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Medical Forum / General / Laboratory / September 2008What could these high RBC indices mean
I'm writing up a question for my med student friend, and I'd like to know, what could these high RBC indices mean; are they normal or pathological --the patient is a 28 yr old woman--: MCV: 110 fL MCHC: 45 g/dL MCH: 42.25 pg/RBC Hct: 41.8% > I'm writing up a question for my med student friend, and I'd like to > know, what could these high RBC indices mean; are they normal or [quoted text clipped - 4 lines] > MCH: 42.25 pg/RBC > Hct: 41.8% Your friend is a med student and doesn't understand basic hematology? What school is this?  SignatureJohn Gentile Newsletter editor Rhode Island Apple Group > > I'm writing up a question for my med student friend, and I'd like to > > know, what could these high RBC indices mean; are they normal or [quoted text clipped - 12 lines] > Newsletter editor > Rhode Island Apple Group First year. Just started. > I'm writing up a question for my med student friend, and I'd like to > know, what could these high RBC indices mean; are they normal or [quoted text clipped - 4 lines] > MCH: 42.25 pg/RBC > Hct: 41.8% If the hematocrit was now 65%, would there be a change in the diagnosis, and if so, what? > > I'm writing up a question for my med student friend, and I'd like to > > know, what could these high RBC indices mean; are they normal or > > pathological --the patient is a 28 yr old woman--: > > > MCV: 110 fL Abnormally large red cells Ref range ~75-95fL. Causes of macrocytosis include Pregnancy, alcoholisim, liver dysfunction, Pernicious anemia > > MCHC: 45 g/dL Indices of red cell hemoglobinization. Ref range ~34-36 (in these units) below normal mchc usually indicates hypochromic (i.e. > 1/3 central pallor) red cells often seen in chronic anemias such as iron deficiency. Above normal MCHC can indicate spherocytosis, or cold agglutinins causing technical difficulties in getting accurate RB C count due to clumping. > > MCH: 42.25 pg/RBC Similar to MCHC, and rbc indice using (IIRC) hematocrit / Rbc vs hgb/ RBC for MCHC > > Hct: 41.8% Fraction of whole blood comprised of red cells. ref range ~.33-.45 depending on age and sex. > If the hematocrit was now 65%, would there be a change in the > diagnosis, and if so, what? Hct of 0.65 in a 28 yr old female would possibly indicate Polycythemia ( Pathologically increased RBC production) Or possibly severe dehydration. These are just of the top of my head and not meant to be definative. > > > I'm writing up a question for my med student friend, and I'd like to > > > know, what could these high RBC indices mean; are they normal or [quoted text clipped - 27 lines] > > These are just of the top of my head and not meant to be definative. Well, she isn't dehydrated. And here's new RBC indices, plus her ABGs, and HR and SV: MCV: 110 fL MCHC: 32 g/dL MCH: 36 pg/RBC Hb: 20.8 g/dL Hct: 65% FIO2: 21% PaO2: 30 mmHg PaCO2: 60 mmHg pH: 7.1 HCO3: 18.4 mmol/L SBE: -10.1 mmol/L SaO2: 45% A-a gradient: 45 mmHg Shunt fraction: 68% HR: 90 bpm SV: 100 mL What can you glean from this info? Is it possible to be hypoxemic by SaO2 and CaO2, but still be oxygenated normally due to a high cardiac output? Should this pt be in the ICU, on HFOV w/ PEEP? > I'm writing up a question for my med student friend, and I'd like to > know, what could these high RBC indices mean; are they normal or [quoted text clipped - 4 lines] > MCH: 42.25 pg/RBC > Hct: 41.8% In a nutshell, these results are wrong. The MCHC of 45 g/dl is wrong. MCHCs don't get that high. They don't ever. Not even one in a million get that high. It's not an exceptionally abnorml result, it's a physically impossible and therefore wrong result. There are two explanations: either the patient has cold agglutinins, or the analyser used to perform the blood count is broken. > > I'm writing up a question for my med student friend, and I'd like to > > know, what could these high RBC indices mean; are they normal or [quoted text clipped - 14 lines] > There are two explanations: either the patient has cold agglutinins, or the > analyser used to perform the blood count is broken. That's why I put it; to see if he can tell if the lab is doing poor analysis. On Aug 25, 9:15 am, "Manky Badger" <you.m...@be.joking> wrote: > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 19 lines] > the > analyser used to perform the blood count is broken. That's why I put it; to see if he can tell if the lab is doing poor analysis. ____________________________________________________ So, let me get this right - you set the question for him? Is there any lab in the world that would send out such an MCHC ? > On Aug 25, 9:15 am, "Manky Badger" <you.m...@be.joking> wrote: > [quoted text clipped - 31 lines] > > - Show quoted text - An incompetent one. Bob needs to know garbage results, just in case. We don't want him to start treatment based on bad data. For example, if you have a pt's HCO3 at 10 mmol/L, there might be a lab error, b/c HCO3, I've heard, doesn't usually go below 12 mmol/L > > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 41 lines] > > - Show quoted text - Severe diabetic kletoacidosis will have bicarbonate <10 On Aug 25, 2:17 pm, "Manky Badger" <you.m...@be.joking> wrote: > So, let me get this right - you set the question for him? > > Is there any lab in the world that would send out such an MCHC ?- Hide > quoted text - An incompetent one. Bob needs to know garbage results, just in case. We don't want him to start treatment based on bad data. For example, if you have a pt's HCO3 at 10 mmol/L, there might be a lab error, b/c HCO3, I've heard, doesn't usually go below 12 mmol/L ___________________________________________________________ I'm not entirely sure what's going on here. Are you saying that there are labs that would send out such rubbish results? Have you any experience to back up such a suppossition? I can't help but suppose that the professors at the medical school might be the best people to set such questions. (sorry) > On Aug 25, 2:17 pm, "Manky Badger" <you.m...@be.joking> wrote: > [quoted text clipped - 17 lines] > the best people to set such questions. > (sorry) You're right. Like Manky said this are either cold aggultinin (guess based on MCV as opposed to lipemia), a clotted CBC specimen or someone got MCHC wrong. The rest doesn't matter. None of my techs would put out that crap. "Ask a proffessor in med school", now that's a good one....... you can ask me if you have a paypal account. "There are only two classes of mankind in the world doctors and patients"---Rudyard Kipling On Aug 26, 3:08 pm, "Manky Badger" <you.m...@be.joking> wrote: > "douglas" <Protoman2...@gmail.com> wrote in message > [quoted text clipped - 21 lines] > the best people to set such questions. > (sorry) You're right. |
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