Microcytosis Caused by RBC Fragmentation

Abstract

ABNORMALLY low RBC size, expressed as low mean corpuscular volume (MCV), most often is due to iron deficiency or one of the thalassemia syndromes. More rarely, low MCV is associated with pyridoxinesensitive anemia, sideroblastic anemia, anemia of chronic disease,¹and hemoglobinopathies such as CC.²Generally in the latter group microcytosis, if present, is not great. We report a case of a patient with severe burns, considerably low MCV, and none of these diseases. Histograms of RBC size distribution (erythrograms) showed that severe RBC fragmentation caused this patient's low MCV. <h3>Report of a Case</h3> A 2-year-old boy was admitted to the Los Angeles County-University of Southern California Burn Center for a 70% total body third-degree scald burn. Despite appropriate intravenous fluids, antibiotics, and topical care, shock became intractable and he died 36 hours later. At admission the hemoglobin level was 14.1 g/dl; hematocrit value, 40.2%; MCV, 63 cuμ; and