APPROACH TO HAEMATOLOGICAL PROBLEMS IN ADULTS FROM AN AUTOMATED CELL COUNTER REPORT*

Please look at:

1. Bi or pancytopenia

2. MCV

3. RDW

4. Lymphocytosis/Monocytosis

5. Comments

Very Low MCV (<70) Category I :

Iron deficiency anemia (Low RBC)

Thalassemia trait (Normal RBC, RDW)

Low MCV or Normal MCV (with comments saying “fragments” or tear drops)

Microangiopathic disorders (HUS,TTP) (Both are life threatening but curable diseases)

Look for large platelets in graph (Fragments&large platelets _Danger sign)

Low MCV (70-80) Categoty II:

All of the above

Anemia of chronic disease

Very High MCV (>115) Categroy III

Megaloblastic anemia (will have pancytopenia, high LDH)

Falsely high in autoimmune haemolytic anemia due to agglutination ( high LDH, positive direct coomb’s test)

Moderately high MCV (90-110) category IV (with cytopenia)

All of the above

Myelodysplasia

Myeloma

Aplastic anemia (before transfusion)

Normal MCV (80-90) Category V

Renal failure

Chronic hemolysis

Pure red cell aplasia

In bicytopenia or pancytopenia

• If you rule out viral infections, hypersplenism and megaloblastic anemia, bicytopenia or pancytopenia are almost always dangerous.

• In bi or pancytopenia decrease in Polymorphs or increase in lymphocytes and absence of evidence of large platelets in graph is a serious indicator of marrow disease (except in viral infections). Lymphocytosis and monocytosis (falsely high) almost always raise a supicion leukemia/lymphoma. (Blasts are often misterpreted as monocytes in the automated cell counter)

• Do NOT delay the diagnosis AS PROGRESSIVE NEUTROPENIA MAY LEAD TO LETHAL INFECTIONS.

In Bi/Pancytosis Myeloproliferative diseases are likely if you can rule out reactive causes. *Exceptions to the above guidelines do exist.

Dr Suthanthira Kannan MD FRCPA,

Consultant Hemato oncologist, GKNM, Coimbatore

E mail: hematcentre@gmail.com

94861 91238 (working hours only)

 
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