I was talking with one of the trainees about the good old days… I’m sure
they think I used to run the path lab on Noah’s Ark… We got talking about tests
for red cell membrane abnormalities and I felt I might benefit from a little
refresher on the subject. So here’s what I found.
Given a blood count with unexplained high MCHC (that doesn’t correct
on warming) and reticulocytosis you have a look at the blood film.
If there’s lots of spherocytes we would do a direct antiglobulin test to
rule out autoimmune haemolytic anaemia.
Back in the day we used to perform the
osmotic fragility test but that is “so last century”. These days we
use flow cytometry to look for eosin-5-malemide (EMA) which, being a
structural red cell protein, is reduced in people with hereditary spherocytosis.
If there’s lots of elliptocytes we used to say “that’s hereditary
elliptocytosis” and move on. These days there’s all sorts of molecular
tests that can be done.
I found out that I wasn’t really that out of touch, but I am now rather
inexperienced… mainly because these tests are only done in specialist centres
these days.
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