Hb = 83 g/L, that is moderate anaemia.

Anaemia happens when blood doesn’t have enough haemoglobin or red blood cells

Red cell count = 3.05, that is low.

Red cell count represent the number of red blood cells per microliter (mcL) of blood. Normal values are:

• 4.3 to 5.6 million red blood cells per microliter (mcL) of blood for men.
• 3.9 to 5.1 million red blood cells per mcL of blood for women.

Low Red Cell Count can be due to:

• Abnormal destruction of red blood cell 
• Reduced RBC production. 
• Significant haemodilution due to large volume fluid resuscitation may lead to a falsely low red cell count.
• Haemolysis during phlebotomy.

Haematocrit = 0.243, that is low.

Haematocrit is  the percentage by volume of cells in the blood.  The measurement depends on the number and size of red blood cells. It is normally 40.7–50.3% for males and 36.1–44.3% for females.

Haematocrit value is usually 1/3 of Hb level. ( Hb x 3 = haematocrit).

So, for this patient expected Haematocrit is 83 x 3 = 249 (That is 0.249). That is what is expected for this patient.

Value higher that that reflect haemoconcentration, that is dehydration. While value less than that reflects haemodilution.

M.C.H.C = 342 g/L. This is normal.

 Mean corpuscular haemoglobin concentration (M.C.H.C) is a measurement of the average amount of haemoglobin in a single red blood cell (RBC). Normal range is between 320 g/L to 360 g/L.

When patient has anaemia with normal M.C.H.C, the anaemia is considered normochromic anaemia.

Mean Cell Volume = 80 fL, this is within normal range. Normal MCV is between 80 fL to 100 fL (Values might vary depending on the lab). The MCV or mean cell volume, is a measure of the average volume of a red blood cells/corpuscle. The measure is obtained by multiplying a volume of blood by the proportion of blood that is cellular, and dividing that product by the number of erythrocytes in that volume.

MCV = Haematocrit/ [RBC].

So, This patient has Normochromic and normocytic anaemia.

M.C.H = 27.2, that is within normal ranges. Normal levels of M.C.H are between 26 and 33 picograms (pg) of hemoglobin per RBC. Mean corpuscular hemoglobin (MCH) is a measurement of the average amount of hemoglobin in each red blood cell.

RDW (Red Cell Distribution Width) = 18%, this is high. A normal RDW ranges from 12% to 15%. A red cell distribution width (RDW) test measures the differences in the volume and size of your red blood cells.

High RDW and normal MCV is associated with the following conditions:

• Early iron, vitamin B12, or folate deficiency.
• Dimorphic anemia (for example, iron and folate deficiency) or Sickle cell disease.

WBC = 18.3, Platlets = 188, these two values rule out bone marrow failure as a cause.

This patient has isolated hyperbilirubinaemia which is usually due to a pre-hepatic cause, most likely haemolysis.

From the list of causes of anaemia that is associated with high RDW and normal MCV, Sickle cell disease is the only condition that is cause haemolysis.

This Patient had sickle cells disease.

** A special thanks to Dr Mostafa Othman for presenting this case.