KLP 8 - 22295 - Hana

Name: Hana Adiva Praditri
NIM: 22295
Group: 8
LABORATORY TEST FOR ANEMIA
INTERNATIONAL B
1. A 25-years-old woman came with symptoms of fatigue, lack of focus in daily activities,
dizziness, and headache. The patient told that she rarely consume red meat during
anamnesis. After physical examination, doctor suspected that the patient had anemia.
Then, the doctor suggested to carry out a follow-up examination, namely an
erythrocyte examination and other routine blood tests to the patient.
Erythrocyte count for the patient showed:
A=47 cells, B=73 cells, C=60 cells, D=68 cells, E=67 cells
Hematocrit examination showed:
Other hematology examination showed:
Hemoglobin 6 g/dL
Leukocyte count 8 x 109 /L
Neutrophil 60%
Lymphocyte 30%
Monocyte 6%
Eosinophil 4%
Basophil 0%
Thrombocyte count 320 x 109 /L
Questions:
a. From the erythrocyte count examination, what is the numbers of erythrocyte
in the patient above? What is the interpretation for the number of
erythrocyte in patient?
= 3.15 x 1012 /L
A normal RBC count for women is 3.6 - 5.6 x 1012 /L and from the
examination aboved we can see that this woman has a lower RBC count than
the normal range. This may indicate anemia, a condition where the number of
erythrocytes is reduced or low. In addition, anemia may occur due to a low
erythrocyte mass or an increase in plasma volume. Because the hemoglobin in
erythrocytes normally functions to transport oxygen from the lungs to the
body's tissues, anemia can cause hypoxia and subsequently impaired cell
metabolism in the affected organs.
a. From the hematocrit examination, what is the patient’s hematocrit level?

What is the interpretation of the patient’s hematocrit level?
The hematocrit examination showed that the patient’s hematocrit level is 20%,
which we can know from here that the patient’s hematocrit is considered low
as it is below the normal range of the hematocrit level (38-47% for men and
36-46% for women). A lower level than normal hematocrit level can indicate:
 A deficiency in the number of healthy red blood cells (anemia)
 Long-term illness, infection, or a white blood cell disorder like leukemia or
lymphoma which result in a large number of white blood cells.
 Deficiencies in vitamins or minerals
 Blood loss, either recent or long-term
 Excessive dehydration
 Pregnancy
b. What is the interpretation of the other laboratory examination’s results in

the table above?
The normal ranges for hemoglobin, leukocyte, and platelet according to Mayo
Clinic, are 11.6-15 g/dL (women) for hemoglobin, 3.4-9.6 x 10 9 L for
leukocyte, and 157-371 x 109 L (women) for the platelet count. From here and
from the laboratory examination itself we can see that the patient’s hemoglobin
is lower than normal range, however the leukocyte and platelet count is still in
the normal range. Low level of hemoglobin leads to anemia, which may causes
symptoms like fatigue and trouble breathing.
The normal percentages of leukocytes in the overall count are usually in these
ranges, according to the Leukemia & Lymphoma Society (LLS):
Looking back to the laboratory examination’s results, all the percentage of

patient’s each leukocyte are in the normal range.
c. What is the patient’s erythrocyte indices’ value (MCV, MCH, and

MCHC)? What is the interpretation?
MCV=40x10/3.15=63.4 fL
The normal range for MCV is 80-100 fL (normocytic erythrocytes), but in this
case, the patient’s MCV id below 80 fL, which shows that the RBC are
relatively small (microcytic) and it usually occurs as a result of iron deficiency
that has led to anemia.
MCH= 6x10/3.15=19 pg
The results of the patient’s MCH is 19 pg, this indicate that the patient suffers
from hyporchromic erythrocytes, a condition where the red blood cells have
less hemoglobin than normal. The normal range itself for MCH is 27-33 pg
(normochromic erythrocytes).
MCHC= 6x100/20=30 g/dL

From the result above, we can tell that the patient has a low level of MCHC,
meaning that the patient’s RBC do not have enough hemoglobin and the RBC
itself are smaller than usual.
d. Is the doctor’s suspicion proven to be true? What is the possible diagnosis

in this case?
Judging from all of the laboratory examination results, a possible diagnosis in
this case is probably micryoctic hyporchromic anemia. Hypochromimc
micryotic anemia itself indicate iron deficiency anemia, thalassemia,
elliptocytosis, or even sideroblastic anemia (Healthline, 2019)
2. A patient came to you in pale condition. The patient has recently complained of
fatigue and weakness. You suspected the patient is anemic so you decided to
do some tests to find out if your suspicions are correct.
a. You decided to do hemoglobin examination to the patient with
cyanmethemoglobin method.
 Explain the principle of cyanmethemoglobin test!
In the cyanmethemoglobin method, blood is diluted in an alkaline
Drabkin solution consisting of potassium ferricyanide/potassium
ferricyanide (K3Fe(CN)6), potassium cyanide/potassium cyanide
(KCN), sodium bicarbonate and surfactant. Hemoglobin is oxidized to
methemoglobin (Fe3+) by potassium ferricyanide, K3Fe(CN)6.
Potassium cyanide/potassium cyanide (KCN) then converts
methemoglobin to cyanmethemoglobin: Hb(Fe2+) K3Fe(CN)6 →
methemoglobin (Fe3+) KCN → cyanmethemoglobin.
The absorbance of cyanmethemoglobin at a wavelength of 540 nm

corresponds to the hemoglobin concentration. Sulfhemoglobin cannot
be converted into cyanmethemoglobin so it cannot be measured using
this method. However, a sulfhemoglobin fraction of more than 0.05
g/dL is rarely found in clinical practice (the value of sulfhemoglobin is
negligible).
 Explain the equipment and reagents needed to perform

cyanmethemoglobin test!
- Equipment:
o 10x75mm test tube
o 0.02 mL pipette
o Photoelectric calorimeter with green filter or
spectrophotometer at length 540 nm wave
o Apparatus
- Reagents:
The solvent is a detergent-modified Drabkin's solution. The
components of Drabkin's solution (pH 7.0 - 7.4) comprises of:
o Potassium ferricyanide: 400 mg → oxidizes hemoglobin
(Fe2+) to 3+ methemoglobin (Fe)
o Potassium cyanide (KCN): 100 mg → converts
methemoglobin to cyanmethemoglobin
o Potassium dihydrogen phosphate (anhydrous) (KH2PO4):
280 g
o Non-ionic detergent (Sterox SE): 1 mL → lyses erythrocytes
and reduces turbidity due to protein precipitation
o Distilled water: 2 litres
Drabkin's solution must be clear or pale yellow and when measured
in the photoelectric calorimeter it must give a reading of 0 at a
wavelength of 540 nm against the blank (to avoid erroneous
readings in the hemoglobin measurement). Detergents increase lysis
of erythrocytes and decrease turbidity due to protein precipitation.
Erythrocytes need to be lysed or broken down because hemoglobin
is contained in erythrocytes.
b. You decided to further clarify the patient’s condition by using the

RBC count.
The picture above is one of the squares used to calculate RBC. How
many RBC are there in the square? Explain the rules for calculating
RBC!
We can see that there are 10 RBC inside the squares and to count the
RBC, first we have to determine which line are we using. Is it the top and
right or the bottom and left? Then we just count all of the red blood cell
inside and on the line of the square that is used as mentioned before.
c. After you count 5 squares, you get an average RBC count is 70 cells.
What is the patient’s erythrocyte count?
= 3.5 x 1012 /L
The results from the calculation is 3.5 x 1012 /L, this indicate that the
patient has a RBC count below the normal range, meaning that the patient
is suffering from anemia.
References
The McGill Physiology Virtual Laboratory. (n.d) Blood cell indices > MCV and MCHC.
[online] Available at: <https://www.medicine.mcgill.ca/physio/vlab/bloodlab/mcv-
mchc_n.htm> [Accessed 24 June 2021].
LabCE. (n.d) Red Blood Cell (RBC) Indices: Definitions and Calculations. [online]
Available at:
<https://www.labce.com/spg579119_red_blood_cell_rbc_indices_definitions_and_calcula
.aspx>[Accessed 24 June 2021].
Mayo Clinic. 2020. Complete blood count (CBC) [online] Available at:
<https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac-
20384919> [Accessed 24 June 2021].
Richardson, M., 2007. Microcytic Anemia. Pediatrics in Review, [online] 28(1), pp.5-14.
Available at: <https://pedsinreview.aappublications.org/content/28/1/5> [Accessed 24
June 2021].
Higuera, V., 2018. WBC (White Blood Cell) Count. [online] Available at:
<https://www.healthline.com/health/wbc-count> [Accessed 24 June 2021]

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Name: Hana Adiva Praditri

a. From the hematocrit examination, what is the patient’s hematocrit level?

b. What is the interpretation of the other laboratory examination’s results in

Looking back to the laboratory examination’s results, all the percentage of

c. What is the patient’s erythrocyte indices’ value (MCV, MCH, and

MCHC= 6x100/20=30 g/dL

d. Is the doctor’s suspicion proven to be true? What is the possible diagnosis

The absorbance of cyanmethemoglobin at a wavelength of 540 nm

 Explain the equipment and reagents needed to perform

b. You decided to further clarify the patient’s condition by using the

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