Contents
Smear staining and its morphological characteristics are an important laboratory technique in the study of erythrocytes. Before starting a microscopic examination, you can count the number of red blood cells and determine the level of hemoglobin.
The diagnosis requires clarification, but these data can be based on further microscopic examination of erythrocytes.
In the presence of hypochromia in the final result of a complete blood count, there is a high probability that the patient develops hypochromic (microcytic) anemia. To clarify the diagnosis, both qualitative and quantitative characteristics of blood are taken into account.
Before morphological study
The color index (CPI), which characterizes the general condition of erythrocytes, can be calculated using a simple and reliable formula:
CPU u3d (Hb, g / l • XNUMX) / the first three values uXNUMXbuXNUMXbof the total content of erythrocytes
Possible results and their interpretation:
The CPU is in the range of 0,85-1,05 – the norm for the content of red blood cells containing a sufficient amount of hemoglobin.
CPU less than 0,8 – hypochromic anemia (hypochromasia), when the number of red blood cells is normal, but hemoglobin is not enough.
CP above 1,1 – hyperchromia (hyperchromasia), above 1,4 – there is a deficiency of folic acid (vitamin B12), or pernicious anemia.
The color index is the ratio of hemoglobin content to erythrocytes, expressed in numbers. Hemoglobin deficiency and a low level of color index are a sign of iron deficiency or sideroahrestic anemia, which is formed due to impaired hemoglobin synthesis in erythroblasts. These conditions belong to the class of hypochromic anemias.
The correct calculation of the color index depends on the accuracy of determining the level of Hb and counting the number of red blood cells. These criteria determine the presence or absence of an anemic syndrome.
Qualitative and quantitative analysis
The calculation of the number of erythrocytes, performed using a hematological analyzer, is not very informative. To obtain complete information, morphological or qualitative analysis is used.
What this research allows you to do:
Examine the smear;
Determine the size of red blood cells;
Visually see the degree of saturation of red blood cells with hemoglobin.
Morphological signs of hypochromic anemia:
Hypochromia;
Hypochromia and microcytosis;
The appearance of schizocytes (fragments of red blood cells) and normoblasts (young cells);
Polychromatophilia – a condition when there are erythrocytes in the smear that can be stained with acid and alkaline dyes;
Fluctuations or lack of reaction from the white blood.
Cell size as an important indicator
If the CPU values deviate from the norm, the hematologist analyzes the size of red blood cells:
Erythrocytes of normal size (normocytes), having a size of 7-8 microns, can be with some types of anemia;
Macrocytes (erythrocytes with a diameter of more than 8 mm) – a sign of anisocytosis with a predominance of macrocytes;
Microcytes (erythrocytes with a diameter of less than 8 mm) are a sign of microcytic anemia.
When deviations from the norm appear, the hematologist examines the material using the Price-Jones curve.
The intensity of staining of erythrocytes
An important criterion for evaluating erythrocytes is the intensity of their staining:
Normochromia (normochromasia), when erythrocytes saturated with Hb look like normal cells with a small bright spot in the middle of the cell, while the CP is in the range of 0,85-1,0. This condition does not always correspond to the norm; it can be observed with normochromic anemia.
Hyperchromia (hyperchromasia), when the median enlightenment does not differ from the rest of the erythrocyte due to excessive saturation with pigments. The CPU is more than 1,1.
Hypochromia (hypochromasia), when the median enlightenment is excessively large, and the rim of the cell is very narrow due to poor saturation with red pigment. The condition is characterized by poor performance of their functions by erythrocytes.
The doctor, having assessed the characteristics of erythrocytes during a morphological study, will identify anemia and reflect the diagnosis, drawing up a conclusion.
Degrees of hypochromia
Gradation of hypochromic anemia:
Grade 1 – the rim of the cells is colored, the zone of enlightenment is larger than usual;
2 degree – the central enlightenment is wider than usual, approaches the membrane, the colored area is clear;
Grade 3 – only the area near the membrane is colored, the erythrocyte looks visually like a pale ring. It manifests itself in severe anemia, in very advanced stages.
Very often, hypochromia is accompanied by microcytosis, these symptoms are signs of hypochromic anemia. They become even more important if it is required to distinguish microcytic anemias from each other or to differentiate them from other blood pathologies.
Reliable sign of hypochromic anemia
There are the following forms of anemic conditions included in the group of hypochromic anemia:
Iron-deficiency anemia. The most common form of hypochromic anemia.
Characteristic features:
Microcytosis in combination with hypochromia;
The color index is below normal;
Decreased serum iron levels;
Positive dynamics of treatment.
Iron-saturated anemia (sideroachresticheskaya). The level of Hb in this pathology is steadily decreasing due to inefficient absorption of iron to the site of hemoglobin synthesis. It occurs due to intoxication with industrial poisons, chemicals, side effects of drugs that affect the formation of red blood cells.
Characteristic features:
Low Hb;
Hypochromia;
Normal iron levels;
Lack of effect from the use of drugs with a high iron content.
Iron redistributive anemia. The etiology of this form of anemia is based on excessive hemolysis of red blood cells, tuberculosis, purulent processes, and cardiac pathologies. Refers to hypochromic microcytic anemia.
Characteristic features:
low Hb;
Hypochromia;
Serum iron levels are normal;
Lack of effect from iron therapy.
With a combination of signs of different types, a mixed form of hemochromatosis is diagnosed.
Causes of hypochromia
The basis of the etiology of hypochromia is hypochromic anemia.
Risk factors contributing to the development of hypochromia and anemia:
Prolonged or chronic blood loss (gastrointestinal tract, uterus);
Chronic inflammatory processes (enteritis, resection of organs), leading to impaired absorption of iron in the gastrointestinal tract;
Malignant tumors of the gastrointestinal tract (stomach cancer);
Increased need for iron, vitamins and trace elements during pregnancy, lactation, increased growth of children and adolescents;
Lack of iron and vitamins that help to absorb it due to a sharp decrease in the intake of food into the body (with vegetarianism or dieting).
Clinical signs of anemia depending on the severity and level of hemoglobin:
1 degree (mild) – the level of Hb is below normal, but does not fall below 90 g / l;
2 degree (moderate) – the level of Hb in the range of 70-90 g / l, the CPU is below 0,8, with a visual assessment of the smear, moderate hypochromia is noted;
3 degree (severe) – the level of Hb is below 70 g / l, the CPU is reduced, with a visual assessment of the smear, pronounced hypochromia is noted.
The lower the degree of anemia, the weaker its manifestations are.
Symptoms and Treatment
General symptoms of the disease, characteristic of all types of hypochromia:
Frequent causeless dizziness and weakness;
“flies” before the eyes;
Shortness of breath even with minimal physical effort;
Decrease in physical abilities (failure) and intellectual abilities (impaired concentration of attention);
Tachycardia.
So, for example, with iron deficiency anemia, you need to take iron-containing preparations, include foods rich in this element and vitamins in the diet. The duration of therapy for anemia is 6 months or more.
In the treatment of sideroachrestic anemia, the use of ferrum-containing drugs is ineffective and harmful, since it provokes tissue hemosiderosis. In this case, vitamin B is prescribed6 orally (50-200 mg / day) and intramuscularly (100 mg 2 times a week). Therapy lasts 2 months or longer (for hereditary pathologies). To prevent hemosiderosis and reduce the concentration of iron in the body, deferoxamine is prescribed. The drug binds ferric iron, but does not affect the iron of hemoglobin, ferritin, hemosiderin.
In the treatment of iron-redistributive anemia, its cause (inflammation) is first eliminated, supportive treatment is carried out in the form of vitamin therapy.