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Alinity hq Featured Case



This patient has been diagnosed with iron deficiency anemia.


The peripheral blood showed markedly decreased RBC count, HGB, HCT, MCV, MCH and MCHC, whereas the RDW was increased. There was also an increase in the reticulocyte percentage and in the IRF, but with low MCHr. The WBC count was in the normal range, and PLT count was slightly elevated.


These findings are consistent with iron deficiency, causing hypochromic microcytic anemia. In addition to the low MCV and decreased cellular hemoglobin concentration, the low MCHr suggests that iron is not available for hemoglobin synthesis, and the newly formed reticulocytes are hypochromic. (Hoffman; Costa). On the CHC vs. Volume (RBC) scatterplot, a small population of normochromic, normocytic RBC can be noted. One possible explanation is that this patient is in the early stages of treatment, and the production of sufficiently hemoglobinated RBC has already started (as suggested by the increased IRF) but has not reached a level to correct the low MCHr value. It has been described in the literature that after appropriate treatment for nutritional anemia (iron deficiency, B12 or folate), a significant increase in IRF occurs, usually several days before an increase in the total reticulocyte count (Briggs). Another explanation for the second RBC population is that the patient has received a transfusion because of extreme anemia.

Numerical Results

WBC 4.94 10e3/μL
NEU 3.13 10e3/μL 63.4 % Left Shift
LYM 1.00 10e3/μL 20.3 %
MONO .464 10e3/μL 9.39 %
EOS .258 10e3/μL 5.22 %
BASO .083 10e3/μL 1.68 %
IG 0.00 10e3/μL .004 %
NRBC 0.00 10e3/μL
NR/W 0.00

RBC 3.60 10e6/μL
HGB 7.35 g/dL
HCT 23.1 %
MCV 64.1 fL
MCH 20.4 pg
MCHC 31.8 g/dL
RDW 20.7 %

RETIC 115. 10e3/μL 6.39 %
IRF .512
MCHr 20.8 pg

PLT 408. 10e3/μL
MPV 6.71 fL
%rP 2.52 %

FIGURE 1. CHC x Volume (RBC):
Cellular hemoglobin concentration vs. RBC volume plot
RBC are clustered around the 60 fL hash mark for volume and around the 28 pg for CHC, consistent with hypochromic microcytic anemia. In addition, a small population of normochromic, normocytic RBC can be noted in the middle of the scatterplot.
Size vs. Intermediate angle light scatter plot
The presence of microcytic RBC is evident by the closeness of the PLT (yellow) and the RBC (red) population on the ALL x IAS3 scatter plot. However, the two are clearly separated as a result of differences in their internal complexity and light scatter characteristics. The small number of normocytic normochromic RBC appear as a partially separated cluster on the top of the majority of the RBC.
FIGURE 3. Volume (RBC):
RBC volume histogram plot
The RBC volume histogram is shifted to the left indicating the presence of microcytes. In addition, the curve has an asymmetric shape and a wide base, which is consistent with the high RDW and variability in size of the RBC (anisocytosis).
Reticulocyte/platelet – Size vs. fluorescence plot
The reticulocyte fraction (green) is more pronounced compared to a normal sample, with the top-most portion representing the immature reticulocyte fraction (IRF).
Alinity hq casebook. Iron Deficiency Anemia. ADD-00061876-v2 2019. p.22-23

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