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Alinity hq



This patient was diagnosed with beta thalassemia minor.


The peripheral blood showed normal WBC and differential counts, with normal PLT and RBC counts. However, HGB concentration, HCT, MCH and MCHC were low, and the MCV was extremely low. The reticulocyte concentration was slightly high with elevated IRF, indicating high RBC turnover. The RDW was low-normal, implying uniformly sized RBC.


These results are consistent with hypochromic microcytic anemia. The two main causes of microcytic hypochromic anemia are iron deficiency and thalassemia trait (Han). In iron deficiency, RBC, MCV and MCH are decreased proportionately to the degree of anemia, while in thalassemia trait MCV and MCH tend to be significantly low, despite of moderate anemia, and are accompanied with normal to high RBC count (Hoffbrand, Harrington). RDW is typically elevated in iron deficiency anemia, due to variation in red cell size, while in thalassemia (alpha or beta) red cells tend to be more homogeneous in size and thus RDW is low or normal (Flynn). Further testing, like analysis and serum iron, ferritin and total iron binding capacity, hemoglobin electrophoresis and molecular diagnostic tests are required to confirm the diagnosis.

Numerical Results

WBC 7.32 10e3/μL
NEU 3.48 10e3/μL 47.6 % Left Shift
LYM 3.00 10e3/μL 41 %
MONO .512 10e3/μL 7.0 %
EOS .286 10e3/μL 3.92 %
BASO .041 10e3/μL .559 %
IG 0.00 10e3/μL .004 %
NRBC 0.00 10e3/μL
NR/W 0.00

RBC 5.14 10e6/μL
HGB 9.99 g/dL
HCT 32.0 %
MCV 62.1 fL
MCH 19.4 pg
MCHC 31.2 g/dL
RDW 9.35 %

RETIC 134. 10e3/μL 2.61 %
IRF .433
MCHr 19.1 pg

PLT 297. 10e3/μL
MPV 7.39 fL
%rP 3.23 %

FIGURE 1. CHC x Volume (RBC):
Cellular hemoglobin concentration vs. RBC volume plot
This scatterplot clearly demonstrates a microcytic hypochromic RBC population, positioned towards the lower left corner of the square that defines RBC volume of 60-120 fL, and cellular HGB concentration of 28-41 g/dL, consistent with an MCV of 62 fL and MCHC of 31g/dL. The RBC population is compact, corresponding to the RDW of 9.35%.
FIGURE 2. Volume (RBC):
RBC volume histogram plot
The histogram is shifted to the left due to the low MCV (62 fL). As the cells are uniformly small, the histogram is very narrow. The RDW of 9.35% is not particularly low, since RDW depends on the MCV; when the MCV is low, it increases the RDW because of the way of calculation: RDW (%CV) = Standard Deviation (of RBC volume distribution) / MCV.
Intermediate angles of light scatter plot
This scatterplot shows the separation of the PLT and RBC populations based on intermediate light scatter (IAS2 vs. IAS3). Microcytic RBC are positioned close to the PLT cluster (yellow); however, differences in the internal complexity of RBC and PLT enable differentiation between them. The PLT count is not affected by the presence of microcytic RBC.
Alinity hq casebook. Beta thalassemia. ADD-00061876-v2 2019. p.24-25

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