(Creative Summary)

Procedural type of infographics and has pictures

Oxillo, C.J, Penaso, A.M.A. & Paulino, E.G.

Anemia Topics
1. RETICULOCYTE COUNT (MILLER DISC)
The Miller disk method is a method of counting reticulocytes that employs the aid of
an optical device." The disk" is a reticle that is placed in one ocular of the microscope.
Engraved on the disk is a small square B sur- rounded by a large square A, the area of
which is nine times that of the small square 
A (Retic) dako and B (RBC 1008) is gamay

 Reduce the labor-intensive process

 Disc is composed of two squares, with the area of the smaller square
measuring 1/9 the area of the larger square.
 Disc is inserted into the eyepiece of the microscope
 RBCs are counted in the smaller square, and reticulocytes are counted in the
larger square, and reticulocytes are counted in the larger square.
 A minimum of 122 cells should be counted in the small square, because this
is equivalent to 1008 red cells in the larger square
 Formula:

o Reticulocytes (%)
 = no. reticulocyte in square A x 100
no. RBCs in square B x 9
o Example:
 Reticulocytes = 15
  Red blood cells = 112
o Answer:
 Reticulocytes % = 15 x 100
= 1.5% = N
112 x 9
Sources of Error/Comments
 Very anemic  adjust the proportion of dye
 Not mixed = error (not stained well)
 Refractile bodies may resemble reticulocytes.
 Other RBC inclusions
o Heinz = appear round or oval, and tend to adhere to the cell membrane
o Howell-Jolly bodies = round nuclear fragments and are usually singular
Pappenheimer bodies = confirmed with an iron stain, such as Prussian blue.

2. ABSOLUTE RETICULOCYTE COUNT

It is a calculated index derived from the product of two parameters namely
Reticulocyte count percentage and RBC count. It is a marker of red cell production and
helps in distinguishing hypo and hyper proliferative anemias.
 Actual number of reticulocytes in 1 liter (L or 1 microliter (mL) of blood
 Formula:
o ARC
o = reticulocytes (%) x RBC count (x10^12/L)
100
 Example:
o Reticulocyte = 2%
o RBC count = 2.20x10^12/L

o ARC = 2 x (2.20x10^12/L)
= 44x10^9/L
100
 Reference Interval: 20 to 115x10^9/L

3. CORRECTED RETICULOCYTE COUNT (if there is a low RBC, the bone marrow
releases shift reticulocyte para ma puno tung mga kulang na RBC)
It is expressed as a percentage of total RBCs; it must be corrected according to the
extent of anemia with the following formula: reticulocyte % × (patient Hct/normal Hct)
= corrected reticulocyte count.
  Few RBCs  low hematocrit  falsely elevated reticulocyte
 Used of correction factor as 45% - NORMAL HEMATOCRIT OF PATIENT
 Formula:
o CRC = Reticulocyte (%) x Patient HCT (%)
45%
 Example:
o Reticulocyte (%) = 3%
o HCT = 35%
 Answer:
o CRC = 3 x 35%
= 2.3%
45%
 Reference Interval:
o HCT of 35% = 2 to 3% reticulocyte
o HCT of <25% = 3 to 5% reticulocyte

4. RETICULOCYTE PRODUCTION INDEX

The reticulocyte production index (RPI), also called a corrected reticulocyte count
(CRC), is a calculated value used in the diagnosis of anemia. This calculation is
necessary because the raw reticulocyte count is misleading in anemic patients. The
problem arises because the reticulocyte count is not really a count but rather a
percentage: it reports the number of reticulocytes as a percentage of the number of red
blood cells. In anemia, the patient's red blood cells are depleted, creating an
erroneously elevated reticulocyte count.
SHIFT RETIC – PREMATURE RELEASED FROM BM – FALSE INCREASE IN RETIC
 Anemia  shift reticulocyte  falsely increase
With Shift Reticulocyte
Mon Tues Wed
SR1 SHIFT 3 3 3
SR2 4 4
SR3 5
R1 NORMAL 2
R2 2
R3 2
TOTAL 5 9 14

 Patient’s hematocrit is used to determine the appropriate correction factor

(reticulocyte maturation time in days):
Patient’s Hematocrit Value (%) Correction Factor (Maturation Time,
 Days)
40-45 1
35-39 1.5
25-34 2
15-24 2.5
15 3
 Formula:
o RPI = reticulocyte (%) x (%HCT/45)
maturation time
Or

RPI = CRC
Maturation time

 Example:
o Reticulocyte count = 7.8%
o HCT = 30%
 Answer:
o RPI = 7.8 (30%/45) CRC
= 2.6 – can be round up to 3
2
 Reference Interval:
o RPI >3 = adequate bone marrow response

RPI <2 = inadequate bone marrow response

5. ACIDIFIED SERUM LYSIS TEST: HAM METHOD
The Ham test (acidified serum lysis) establishes the diagnosis of
paroxysmal nocturnal hemoglobinuria (PNH), demonstrating a characteristic
abnormality of PNH red blood cells by acidified fresh normal serum . It checks whether
red blood cells become more fragile when they are placed in mild acid.
Principle:
 Erythrocytes are incubated with fresh heated serum to test for hemolysis. Weak
acid is used in specific serum cell mixture
Positive in:
 PNH
 Aplastic anemia
 HEMPAS – hereditary erythroblastic multinuclearity or type 2 congenital
 Leukemia
 Myelogenous leukemia