Anemia Diagnosis, Classification, and Monitoring Using Cell-Dyn ...

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Laboratory Hematology 6:93-108 © 2000 Carden Jennings Publishing Co., Ltd.

Official Publication

Anemia Diagnosis, Classification, and Monitoring Using Cell-Dyn Technology Reviewed for the New Millennium L. VAN HOVE,1 T. SCHISANO,1 L. BRACE2 1

Abbott Laboratories, Diagnostics Division, Hematology, Santa Clara, California; 2University of Illinois at Chicago, Department of Pathology, Division of Hospital Laboratories, Chicago, Illinois

ABSTRACT

with this evaluation’s Cell-Dyn data and compared with published information. In summary, hydrodynamically focused hematology analyzers provide accurate MCV and MCHC results in the classification of anemias. Lab Hematol. 2000;6:93-108.

This review attempts to clarify the criteria used to diagnose and classify anemias. Because Abbott Cell-Dyn masters most of the technologies involved in anemia diagnosis and classification, data generated on various Cell-Dyn hematology analyzers were used to demonstrate the effect of technology differences on reported erythrocyte parameters. In this study, a pulse-editing system (Cell-Dyn 3700) and 2 hydrodynamic focused analyzers (CellDyn 4000 and 3200) are included. The Cell-Dyn 4000 system reports red cell parameters by impedance and the Cell-Dyn 3200 system by light scatter analysis. Anemia is diagnosed by hemoglobin and hematocrit (H&H) using the World Health Organization limits for hemoglobin (male, 13 g/dL; female, 12 g/dL) and hematocrit (male, 0.39; female, 0.36). The various automated red cell parameters involved in anemia work-up are defined and reference ranges are provided. The value of the rule of 3 is discussed in monitoring the performance of the H&H along with its relationship to the mean cell hemoglobin concentration (MCHC), or cell chromicity. Anemia classification based on the mean cell volume (MCV) and MCHC is presented, including various factors that affect the MCV across the different technologies, such as physiologic changes (oxygenation and blood aging) and various red blood cell pathologies, that result in inaccurate results. Typical MCVs and red cell parameters for different anemias are given. Red cell deformation and viscosity effects on the MCV and MCHC measurements across the different technologies are discussed in detail and show that the MCHC from hydrodynamically focused systems is a clinically useful parameter, whereas the MCHC from pulse-editing systems should be used only as a quality control parameter. The relevance of a clinically useful MCHC and accurate MCV in the classification of anemias is documented

KEY WORDS:

Anemia · Anemia classification · Anemia diagnosis · Cell-Dyn · H&H · HCT · Hb · IRF · MCH · MCHC · MCV · Microhematocrit · RDW · Retic

INTRODUCTION Because many users expressed the need to better understand the Cell-Dyn red cell indices and their usefulness in the diagnosis and classification of anemias, we have attempted to provide a clinically oriented, up-to-date review of the red cell parameters, focusing on Cell-Dyn technology.

ANEMIA DIAGNOSIS Anemia is the most common hematologic disorder. Twenty percent of all hospital admissions among the elderly are due to anemia [1]. Anemia is best defined in relation to H&H (hemoglobin [Hb] and hematocrit [HCT]) levels below the normal reference range, because a patient’s symptoms and physiologic consequences are the result of decreased oxygen-carrying capacity of the blood. According to World Health Organization (WHO) criteria [2], anemia is diagnosed in males when Hb is