What is the clinical significance of a patient's laboratory results showing a normal White Blood Cell (WBC) count, elevated Red Blood Cell (RBC) count, elevated hemoglobin, normal hematocrit, normal Mean Corpuscular Volume (MCV), normal Mean Corpuscular Hemoglobin (MCH), normal Mean Corpuscular Hemoglobin Concentration (MCHC), normal platelet count, normal Red Cell Distribution Width (RDW), normal Mean Platelet Volume (MPV), and abnormal differential counts including low neutrophil percentage and normal lymphocyte percentage?

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From the Guidelines

The patient's blood test results indicate a generally healthy profile with minor elevations in red blood cell count and hemoglobin, which do not currently necessitate therapeutic intervention, as they are below the thresholds for phlebotomy recommended by the ACC/AHA guidelines 1.

Key Findings

  • The red blood cell count (5.62 M/uL) and hemoglobin (16.2 g/dL) are slightly elevated but well below the thresholds for therapeutic phlebotomy, which are hemoglobin greater than 20 g/dL and hematocrit greater than 65% 1.
  • The neutrophil percentage (49%) is slightly below the normal range, but the absolute neutrophil count is within normal limits, suggesting this finding is not clinically significant.
  • All other blood parameters, including white blood cell count, hematocrit, red cell indices (MCV, MCH, MCHC), platelets, and other white cell differentials, are within normal limits.

Clinical Implications

  • The slight elevations in red blood cell parameters could be indicative of mild polycythemia or possibly dehydration, but without further symptoms or significant deviations, they do not currently require medical intervention.
  • It is essential to stay well-hydrated before future blood tests to determine if the slight elevations were related to concentration of the blood from dehydration.
  • If the elevated red blood cell parameters persist or increase in future tests, further evaluation may be necessary to rule out conditions like polycythemia vera or secondary polycythemia due to chronic hypoxia, considering the guidelines for managing hematologic problems in adults with congenital heart disease 1.

Management

  • No immediate therapeutic intervention is recommended based on the current blood test results.
  • Monitoring and potentially addressing dehydration by ensuring adequate hydration could help in assessing the stability of the red blood cell parameters in future tests.
  • Future evaluations should consider the patient's overall clinical presentation and the presence of any symptoms that could indicate hyperviscosity or other complications related to elevated red blood cell mass, guiding the need for further testing or intervention according to the ACC/AHA guidelines 1.

From the Research

Blood Test Results

  • The patient's white blood cell (WBC) count is 5.5 K/uL, which is within the normal range of 4.5-11.5 K/uL 2, 3.
  • The red blood cell (RBC) count is 5.62 M/uL, which is slightly higher than the normal range of 4.50-5.30 M/uL.
  • The hemoglobin level is 16.2 g/dL, which is at the higher end of the normal range of 13.0-16.0 g/dL.
  • The hematocrit level is 47.7%, which is within the normal range of 40.0-57.0%.
  • The mean corpuscular volume (MCV) is 85 fL, which is within the normal range of 80-99 fL.
  • The mean corpuscular hemoglobin (MCH) is 28.8 pg, which is within the normal range of 27.0-31.0 pg.
  • The mean corpuscular hemoglobin concentration (MCHC) is 34 g/dL, which is within the normal range of 32-36 g/dL.

Platelet and Differential Counts

  • The platelet count is 197 K/uL, which is within the normal range of 150-450 K/uL.
  • The red cell distribution width (RDW) is 12.0%, which is within the normal range of 11.5-15.5%.
  • The mean platelet volume (MPV) is 9.1 fL, which is within the normal range of 7.4-10.4 fL.
  • The neutrophil count is 2.7 K/uL, which is within the normal range of 1.4-6.5 K/uL.
  • The lymphocyte count is 2.2 K/uL, which is within the normal range of 1.2-3.4 K/uL.
  • The monocyte count is 0.5 K/uL, which is within the normal range of 0.0-0.7 K/uL.
  • The eosinophil count is 0.1 K/uL, which is within the normal range of 0.0-0.5 K/uL.
  • The basophil count is 0.0 K/uL, which is within the normal range of 0.0-0.2 K/uL.

Percentage of Blood Cell Types

  • The percentage of neutrophils is 49%, which is lower than the normal range of 50-75%.
  • The percentage of lymphocytes is 40%, which is within the normal range of 30-50%.
  • The percentage of monocytes is 8.6%, which is within the normal range of 0.0-10.0%.
  • The percentage of eosinophils is 2%, which is within the normal range of 1-6%.
  • The percentage of basophils is 0%, which is within the normal range of 0-1%.

Relationship to Anemia and Blood Transfusion

  • Studies have shown that anemia is common in critically ill patients and is associated with adverse outcomes 3, 4, 5.
  • Phlebotomy associated with laboratory testing is a potentially modifiable contributor to anemia in critically ill patients 4, 5.
  • Blood loss from laboratory testing is substantial in ICU patients and is significantly associated with red blood cell transfusion 5.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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