RDW 15.4

The technologist reviewed the previous results with the comments presented and decided that the patient's history might hold some clues to these variant results. It was noted that the Hgb and Hct had failed the correlation check (Hgb ( 3 = Hct┬▒ 2). The technologist discovered that the patient had MDS. MDS has an unknown etiology but may falsely increase the Hgb,14 thus elevating the indices (MCH and MCHC). With this in mind, the technologist decided to apply the laboratory procedure for correcting Hgb values that eliminates tedious manual procedures such as centrifugation, plasma blanks, and pipetting. The Hgb concentration is calculated with the following equation, which indicates that there is a ratio between the MCV and MCHC of 2.9814:

Therefore, the corrected Hgb/L =

This calculation corrects the Hgb. As a result of this new value, the MCH and MCHC can be corrected with the new Hgb result.

The CBC now reports as

RBC 2.71 X 1012/L

Hgb 7.7* corrected result

MCV 84.2 fL

MCH 28.4 pg* recalculated result

MCHC 33.4%* recalculated result

Platelets 52 X 109/L

RDW 15.4

MDS is a classification of malignant clonal disorders that show cytopenias, dysplastic-looking cells in the peripheral smear, increasing numbers of blasts in the bone marrow, and a tendency to progress into a leukemic process. This case indicates a corrective action that is not often used but appropriate when all other causes of hemoglobin abnormality have been eliminated.

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