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1. HEMATOLOGY LABORATORY
MODULE 8: RED BLOOD CELL INDICES
MLS 3A
UNIT MAP
RED BLOOD CELL INDICES
•Are calculated to determine the size and hemoglobin
content of the average red blood cell
•They provide a quality control check and important data
that help physicians pinpoint, differentiate and classify
certain types of anemia
•The diagnostic interpretation of the indices should always
be combined with a careful examination of the blood film
because indices are average values for many cells
examined manually or electronically
•Three parameters included in RBC indices:
1.Mean Cell Volume (MCV)
2.Mean Cell Hemoglobin (MCH)
3.Mean Cell Hemoglobin Concentration (MCHC)
NOTE:
•RBC indices could be a very important factor to help
assess if the patient either has anemia or RBC disorder
•It could also help the doctor find out why the patient is
suffering from a certain kind of illness which may be linked
to RBCs
•RBC indices could give you a rough example on what you
would expect during viewing of the RBC
-Sometimes, RBC indices could already give you a
picture what the RBC of a patient would look like under
the microscope
A.MEAN CELL VOLUME (MCV)
•Mean Cell Volume or Mean Corpuscular Volume (MCV)
•Average volume of the RBC
•Expressed in femtoliters (fL), or 10-15 L
NOTE:
•MCV determines that size of the RBC since you will
determine the volume or what the RBC would look like
under the microscope
•Normal RBCs (normocytic) are RBCs with normal size;
when you have a result of less than 80 fL the RBCs are
smaller (microcytic); if the value is greater than 100 fl, the
RBCs are bigger than the normal RBC size
•Most stable parameter
•“cytic”
•Normal Range: 87 ±5 = 82-92
•Check the smear especially if it is microcytic hypochromic
REFERENCE RANGE INTERPRETATION
80-100 fL  Normocytic RBCs 
Less than 80 fL Microcytic RBCs
Greater than 100 fL Macrocytic RBCs
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2. HEMATOLOGY LABORATORY
MODULE 8: RED BLOOD CELL INDICES
MLS 3A
•Increase in MCV:
1.Alcoholism with or without hepatic disease
•Alcohol inhibits utilization of folic acid
•Macrocytic RBC
-Deficiency in folic acid produces macrocytes
2.Cancer patient
•Cancer therapy or chemotherapy
•Some chemo drugs inhibit utilization of folic acid
•Medication: extra folic acid
3.Azidothymidine (AZT)
•Drug for AIDS patients
•Will lead to macrocytic RBC

4.Chronic hemolytic anemia
•Macrocytes: reticulocytes
•Classification is based on the increase or decrease of
the cells

5.Leukemia, Myeloma
•Presence of round macrocytes because of the
chemo drugs

6.B12 deficiency
-Impaired DNA synthesis

7.Folic acid deficiency

8.Hyperglycemia
•High glucose
•Up to 500
•Transient shift

9.Mycoplasma pneumonia
•Due to increased immunoglobulin

10.Cold agglutinins
•Coats the membrane of the RBC
•↑ MCV once it passes the aperture of the analyzer
-Gives a false result
•Remedy:
-Warm to 37°C for a few minutes and rerun the
test
11.Transfusion
•Dual population
•Normal RBC and spherocyte but returns to normal

12.Contamination
•Do not take samples on intravenous (IV) lines or
catheters
•Drawing of blood from IV lines in prohibited
especially indwelling catheters

FORMULA:
NOTE:
•Take note in your SI unit if the RBC count is not in SI unit,
it must be converted first before dividing$"
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3. HEMATOLOGY LABORATORY
MODULE 8: RED BLOOD CELL INDICES
MLS 3A
•Unit:
-Conventional: cubic micra
-SI: femtoliters (fL)
EXAMPLES FOR MCV:
B.MEAN CELL HEMOGLOBIN (MCH)
•Mean Cell Hemoglobin or Mean Corpuscular Hemoglobin
(MCH)
•Average weight of hemoglobin in a RBC
•Expressed in picograms (pg), or 10
-12 g
•Reference Range: 26-32 pg
NOTE:
•SI unit: femtomole (fmole)
•Check the shape and size of the RBCs in the smear
because sometimes there will be wrong in computation or
the sample is lipemic (abnormal hemoglobin)
•Conversion of pg to fmole:
-(pg)(0.06206) = fmole

FORMULA:
EXAMPLES FOR MCH:
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4. HEMATOLOGY LABORATORY
MODULE 8: RED BLOOD CELL INDICES
MLS 3A


NOTE:
•In example #3,114 is not yet decilitre
-Hemoglobin should be g/dL
-Convert liter to decilitre
-Per liter, there are 10 dL so just divide 114 by 10 to
give a result of 11.4 g/dL
-1 L = 10dL
C.MEAN CELL HEMOGLOBIN CONCENTRATION
•Mean Cell Hemoglobin Concentration or Mean
Corpuscular Hemoglobin Concentration (MCHC)
•Average concentration of hemoglobin in each individual
RBC
•Represents the color of the RBC
•Expressed in grams per decilitre (g/dL)
NOTE:
•SI unit: mmol/L
-% x 0.6206 = mmol/L
•> 36
-Hyperchromic
-Cells involved are spherocytes
•> 38
-Check the calculation and check if there is a presence
of cold agglutinin
•Macrocytic normochromic and macrocytic hypochromic
-Dependent on the data and blood picture

FORMULA FOR MCHC:
REFERENCE RANGE INTERPRETATION
32-36 g/dL  Normochromic
Less than 32 g/dL Hypochromic
Greater than 36 g/dL        Hyperchromic
Greater than 38 g/dL        Check for error in Hgb result
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5. HEMATOLOGY LABORATORY
MODULE 8: RED BLOOD CELL INDICES
MLS 3A
EXAMPLES FOR MCHC:


NOTE:
•In example #1, because it is greater than 36, it is a
hyperchromic red blood cell
-Under the microscope, the red blood cell would be
darker than usual
•Greater than 38 g/dL: check for errors because it is
inaccurate since it is rare to have a very hyperchromic
RBC
RBC INDICES INTERPRETATION
What is the significance why do we need to understand
the RBC indices?
•Later on, the physician will examine the different RBC
indices
•He could interpret it as both the size and the color of the
cell to indicate what type of anemia
•The red blood cells in different types of anemia could
either be decreased in number, decreased in size, or lacks
hemoglobin concentration
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6. HEMATOLOGY LABORATORY
MODULE 8: RED BLOOD CELL INDICES
MLS 3A
NOTE:
•Microcytic hypochromic
-RBC are smaller in size and decreased hemoglobin
concentration
•Normocytic normochromic
-Normal size RBC and normal hemoglobin
concentration
•Blood Loss
-Losses the blood but does not alter the size and
hemoglobin concentration
•Macrocytic normochromic
-Large RBC and normal hemoglobin concentration
•Mean Corpuscular Diameter (MCD)
-Average diameter of RBC
-In microns
-Price-Jones and Nicholson
•Mean Corpuscular Average Thickness (MCAT)
-Data from MCV and MCD
•Red Cell Distribution Width (RDW)
-Mathematical calculation to know the size of the RBC
-Population it measures and population of RBC as it
passes the aperture
-Detects anisocytosis
-Large curve = varied size of RBC
-Normal Range: 11.5-14.5
-Formula: SD of Mean Cell Size divided by MCV
multiplied by 100
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