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Vedashree: Evaluation of haematological parameters and categorisation of anemia in adults in a tertiary care hospital


Introduction

Anemia is a common clinical condition with reduction in haemoglobin concentration for the age, sex and physiological condition.1 It is classified based on the morphological characteristics which include the red cell size, degree of hemoglobinization and shape of red blood cells(RBCs).2 Anemia is the manifestion of an underlying disease. Typing of anemia and further workup include evaluation of haemoglobin and RBC indices which include mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC).3 The haemoglobin concentration is the most commonly used parameter of anemia.4 Modern instruments are capable of counting and estimating the size of circulating blood cells.5,6 It is based upon the generation of an electrical pulse when a blood cell passes through a small a perture surrounded by electrode.7 Each electrical pulse generated represents an individual cell and the pulse height corresponds to the cell volume. The measured variables of RBCs thus provided are haemoglobin, hematocrit, MCV and Red cell distribution width. 8,9 The evaluation of RBC parameters like Hemoglobin, Hematocrit and R BC indices helps in characterising the type of anemia and formulation of differential diagnosis.3 The levels of haemoglobin vary in different pathological conditions ranging from infections to inflammatory processes. 10 Thus estimation of haemoglobin is also useful in diagnosing the underlying disease process. The diagnostic accuracy of classifying anemia is highest when the RBC parameters like MCH, MCV and MCHC are evaluated.11 Thus the entity of RBC parameters is of significant value in diagnosis and evaluation of anemia.

Aim

To study the prevalence of anemia in adults in a tertiary care hospital demographically.

Objectives

  1. To collect the haematological parameter of patients who showed abnormal red cell indices.

  2. To analyse the various red cell indices and correlate with haemoglobin percent.

Materials and Methods

This retrospective study was carried out in department of Pathology, Chamarajanagar institute of medical sciences, teaching associated district hospital laboratory for a period of 3 months from October 2016 to December 2016.

Inclusion criteria

Patients in the age group of 18–60 years with haemoglobin less than normal range for the age and sex.

Exclusion criteria

  1. Patients less than 18 years of age and more than 60 years.

  2. Patients with anemia associated with other hemotological abnormalities.

The study included 105 cases which showed low haemoglobin percent in fully automated blood cell counter- model PCE-210 and then correlated with red cell indices parameters. The severity of anemia was graded based on the haemoglobin concentration (gm/dl) according to World Health Organisation guidelines (WHO guidelines) (Table 1). The type of anemia was studied based on the red cell indices. The distribution of severity and type of anemia was studied in each age and sex group. The study was then compared with other studies. The severity of anemia was graded based on WHO the cut off range of haemoglobin concentration.

Table 1
Mild Moderate Severe
Female 11 – 11.9 8 - 10.9 <8
Male 11 – 12.9 8 – 10.9 <8

Normal range of Hemoglobin concentration (gm/dl) for grading severity of anemia (WHO guidelines)

Table 2
MCV MCH MCHC
80 – 100 fl 27-32 pg 32-36 gm/dl

Normal values of RBC indices (WHO guidelines)

Observation and Results

We studied 105 cases which showed low haemoglobin percentage in automated blood cell counter. Out of 105 cases 79(75.23%) were female and 26(24.76%) were males as shown in Table 3. The severity of anemia was assessed based on the range of haemoglobin percentage as mild, moderate and severe as shown in the Table 1. Based on the severity of anemia, 52 patients had mild degree with 39 female patients (37.14%), 13 male patients (12.3%), 27 patients had moderate degree with 14 female patients(13.4%), 13 male patients(12.3%) followed by 26 female patients(24.76%) had severe degree of anemia.

There was female preponderance in all degrees of anemia. The age range in our study was 21 to 50 years with the maximum number of cases of anemia between 21 to 30 years. Based on red cell indices, the morphological type of anemias were studied in relation to the age and sex of the patients. Patients with normal MCV and MCH were categorised as normocytic and normochromic. Patients with low MCV and low MCH were categorised as microcytic and hypochromic respectively. Patients with low MCV and normal MCH were categorised as microcytic and normochromic. There were no patients with high MCV in our study. 85 cases had normal MCHC values and the remaining 20 patients had decreased values as shown in Table 6. Microcytic hypochromic anemia was the most common morphological type constituting 60(57.07%) patients followed by normocytic normochromic constituting 26(24.76%) patients. The distributions of age group based on morphological type of anemia are as shown in Table 4.

Table 3
Morphology Male Female
Microcytic hypochromic 6(5.7%) 53(50.4%)
Normocytic normochromic 6(5.7%) 20(19.04%)
Microcytic normochromic 6(5.7%) 14(13.3%)
Marcocytic 0(0%) 0(0%)

Sex distribution of anemia cases based on morphology

Table 4
Morphology 21 – 30 yrs 31-40 yrs 41-50 yrs
Microcytic hypochromic 28(26.6%) 19(18.09%) 13(12.38%)
Normocytic normochromic 13(12.38%) - 13(12.38%)
Microcytic normochromic 19(18.09%) - -
Marcocytic - - -

Age distribution of anemia cases based on morphology

Table 5
Mild Moderate Severe
21-30 yrs 20(19%) 20(19%) 20(19%)
31-40 yrs 0(%) 13(12.3%) 7(6.7%)
41-50 yrs 13(12.3%) 6(5.7%) 6(5.7%)

Age–wise distribution of anemia cases based on severity

Table 6
Normal Reduced Increased
MCV 26(24.7%) 78(74%) 0(0%)
MCH 46(43.8%) 59(56.1%) -
MCHC 85(80.9%) 20(19.04%) -

MCV, MCH and MCHC distribution

Discussion

Anemia is the reduction in the haemoglobin levels and implies the manifestion of various pathological conditions. Thus evaluation of anemia aids in diagnosing the various disease processes and guides in efficient management of patients. The basic parameters that are helpful in evaluation are haemoglobin, and RBC indices. The present study was conducted on 105 patients and the results were obtained by the fully automated blood cell counter. Most of the patients in this study were female in the age group of 21-30 years and the most common type of anemia was microcytic hypochromic. This is similar to the study conducted by Reena Kouli et al which was done on 1330 cases12 in tertiary care centre of north east India and study by S.Patel in Gujarat. 13 In our study, 26(24.76%) male and 79 (75.23%) female had anemia which i s similar to the study by Reena Kouli et al12 but in contrast to study by Gerardo Alvarez-uria et al 14 which showed 50.55% males and 49.45% females. In our study, among females mild degree of anaemia (37.14%) was more common followed by severe and moderate degree in contrast to the study by Reena Kouli et al which showed moderate degree of anaemia (47.2%) to be more common in females followed by mild and severe degree. Our study showed equal distribution of mild and moderate degrees of anemia among males and no patients had severe degree i n contrast to study by Reena Kouli et al which showed more number of males patients having moderate degree of anemia followed by mild and severe degree.

Conclusion

Anemia is considered as one of the most common hematologic abnormality. It is more common in India. The early diagnosis and classification helps in timely intervention and treatment thus reducing the morbidity associated with it. The utility of haematological parameters obtained from automated cell counters aids in increased diagnostic accuracy. In the present study, there was predominance of anemia in 2nd decade among females and microcytic hypochromic type was common. Also the study showed maximum number of mild degree of anemia. Thus the combination of various RBC parameters and haemoglobin percentage provides adequate information of the haematological profile.

Source of funding

None.

Conflict of interest

None.

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