hyperchromic anemia

WordNet

a deficiency of red blood cells (同)anaemia
a lack of vitality (同)anaemia
genus of terrestrial or lithophytic ferns having pinnatifid fronds; chiefly of tropical America (同)genus Anemia

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/22 21:42:28」(JST)

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hemoglobin

The mean corpuscular hemoglobin concentration, a measure of the concentration of hemoglobin in a given volume of packed red blood cells. It is reported as part of a standard complete blood count.

It is calculated by dividing the hemoglobin by the hematocrit. Reference ranges for blood tests are 32 to 36 g/dL,^[1] or between 19.9 ^[2] to 22.3^[2] mmol/L. It is thus a mass or molar concentration. Still, many instances^[3]^[4] measure MCHC in percentage (%), as if it were a mass fraction (m_Hb / m_RBC). Numerically, however, the MCHC in g/dL and the mass fraction of hemoglobin in red blood cells in % are identical, assuming a RBC density of 1g/mL and negligible hemoglobin in plasma.

Interpretation

MCHC is diminished ("hypochromic") in microcytic anemias, and normal ("normochromic") in macrocytic anemias (due to larger cell size, though the hemoglobin amount or MCH is high, the concentration remains normal). MCHC is elevated ("hyperchromic") in hereditary spherocytosis, sickle cell disease and homozygous hemoglobin C disease.^[5]

This count is used to give a rough guide to what shade of red erythrocytes will be (i.e., the paler the color the lower the MCHC will be than the standard).

Complications with cold agglutinin

Because of the way automated analysers count blood cells, a very high MCHC (greater than about 370 g/L) may indicate the blood is from someone with a cold agglutinin. This means that when their blood gets colder than 37°C it starts to clump together. As a result, the analyzer may incorrectly report a low number of very dense red blood cells for blood samples in which agglutination has occurred.

This problem is usually picked up by the laboratory before the result is reported. The blood is warmed until the cells separate from each other, and quickly put through the machine while still warm.This is the most sensitive test for iron deficiency anemia.

There are four steps to perform when an increase MCHC(>370 g/L or 37.0 g/dL) is received from the analyzer:

Remix the EDTA tube—if the MCHC corrects, report corrected results
Incubation at 37°C—if the MCHC corrects, report corrected results and comment on possible cold agglutinin
Saline replacement: Replace plasma with same amount of saline to exclude interference e.g. Lipemia and Auto-immune antibodies—if the MCHC corrects, report corrected results and comment on Lipemia
Check the slide for spherocytosis (e.g. in hereditary spherocytosis, among other causes)

Worked example

Measure	Units	Conventional units	Conversion
Hct	40%
Hb	100 grams/liter	10 grams/deciliter	(deci- is 10⁻¹)
RBC	5E+12 cells/liter	5E+6 cells/μL	(micro is 10⁻⁶)
MCV = Hct / RBC	8E-14 liters/cell	80 femtoliters/cell	(femto- is 10⁻¹⁵)
MCH = Hb / RBC	2E-11 grams/cell	20 picograms/cell	(pico- is 10⁻¹²)
MCHC = MCH / MCV	250 grams/liter	25 grams/deciliter	(deci is 10⁻¹)

References

^ http://www.nlm.nih.gov/medlineplus/ency/article/003648.htm
^ ^a ^b Converted with conversion factor from (Wallach, Jacques Burton (2007). Interpretation of Diagnostic Tests. Lippincott Williams & Wilkins. ). 1 g/dL = 0.6206 mmol/L
^ Blood Test Results - Normal Ranges Bloodbook.Com. Retrieved on Jan 7, 2009
^ MedicineNet > Definition of MCHC Last Editorial Review: 7/21/1999
^ Rifkind, David; Cohen, Alan S. (2002). The Pediatric Abacus. Informa Healthcare. p. 54. ISBN 1-84214-147-3.

External links

FP Notebook
Cornell
Medline

UpToDate Contents

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English Journal

Effects of Acute Exposure to Endosulfan (Organochlorine Pesticides) on Hematology of African Mud Catfish, Clarias gariepinus (Burchell, 1822).

Ndimele PE1, Jenyo-Oni A, Kumolu-Johnson CA, Chukwuka KS, Onuoha S.
Bulletin of environmental contamination and toxicology.Bull Environ Contam Toxicol.2015 Mar 1. [Epub ahead of print]
Changes in the blood parameters of fingerlings of Clarias gariepinus were investigated after 24 and 96-h of exposures to endosulfan. 180 fingerlings of C. gariepinus [mean weight (10.5 ± 1.3 g); total length (11.2 ± 1.2 cm)] were exposed to five different concentrations (1.00, 2.20, 4.80, 11
PMID 25726008

Rheology of red blood cells in patients with HbC disease.

Lemonne N1, Billaud M2, Waltz X3, Romana M4, Hierso R4, Etienne-Julan M5, Connes P6.
Clinical hemorheology and microcirculation.Clin Hemorheol Microcirc.2014 Oct 20. [Epub ahead of print]
Patients with hemoglobin C disease (CC) usually do not develop severe complications in comparison with individuals with sickle cell anemia (SS) or with sickle cell hemoglobin C disease (SC). The present study compared the hematological, biochemical, hemorheological and clinical characteristics of CC
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Anemia and microvascular complications in patients with type 2 diabetes mellitus.

Hosseini MS1, Rostami Z1, Saadat A2, Saadatmand SM3, Naeimi E4.
Nephro-urology monthly.Nephrourol Mon.2014 Jul 5;6(4):e19976. doi: 10.5812/numonthly.19976. eCollection 2014.
BACKGROUND: Although chronic kidney disease-induced anemia is more prevalent in patients with diabetes mellitus (DM), anemia is a common finding prior to manifestation of kidney disease. In presence of some risk factors at the time of diagnosing DM, microvascular complications must be considered. Th
PMID 25695026

Japanese Journal

Subacute Combined Degeneration of the Spinal Cord Concomitant with Gastric Cancer

, , , , , , ,
Internal Medicine 45(14), 875-877, 2006
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NAID 130000076492

１７歳で診断されたＩｍｅｒｓｌｕｎｄ‐Ｇｒａｅｓｂｅｃｋ症候群の１例

伊地知修,碇元直昭,川上清
日本小児血液学会雑誌 13(3), 205-208, 1999
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日本臨床外科学会雑誌 60(3), 721-724, 1999
症例は67歳,男性,全身倦怠感を主訴として来院した.血液検査では大球性高色素性貧血, LDHアイソザイムI, IIの増加,血清ガストリン値の上昇,ビタミンB12の減少を認めた.また,抗胃壁抗体,抗内因子抗体陽性により悪性貧血と診断した.胃透視,胃内視鏡検査では胃体中部から胃角部後壁に不整形な小隆起の集籏を認めIIa集族型早期胃癌と診断した.手術は幽門側胃切除およびD1+No(7)リンパ節郭清を施行 …
NAID 130003601289