Reference: Blood: physiology and circulation (edited by Kara Rogers)

Hemoglobin
Hemoglobin is the iron-containing protein found in the red blood cells that transports oxygen to the tissues.
Hemoglobin forms an unstable, reversible bond with oxygen. In the oxygenated state, it is called oxyhemoglobin
and is bright red, and in the reduced state, it is purplish blue and may be referred to as deoxyhemoglobin.
Hemoglobin develops in bone marrow, specifically in the cells that become red blood cells. About 95 percent of
the dry weight of the red cell consists of hemoglobin. When red cells die, hemoglobin is broken up. Iron is
salvaged, transported to the bone marrow by proteins called transferrins, and used again in the production of
new red blood cells. The remainder of the hemoglobin forms the basis of bilirubin, a chemical that is excreted
into the bile and gives the feces their characteristic yellow-brown colour.

Platelets
The blood platelets are the smallest cells of the blood, averaging about 2-4 micrometres in diameter. Although
much more numerous (150,000-400,000 per cubic millimetre) than the white cells, they occupy a much smaller
fraction of the volume of the blood because of their relatively minute size.
Like the red cells, they lack a nucleus and are incapable of cell division (mitosis), but they have a more complex
metabolism and internal structure. When seen in fresh blood they appear spheroid, but they have a tendency to
extrude hairlike filaments from their membranes. They adhere to each other but not to red cells and white cells.
Tiny granules within platelets contain substances important for the clot-promoting activity of platelets.
The function of the platelets is related to hemostasis, the prevention and control of bleeding. When the
endothelial surface (lining) of a blood vessel is injured, copious platelets immediately attach to the injured
surface and to each other, forming a tenaciously adherent mass of platelets. The effect of the platelet response
is to stop the bleeding and form the site of the developing blood clot, or thrombus. If platelets are absent, this
important defense reaction cannot occur, resulting in protracted bleeding from small wounds (prolonged
bleeding time).
Platelets are formed in the bone marrow by segmentation of the cytoplasm (the cell substance other than the
nucleus) of cells known as megakaryocytes, the largest cells of the marrow. Within the marrow the
abundantgranular cytoplasm of the megakaryocyte divides into many small segments that break off and are
released as platelets into the circulating blood. After about 10 days in the circulation, platelets are removed and
destroyed. There are no reserve stores of platelets except in the spleen, in which platelets occur in higher
concentration than in the peripheral blood.

Leukocytes
White blood cells (or leukocytes, sometimes called white corpuscles), unlike red cells, are nucleated,
independently motile, and lack hemoglobin. They serve primarily to defend the body against infection and
disease by ingesting foreign materials and cellular debris, destroying infectious agents and cancer cells, or
producing antibodies. They also have some reparative functions. White cells are highly differentiated for their
specialized functions. They do not undergo cell division (mitosis) in the bloodstream, however,some retain the
capability of mitosis. The number of white cells in normal blood ranges between 4,500 and 11,000 per cubic
millimetre.

Erythrocytes
The millions of red blood cells that occur in the circulation of vertebrates give the blood its characteristic colour.
The function of the red cell and its hemoglobin is to carry oxygen from the lungs to all the body tissues and to
transport carbon dioxide, a waste product of metabolism, to
the lungs, where it is excreted.
The red blood cell develops in bone marrow in several stages. From a hemocytoblast, a multipotential cell in the
mesenchyme, it becomes an erythroblast (normoblast). During two to five days of development, the erythroblast
gradually fills with hemoglobin, and its nucleus and mitochondria (particles in the cytoplasm that provide energy
for the cell) disappear. In a late stage, the cell is called a reticulocyte, which ultimately becomes a fully mature
red blood cell. The average red cell in humans lives 100 to 120 days.

Hematocrit
The hematocrit is a diagnostic procedure that is used for the analysis of blood. The name is also used for the
apparatus in which this procedure is performed and for the results of the analysis. In the procedure, an
anticoagulant is added to a blood sample held in a calibrated tube. The tube is allowed to stand for one hour,
after which the sedimentation rate (how rapidly blood cells settle out from plasma) is determined. Most acute
generalized infections and some local infections raise the rate of sedimentation.
A raised sedimentation rate may be among the first signs of an otherwise hidden disease. In the second phase
of the procedure, the tube is centrifuged so that its contents separate into three layers—packed red blood cells
at the bottom, a reddish gray layer of white blood cells and platelets in the middle,and plasma at the top. The
hematocrit is expressed as the percentage of the total blood volume occupied by the packed red blood cells.
The depths of these layers are indicative of health or disease. The red blood cell layer is abnormally thick in the
disease polycythemia and too thin in iron-deficiency anemia. White blood cells are too abundant
in leukemia. Finally, plasma is deep yellow in jaundice (often caused by liver disease). The hematocrit is among
the most commonly used of all laboratory diagnostic procedures.

Referensi: PEDOMAN INTERPRETASI DATA KLINIK KEMENTERIAN KESEHATAN REPUBLIK

INDONESIA 2011

Nilai normal

Hemoglobin:
Nilai normal : Pria : 13 - 18 g/dL SI unit : 8,1 - 11,2 mmol/L
Wanita: 12 - 16 g/dL SI unit : 7,4 – 9,9 mmol/L

Eritrosit:
Nilai normal: Pria: 4,4 - 5,6 x 106 sel/mm3 SI unit: 4,4 - 5,6 x 1012 sel/L
Wanita: 3,8-5,0 x 106 sel/mm3 SI unit: 3,5 - 5,0 x 1012 sel/L

Leukosit:
Nilai normal : 3200 – 10.000/mm3 SI : 3,2 – 10,0 x 109/L

Trombosit:
Nilai normal : 170 – 380. 103/mm3 SI : 170 – 380. 109/L

Hematokrit:
Nilai normal: Pria : 40% - 50 % SI unit : 0,4 - 0,5
Wanita : 35% - 45% SI unit : 0.35 - 0,45

Hasil Pemeriksaan Lab

Hemoglobin darah : 12 g/dl (kurang) Eritrosit : 4,5 x 106 cell/mm3 (normal)

Trombosit 253.000/mm3 (normal) Hematokrit : 40 % (normal)
Leukosit 9800/mm3 (normal)
Penurunan nilai Hb dapat terjadi pada anemia (terutama anemia karena kekurangan zat besi), sirosis,
hipertiroidisme, perdarahan, peningkatan asupan cairan dan kehamilan.
Penetapan anemia didasarkan pada nilai hemoglobin yang berbeda secara individual karena berbagai adaptasi
tubuh (misalnya ketinggian, penyakit paru-paru, olahraga). Secara umum, jumlah hemoglobin kurang dari 12
gm/dL menunjukkan anemia.

Karena belum fix anemia apa enggak kita coba:

Reference: Color Atlas of Hematology (Harald Theml,M.D.; Heinz Diem,M.D.; Torsten Haferlach,M.D.)

Clinically Relevant Classification Principle for Anemias: Mean Erythrocyte Hemoglobin Content (MCH)
In current diagnostic practice, erythrocyte count and hemoglobin content (grams per 100ml) in whole blood are
determined synchronously. This allows calculation of the hemoglobin content per individual erythrocyte
(mean corpuscular hemoglobin,MCH) using the following simple formula (p. 10):
Hb (g/dl) · 10
Ery (106/μl)

The mean cell volume, hematocrit, MCH, and erythrocyte size can be used for various calculations (Table 22;
methods p. 10, normal values Table 2, p. 12). Despite this multiplicity of possible measures, however, in routine
diagnostic practice the differential diagnosis in cases of lowHb concentration or low erythrocyte counts relies
above all on the MCH, and most forms of anemia can safely be classified by reference to the normal data range
of 26–32 pg Hb/cell (1.61–1.99 fmol/cell) as normochromic (within the normal range), hypochromic (below the),
or hyperchromic (above the norm). The reticulocyte count (p. 11) provides important additional athophysiological
information. Anemias with increased erythrocyte production (hyper-regenerative anemias) suggest a high
reticulocyte count, while anemias with diminished erythrocyte production (hyporegenerative anemias) have low
reticulocyte counts (Table 22).
It should be noted that hyporegenerative anemias due to iron or vitamin deficiency can rapidly display hyper-
regeneration activity after only a short course of treatment with iron or vitamin supplements (up to the desirable
“reticulocyte crisis”). The practical classification of anemia starts with the MCH:
— 26–32 pg = normochromic
— Less than 26 pg = hypochromic
— More than 32 pg = hyperchromic

12 x 10 / 4500 = 26,67 pg

nomochromic (normal range)