Hypochromia In A General Blood Test - What Is It?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Hypochromia in a general blood test: what does it show?

Smear staining and its morphological characteristics are an important laboratory technique in the study of erythrocytes. Prior to microscopic examination, red blood cell counts and hemoglobin levels can be determined.

With a low level of red blood pigment against the background of a normal content of red blood cells, the hematologist calculates the color index (CP). If its value is below 0.8, a diagnosis of hypochromia is made.

The diagnosis requires clarification, however, these data can be relied on with further microscopic examination of erythrocytes.

In the presence of hypochromia in the final result of a general blood test, there is a high probability that the patient develops hypochromic (microcytic) anemia. To clarify the diagnosis, both the qualitative and quantitative characteristics of the blood are taken into account.

Content:

• Before morphological examination
• Qualitative and quantitative analysis
• Cell size as an important indicator
• The intensity of the staining of erythrocytes
• Degrees of hypochromia
• A reliable sign of hypochromic anemias
• Causes of hypochromia
• Symptoms and Treatment

Before morphological examination

The color index (CP), which characterizes the general condition of erythrocytes, can be calculated using a simple and reliable formula:

CP = (Hb, g / l • 3) / the first three values of the total content of erythrocytes

Possible results and their interpretation:

• CP is in the range of 0.85-1.05 - the norm of the content of erythrocytes containing a sufficient amount of hemoglobin.
• CP less than 0.8 - hypochromic anemia (hypochromasia), when the number of red blood cells is normal, but hemoglobin is insufficient.
• CP above 1.1 - hyperchromia (hyperchromasia), above 1.4 - there is a deficiency of folic acid (vitamin B ₁₂), or pernicious anemia.

The color indicator is the ratio of the hemoglobin content to the red blood cells, expressed in numbers. Deficiency of hemoglobin and a low level of color index is a sign of iron deficiency or sideroachrestic anemia, which is formed due to a violation of hemoglobin synthesis in erythroblasts. These conditions belong to the class of hypochromic anemias.

The correct calculation of the color indicator depends on the accuracy of determining the level of Hb and counting the number of erythrocytes. These criteria determine the presence or absence of anemic syndrome.

Qualitative and quantitative analysis

Counting the number of red blood cells, performed using a hematological analyzer, is not very informative. To obtain complete information, morphological or qualitative analysis is used.

What this study allows you to do:

• Examine the smear;
• Determine the size of red blood cells;
• Visually see the degree of saturation of erythrocytes 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 acidic and alkaline dyes;
• Fluctuations or lack of reaction from the white blood.

Cell size as an important indicator

If the CP 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 the 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 light spot in the middle of the cell, while the CP is in the range 0.85-1.0. This condition does not always correspond to the norm, it can be observed with normochromic anemia.

• Hyperchromia (hyperchromasia), when the middle 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 illumination is excessively large, and the cell rim is very narrow due to poor saturation with red pigment. The condition is characterized by poor performance by erythrocytes of their functions.

The doctor, evaluating the characteristics of erythrocytes during the morphological examination, will identify anemia and reflect the diagnosis, drawing up a conclusion.

Degrees of hypochromia

Gradation of hypochromic anemia:

• Grade 1 - the cell rim is colored, the clearing zone is larger than usual;
• Grade 2 - central clearing is wider than usual, approaching the membrane, the colored area is clear;
• Grade 3 - only the area near the membrane is colored, the erythrocyte is visually similar to 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.

A reliable sign of hypochromic anemias

There are the following forms of anemic conditions, which are included in the group of hypochromic anemias:

1. Iron-deficiency anemia. The most common form of hypochromic anemia.

   Typical signs:

   • Microcytosis in combination with hypochromia;
   • The color index is below normal;
   • Decreased serum iron levels;
   • Positive dynamics of treatment.

2. Iron-saturated anemia (sideroachrestic). The Hb level in this pathology steadily decreases due to ineffective 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.

   Typical signs:

   • Low Hb;
   • Hypochromia;
   • Normal iron levels
   • The lack of effect from the use of drugs with a high iron content.

3. Iron redistribution anemia. The etiology of this form of anemia is based on excessive hemolysis of erythrocytes, tuberculosis, purulent processes, cardiac pathologies. Refers to hypochromic microcytic anemia.

   Typical signs:

   • Low Hb Level;
   • Hypochromia;
   • Serum iron levels are normal;
   • Lack of effect from therapy with iron preparations.

With a combination of signs of different types, a mixed form of hemochromatosis is diagnosed.

Causes of hypochromia

The etiology of hypochromia is based on hypochromic anemia.

Risk factors contributing to the development of hypochromia and anemia:

• Long-term or chronic blood loss (gastrointestinal tract, uterus);
• Chronic inflammatory processes (enteritis, organ resection), 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 assimilate 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 hemoglobin level:

• Grade 1 (mild) - the Hb level is below normal, but does not fall below 90 g / l;
• Grade 2 (moderate) - Hb level in the range of 70-90 g / l, CP is below 0.8, with visual assessment of the smear, moderate hypochromia is noted;
• Grade 3 (severe) - the Hb level is below 70 g / l, CP is reduced, with a visual assessment of the smear, pronounced hypochromia is noted.

The less the degree of anemia, the less pronounced its manifestations.

Symptoms and Treatment

Common symptoms of the disease characteristic of all types of hypochromia:

• Frequent unreasonable dizziness and weakness;
• "Flies" before the eyes;
• Shortness of breath even with minimal physical effort;
• Decrease in physical capabilities (loss of strength) and intellectual abilities (impaired concentration);
• Tachycardia.

The direction of therapy for hypochromia is individual in each case. It is important to identify the cause of the disease and start treating it. The success of therapy depends on the form of anemia.

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 ₆ is prescribed orally (50-200 mg / day) and intramuscularly (100 mg 2 times a week). Therapy lasts 2 months or more (with hereditary pathologies). To prevent hemosiderosis and reduce the concentration of iron in the body, deferoxamine is prescribed. The drug binds trivalent iron, but does not affect the iron of hemoglobin, ferritin, hemosiderin.

In the treatment of iron-redistributive anemia, its cause (inflammation) is first eliminated by supportive treatment in the form of vitamin therapy.

The author of the article: Shutov Maxim Evgenievich | Hematologist

Education: In 2013 he graduated from the Kursk State Medical University and received a diploma "General Medicine". After 2 years, completed residency in the specialty "Oncology". In 2016 completed postgraduate studies at the National Medical and Surgical Center named after N. I. Pirogov.