The author obtained index of red cell volume distribution width(RDW) and other red cell indices in 210 patients of various hematoncologic conditions and 200 healthy control group using, an automated blood analyzer, Coulter Counter Model S-plus II. This study performed to classify various etiologic anemia based on the MCV and RDW, to evaluate availability to the differential diagnosis in korean anemic distoders somewhat different from etiologies of anemias in foreginers. In the most of cases, the increase or decrease of MCV were always combined the pararell changes of MCH and MCHC: But the values of MCV and RDW were not correlated in control group and patient group. So the terms of heterogenous of homogenous anemia were meaningful morphologic classification than hypochromic or normochromic anemia. The heterogenous microcytic anemia contained iron deficiency anemia. In heterogenous normocytic anemia, myelophthisic anemia, acute leukemia were contained. In heterogenous macrocytic anemia, megaloblastic anemia, hemolytic anemia were contained. The homogenous microcytic anemia was observed in anemia of chronic disorders. In homogenous normocytic anemia, acute blood loss, chronic leukemia, multiple myeloma were contained. The aplastic anemia was belonged to homogenous macrocytic anemia. The diagnostic significance of RDW in hemoglobinopathies is most importhant. But this study was not contained hemoglobinopathies. Instead RDW was very helpful to differential diagnosis of most common anemias, iron deficiency anemia and anemia due to chronic disorders in Korea.
Anemia* ; Anemia, Aplastic ; Anemia, Hemolytic ; Anemia, Iron-Deficiency ; Anemia, Macrocytic ; Anemia, Megaloblastic ; Anemia, Myelophthisic ; Cell Size ; Classification* ; Diagnosis, Differential ; Erythrocyte Indices ; Hemoglobinopathies ; Humans ; Korea ; Leukemia ; Multiple Myeloma

BACKGROUND: Macrocytic anemias are commonly seen in clinical practice, and precise etiologic diagnosis is essential for proper management. We evaluated the clinical utility of reticulocyte maturation parameters in macrocytic anemias to discriminate among myelodysplastic syndrome (MDS), megaloblastic anemia (MA), and non-megaloblastic macrocytic anemia associated with chronic liver disease (MA-CLD). METHODS: Using an automated reticulocyte counter, we retrospectively analyzed and compared reticulocyte maturation parameters including immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), mean sphered cell volume (MSCV) of normal control (N=34), and patients diagnosed with MDS (N=31), MA (N=52), and MA-CLD (N=196). RESULTS: Macrocytic anemias from MA, MDS and MA-CLD showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than normal control (P<0.01). MDS showed higher values of reticulocyte maturation parameters including IRF, MRV and MSCV than MA-CLD (P<0.01). IRF and MRV were significantly lower in MA-CLD than in both MA and MDS (P<0.01). MSCV was significantly higher in MDS than in MA (P<0.01). CONCLUSIONS: This study indicates that the measurement of reticulocyte maturation parameters may be a useful tool in the differential diagnosis of macrocytic anemia. The presence of high values of IRF (> or = 0.39), MRV (> or = 129.5 fL), and MSCV (> or = 102.3 fL) makes the diagnosis of MA-CLD unlikely and underlying MDS should be considered.
Adult ; Anemia, Macrocytic/*diagnosis ; Anemia, Megaloblastic/*diagnosis ; Chronic Disease ; Diagnosis, Differential ; Female ; Humans ; Liver Diseases/*diagnosis ; Male ; Middle Aged ; Myelodysplastic Syndromes/*diagnosis ; Reticulocyte Count/*methods

BACKGROUND: Anemia is the most common hematologic problem encountered in the elderly. We conducted this prospective study to define the prevalence and characteristics of anemia in the elderly. METHODS: From August 1999 to October 1999, volunteers with age of 60 or more living in southwest area of Seoul, Korea were selected. Hemoglobin, mean corpuscular volume, red cell distribution width and iron profile were evaluated. WHO criteria cut off value of hemoglobin for the diagnosis of anemia was used, 13 g/dL in men and 12 g/dL in women. RESULTS: A total 1716 community residents aged 60 years or older were studied. Male to female ratio was 344:1372, and median age was 70 years (range:60-92). The prevalence of anemia was 10.2% in men (35/344) and 14.1% in women (194/1372). Normocytic anemia was most common, followed by macrocytic and microcytic anemia in order. CONCLUSION: The prevalence of anemia over the age of 60 was 10.2% in men and 14.1% in women and normocytic anemia was the most common type in our series. Considering that macrocytic anemia was more common than microcytic anemia, we suggest that screening profile for the detection of anemia in older persons should include the level of folate and vitamin B12.
Aged* ; Anemia* ; Anemia, Macrocytic ; Diagnosis ; Erythrocyte Indices ; Female ; Folic Acid ; Humans ; Iron ; Korea ; Male ; Mass Screening ; Prevalence* ; Prospective Studies ; Seoul ; Vitamin B 12 ; Volunteers

Megaloblastic anemia following gastrectomy is due to the total absence or inadequate secretion of intrinsic factor and is manifested by megalobastic changes in bone marrow, blood cells, and other proliferative cells. In Korea, detailed description and precise analyses of the cases of megaloblastic anemia following gastrectomy are relatively rare in contrast to the potential of its incidence from gastrectomy due to many causes or to the importance of its clinical significance. Here, we present the case of a 51-year old man who had undergone a total gastrectomy with esophagojejunostomy and incidental splenectomy due to early gastric cancer and developed megalobastic anemla 7 years after surgery. After gradual improvement of clinical and hematologic features with treatment of parenteral vltamin Bl2, he was followed-up with vitamin B12 maintenance therapy.
Anemia, Macrocytic/*etiology ; Anemia, Megaloblastic/diagnosis/*etiology ; Case Report ; Gastrectomy/*adverse effects ; Human ; Male ; Middle Age ; Vitamin B 12 Deficiency/*etiology

Anemia is defined as an insufficient amount of RBC mass to adequately deliver oxygen to peripheral tissues. For practical purposes, however, the measurements of three parameters that can be obtained from the complete blood count (CBC) are enough to establish the presence of anemia; hemoglobin (Hb) concentration, hematocrit, and RBC number. Among these, the Hb level is the most convenient parameter to establish the diagnosis of anemia. Anemia is not a disease by itself but mostly a consequence of the underlying acquired or genetic abnormality. Although the clues to the cause of anemia may be found from the history and physical examination, three parameters from CBC provide most critical information for the differential diagnosis of anemia; mean corpuscular volume (MCV), red cell distribution width (RDW), and the reticulocyte count. MCV provides information on the size of the red cell. Values greater than 100 fL usually signify a nuclear maturation defect resulting in macrocytic anemias, while values less than 80 fL are diagnostic of hemoglobin synthesis defect causing microcytic anemias. Meticulous evaluation of the serum iron status and body iron storage is essential to the differential diagnosis of microcytic anemias. RDW is a measure of the red cell size variation. It is increased by the appearance of microcytic or macrocytic cells, or both. The reticulocyte count is a useful laboratory measurement of effective red cell production. Hemolytic anemia or acute bleeding can increase the reticulocyte count. There are four clinically useful laboratory measurements indicating the presence of hemolytic process; the reticulocyte count, the serum bilirubin, the serum lactate dehydrogenase (LDH), and the serum haptoglobin concentration. Once the presence of hemolytic anemia is established, laboratory assessment to differentiate between intravascular and extravascular hemolysis is important because clinical conditions producing intravascular hemolysis may be anticipated in certain clinical situations, which may be complicated by acute renal failure or disseminated intravascular coagulation that needs immediate interventions. If the definitive cause of anemia cannot be established by examining the peripheral blood, a bone marrow study may be helpful.
Acute Kidney Injury ; Anemia* ; Anemia, Hemolytic ; Anemia, Macrocytic ; Bilirubin ; Blood Cell Count ; Bone Marrow ; Cell Size ; Diagnosis ; Diagnosis, Differential ; Disseminated Intravascular Coagulation ; Erythrocyte Indices ; Haptoglobins ; Hematocrit ; Hemolysis ; Hemorrhage ; Humans ; Iron ; L-Lactate Dehydrogenase ; Oxygen ; Physical Examination ; Reticulocyte Count

The Brugian filariasis in Korea was once endemic in several areas including Jeju-do and small remote islands located in the southwestern part of the Korean peninsula. But recently it has almost been controlled. The first patient was a 42-year-old man, who visited the hospital with the chief complaints of fatigue, jaundice and edema on the right low extremity. Examination of a peripheral blood smear revealed non-megaloblastic macrocytic anemia, thrombocytopenia and eosinophilia, and a parasite, which was identified as microfilaria of Brugia malayi on the glass slide of blood obtained from the patient at midnight. The second patient was a 23-year-old man, who visited the hospital with the chief complaints of cough, sputum and fever. A parasite resembling that of the first patient was found in a peripheral blood smear accompaning neutrophilia. No more parasites, however, were found in the peripheral blood obtained from the patient at midnight. These two clinical cases of Brugian filariasis indicate that the clinical laboratory in Korea should be able to detect microfilariae for the diagnosis of filariasis.
Adult ; Anemia, Macrocytic ; Brugia malayi ; Cough ; Diagnosis ; Edema ; Eosinophilia ; Extremities ; Fatigue ; Fever ; Filariasis* ; Glass ; Humans ; Islands ; Jaundice ; Jeju-do ; Korea ; Microfilaria ; Parasites ; Sputum ; Thrombocytopenia ; Young Adult