC Indices
Red Cell Distribution Width
→ As Medical Technologists, our work is to assist the doctors. The doctors will order laboratory
tests in order to evaluate the RBCs in particular in terms of assessing anemia.
→ What are the RBC parameters used that the doctors look into when assessing or evaluating
anemia?
✓ They request for the Complete Blood Count (CBC).
✓ The CBC panel contains the panel for RBCs, WBCs and for platelets. But for anemia, our
primary concern are the RBC panel or parameters.
→ A lot of physicians actually do not pay so much attention to the RBC count because what’s
important with RBC is not on how many they are but on how much oxygen they can carry.
✓ Reiteration: The count or the concentration of the RBC is not that important because what
is important with the RBC is how much oxygen it can carry and deliver to the tissues.
→ There are instances that the RBC count is normal but the anemia is existing so that is why, doctors
look to the next parameter which is hemoglobin. This is because our hemoglobin are the ones
responsible for the oxygen-carrying capacity of our RBCs. So, when there is an abnormality in the
hemoglobin, surely the function of the RBC is affected.
→ Hematocrit may also be assessed by the physicians as well as the RBC Indices and Red Cell
Distribution Width.
✓ The RBC Indices are the MCH, MCV and MCHC.
✓ Red Cell Distribution Width is used in order to assess for anisocytosis.
→ In the laboratory or in the clinical setting, we can define anemia as a decrease in the RBC parameter
when compared to the reference range of the population of healthy individuals.
This is an example of a CBC result of a 2-year-old.
→ The hemoglobin is very low, the RBC count is quite low and then the MCH is normal, the MCV
is normal but the MCHC is lower than normal.
→ The doctor may initially look into this as the patient having an anemic episode.
, Aside from the CBC panel, doctors may also evaluate for reticulocytes. Reticulocytes are released in
the circulation normally but when there is the existence of anemia, there will be release of more
reticulocytes into the circulation.
Last immature non nucleated erythrocytic stage
Contains remnants of RNA that becomes visible when stained with supravital stain (refer to red
box below)
The red box shows how the remnants of RNA looks
like when stained with supravital stain. The blue
ones here are aggregates of RNA stained by
supravital stain.
→ It is called supravital stain because the cells
are stained while they are still alive so that the stain
or the dye will be taken up by the cell. After
absorbing the dye, the cytoplasm will be colored (refer to the blue box above). This is how the
reticulocytes will look like under the microscope when stained by supravital stain.
Can we observe this appearance of reticulocytes
when stained with Romanowsky stain?
→ No. You can only observe for this
appearance of the reticulocytes when you
are using supravital stain.
Normally, stays in the bone marrow for 2-3 days and 1 day in the peripheral blood then they become
mature RBC
→ Normal release of reticulocytes in the circulation
Why is reticulocyte included in the assessment of anemia?
→ This is because reticulocytes are indirect assessment of the bone marrow erythropoietic
status.
✓ Reticulocytes are actually a parameter that assesses the function of the bone marrow. In
a normal scenario, when anemia is existing, your body will compensate for the anemia,
including the bone marrow: producing more RBCs, increasing the rate of erythropoiesis,
including increasing the rate of production or release of reticulocyte.
✓ So, if your bone marrow is normally functioning and there is anemia existing, you can expect
that reticulocyte will increase. But, if there is evident anemia, but there is a very little
number of reticulocytes in the circulation, that gives the doctor an idea that something
must be wrong in the bone marrow. So, the doctor may order tests to evaluate the bone
marrow activity or function.
Assessment of bone marrow
Differentiation if anemia is due to:
a. Inadequate erythropoiesis (↓ reticulocyte count, ↓ RPI)
b. Premature destruction as in hemolytic (↑ reticulocyte count, ↑ RPI) – bone marrow is able to
compensate
Inadequate erythropoiesis is called as hypoproliferative because in here, there is impairment in the
erythropoiesis thus, we can expect that there would be decrease in the number of reticulocytes
and other reticulocytes tests.
