Question

Clinical Lab

Mr. L. Cage visits his physician due to a difficult time with various symptoms. He reports being in generally good health and an active jogger, until about two weeks ago. He began experiencing fatigue, as well as some respiratory symptoms. The respiratory symptoms are controllable by over the counter allergy medications, but the fatigue has been g worse. Around a week ago Mr. Cage noted that the fatigue got particularly acute while jogging. He's avoided jogging, but this past weekend he fell asleep during religious services, despite a full night's sleep the night before. He reports falling asleep during the services as never having happened before. Mr. Cage reports waking up tired, and does not notice the fatigue getting much better or worse during the day rowing steadily A CBC with the following results is below RBC: 3.05 x 10/uL WBC: 3.7 x 10%ul. Hgb: 9.4 g/dL Hct: 27.8% PLT: 132 x 10/uL Reticulocytes : 0.3% (reference range is 0.5-2.0%) A picture of the peripheral smear is below: 1. Identify all CBC results that are out of reference range, indicating which are above or below the reference range 2. What are critical values associated with RBC Count, Hgb, and Hct? Hint: You will not find that information in the textbook, but will instead need to look for published values 3. Calculate the MCV, MCH, and MCHC 4. How are retic counts performed? 5. What is the significance of Mr. Cage's retic count?

Answer 1

1. &2.Complete blood count is a laboratory examination measuring several components present in blood and serves as a screening tool for diagnosing anemia, infection, leukemia, etc.

The normal range of RBC in men is 5-6 million cells /mcL.Mr. L.Cage RBC is 3.05 million cells/mcL.His RBC count is low .Symptoms of Low RBC are fatigue, shortness of breath , pale skin ,dizziness, weakness ,etc.When the RBC count is low , it may indicate anemia, leukemia,bone marrow failure, mutiple myeloma, hemolysis, recent blood transfusion, internal or external bleeding, etc.

The normal range of WBC 4,500 - 10,000 cells per microliter. His WBC count also seems low 3,700 cells per microliter. Symptoms of low WBC are body ache,fever, chills and headaches . Low WBC level associated with any medication , bone marrow supression, viral infection, liver & spleen disorders,primary bone marrow disease ,etc.

Hemoglobin normal range in men is  14 to 17 grams per deciliter . Mr. Cage 's Hb is 9.4 g/dL, low. Low hemoglobin values indicates anemia, bone marrow disorders , kidney disorders , bleeding disorders, vitamin deficiencies ,etc.

Hematocrit normal range in men is  38.8 to 50 %.Mr. Cage 's value is 27.8% which is low. Low values indicate moderate to severe anemias, massive blood loss, bone marrow diseases, nutritional deficiences, internal bleeding, hemolytic anemias, kidney diseases, etc

Platelet normal ranges are 150,000 to 450,000 per microliter of blood. Mr.Cage's platelet is 132, 000 per microliter of blood which is low. Low values are indicative of acute leukemia, apastic anemia, chemotherapy. thrompocytopenic purpura, infections, etc.

Reticulocyte normal range is 0.5 % to 1.5 %. Mr.Cage's retic count is low. It may be indicative of iron deficiency anemia, aplastic anemia, nutritional anemia, bone marrow failure, chemotherapy, infection, kidney disorders, etc.

3. MCV = Hematocrit(%)* 10 /RBC million cells per microliter= 27.9*10/3.05= 91.47 fL

MCH= Hemoglobin(g/dL)*10/RBC million cells per microliter= 9.4*10/3.05=30.81 pg

MCHC= Hemoglobin(g/dL)*100/Hematocrit(%)= 9.4*100/27.9= 33,69g/dL.

4& 5.Immature RBC are called reticulocytes. Using reticulocyte count physician can assess the bone marrow whethet it produces enough red blood cells or not. Mr. Cage may be suffering from aplastic or nutritional anemia .