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HEMA 1 LEC > Chapter 5 - RED BLOOD CELL STUDIES > Flashcards

Chapter 5 - RED BLOOD CELL STUDIES Flashcards

1
Q

Characteristics of a normal Red Blood Cell:
• 7 to 8 um in diameter:
• Average volume:
• Average surface area:
• Shape and Deformity:
• Cytoplasm:
• Average life span:

A

1.5 to 2.5 um in thickness

90 fL

160 um2

Discocyte/Discocyte; Flexible & deformable

uniformly pink without inclusions

120 days

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2
Q

: used to measure the effective survival of RBCs in vivo.

A

Chromium-51 (51Cr)

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3
Q

51Cr half-survival time range is

A

28 - 38 days.

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4
Q

RBC Membrane Compositions:

A
  1. Proteins (50%)
  2. Lipids (40%)
  3. Carbohydrate (10%)
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5
Q

: Underlie the lipid layer and regulate membrane shape & deformability

A

RBC Membrane

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6
Q

• Integral proteins:

A

Glycophorin A and component a (band 3)

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7
Q

• Peripheral proteins:

A

Spectrin and Actin (form the cytoskeleton)

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8
Q

• Phospholipids:
External surface:
Internal surface:

A

phosphatidyl choline, glycolipids & sphingomyelin

Cephalin, phosphatidylinositol & phosphatidy|serine

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9
Q

: Amount depends upon the concentration of plasma cholesterol, bile acids, and the activityof the enzyme LCAT.

A

Cholesterol

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10
Q

• Some serve as red cell antigens (e.g. ABH antigen)

A
  1. Carbohydrate (10%)
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11
Q

Anaerobic glycolysi s

A

Embden Meyerhof Pathway

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12
Q

Major source of 2. red cells ATP

A

Embden Meyerhof Pathway

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13
Q

oxidative glycolysis

A

Hexose Monophosphate Shunt/Pentose Phosphate Shunt

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14
Q

generates NADPH and reduced glutathione in the presence of Glucose 6-PO4 dehydrogenase (G6PD). GSH protects the hemoglobin from oxidation by peroxides.

A

Shunt/Pentose Phosphate Shunt

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15
Q

Generates 2,3DPG /2,3BPG

A

RapoportLuebering Shunt

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16
Q

Reduction of methemoglobin by NADPH is more efficient in the presence of methemoglobin reductase (cytochrome b5 reductase) which serves as an intermediate electron carrier.

A

Methemoglobin Reductase Pathway

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17
Q

As RBC ages, there is a decrease in its (?) and an increase in (?). This natural deterioration leads to its phagocytosis.

A

enzymes, ATP and size

density

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18
Q

destruction of senescent red cells by splenic macrophages.

A

Extravascular (Macrophage-mediated)

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19
Q

Hemoglobin undergoes degradation within the macrophage where iron is stored as ferritin, amino acids of globin are returned to the metabolic amino acid pool and protoporphyrin is converted to bilirubin which is released into the plasma and excreted by the liver in bile.

A

Extravascular (Macrophage-mediated)

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20
Q

may be caused by the turbulent environment in the circulation

A

Intravascular destruction (Mechanical hemolysis)

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21
Q

Hemoglobin is released into the plasma and can be filtered by the kidneys.

A

Intravascular destruction (Mechanical hemolysis)

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22
Q

Plasma (?) salvage the released hemoglobin so that its iron is not lost in the urine

A

haptoglobin and hemopexin

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23
Q

Biconcave disc
Normal

A

Normocyte

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24
Q

Smaller RBCs, with diameter less than 7 µm

A

Microcyte

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25
Q

Any defect that results in impaired Hb synthesis

A

Microcyte

Hypochromic

Anulocyte

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26
Q

Iron deficiency anemia;

A

Microcyte

Hypochromic/Anulocyte

Ellipto

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27
Q

Sideroblastic anemia

A

Microcyte

Pappenheimer

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28
Q

Thalassemia

A

Microcyte

Hypochromic/Anulo

Ellipto

Target

BS

PP

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29
Q

Anemia of Chronic Inflammation

A

Microcyte

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30
Q

Lead Poisoning

A

Microcyte

BS

CR

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31
Q

RBCs >9 µm in diameter, with an MCV >100 fL

A

Macrocyte

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32
Q

larger than 10 µmn diameter

A

Gigantocyte/ Megalocyte

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33
Q

-Accelerated erythropoiesis

A

Macrocyte

Gigantocyte/ Megalocyte

HJ

BS

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34
Q
  • Defective DNA synthesis
A

Macrocyte

Gigantocyte/ Megalocyte

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35
Q

-In conditions where membrane cholesterol and lecithin levels are increased

A

Macrocyte

Gigantocyte/ Megalocyte

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36
Q

Hemolytic anemia & Acute Blood Loss

A

Macrocyte

Gigantocyte/ Megalocyte

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37
Q

Megaloblastic Process; Chemotherapy

A

Macrocyte

Gigantocyte/ Megalocyte

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38
Q

Liver disease, Alcoholism

A

Macrocyte

Gigantocyte/ Megalocyte

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39
Q

Presence of 2 distinct populations of red cells that may differ in size, shape or hemoglobin content

A

Dimorphic RBCs

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40
Q

anemia after transfusion

A

Dimorphic RBCs

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41
Q

ANISOCYTOSIS & POIKILOCYTOSIS GRADING

Normal
Slight
1+
2+
3+
4+

A

5%

5 10%

10 25%

25 50%

50 75%

> 75%

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42
Q

MACROCYTOSIS GRADING

1+ (slight)
2+ to 3+ (moderate)
4+ (marked)

A

25%

25% - 50%

> 50%

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43
Q

Homogenous with central palor
Normal

A

Normochromic

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44
Q

RBCs show inc central pallor (exceeds 1/3 of the diameter of the red cell

A

Hypochromic

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45
Q

Thin & poorly hemoglobinized cells

A

Anulocyte

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46
Q

defect in hb synthesis due either to:
decrease in heme synthesis
defect in globin chain synthesis
Iron Deficiency Anemia (IDA)
Thalassemia

A

Hypochromic

Anulocyte

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47
Q

Cells that lack central pallor and with reduced diameter

A

Spherocytic (Hyperchromic)

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48
Q

Defects in the cytoskeletal proteins

A

Spherocytic (Hyperchromic)

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49
Q

Hereditary and acquired spherocytosis

A

Spherocytic (Hyperchromic)

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50
Q

Area of central pallor is one-half of cell diameter

A

1+

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51
Q

Area of pallor is two-thirds of cell diameter

A

2+

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52
Q

Area of pallor is three-quarters

A

3+

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53
Q

Thin rim of hemoglobin

A

4+

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54
Q

: 1/3 to 2/3 of cells diameter

A

1+ (slight) central pallor

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55
Q

: more than 2/3

A

2+ to 3+ (moderate)

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56
Q

: thin rim on the periphery

A

4+ (marked)

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57
Q

Percentage of Polychromatophilic Cells

Slight

1+

2+

3+

4+

A

1 %
3 %
5 %
10 %
>11 %

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58
Q

PcC/f

1+

2+

3+

A

( 1 3 polychromatophilic cells/field)
( 3 5 PcC/f)
( >5 PcC/f )

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59
Q

Range from egg-shape, slightly oval to sausage, rod, or pencil forms

A

Ovalocytes (Elliptocytes)

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60
Q

Hb appears to be concentrated at the two ends of the cell, leaving a normal central pallor area.

A

Ovalocytes (Elliptocytes)

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61
Q

decrease in skeletal membrane CHON band 4.1

A

Ovalocytes (Elliptocytes)

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62
Q

increase heat sensitivity of spectrin

A

Ovalocytes (Elliptocytes)

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63
Q

Hereditary elliptocytosis

A

Ovalocytes (Elliptocytes)

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64
Q

Small numbers may by acquired in:
- iron deficiency,
- megaloblastic anemia,
- myelophthisic anemia,
- thalassemias & sickle cell anemia

A

Ovalocytes (Elliptocytes)

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65
Q

Smaller in diameter than normal RBC

A

Spherocyte

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66
Q

With concentrated hb content

A

Spherocyte

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67
Q

No visible central pallor

A

Spherocyte

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68
Q

indicates a hemolytic process (hemolysis results from a membrane abnormality

A

Spherocyte

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69
Q

Hereditary Spherocytosis

A

Spherocyte

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70
Q

Autoimmune hemolytic anemia

A

Spherocyte

Agglutination

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71
Q

Normal aging process

A

Spherocyte

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72
Q

Storage phenomenon

A

Spherocyte

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73
Q

Severe burns

A

Spherocyte

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74
Q

With irregularly sized & unevenly spaced spicules

A

Burr cell

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75
Q

Depletion of ATP

A

Burr cell

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76
Q

Exposure to hypertonic solution

A

Burr cell

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77
Q

May occur in situations that cause a change in tonicity of the intravascular fluid

A

Burr cell

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78
Q

Associated w/ renal insufficiency

A

Burr cell

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79
Q

What is the difference between a burr cell and an echinocyte?

A
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80
Q

With few (3-12) irregularly spaced, pointed spicules/thornlike projections of various lengths and widths

A

Acanthocytes

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81
Q

May be caused by changes in the ratio of plasma lipids

A

Acanthocytes

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82
Q

Associated w/ end stage liver disease

A

Acanthocytes

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83
Q

Alcoholic cirrhosis

A

Acanthocytes

84
Q

PK deficiency

A

Acanthocytes

85
Q

Congenital abetalipoproteinemia

A

Acanthocytes

86
Q

Post-spenectomy

A

Acanthocytes

Target

Pappenheimer

Cabot rings

87
Q

Normal sized cell with an elongated or a slitlike mouth or stoma

A

Stomatocytes (Mouth cells)

88
Q

cup-shaped

A

Stomatocytes (Mouth cells)

89
Q

Membrane defect that results in high cellular sodium and low potassium content

A

Stomatocytes (Mouth cells)

90
Q

Hereditary stomatocytosis

A

Stomatocytes (Mouth cells)

91
Q

Rh null disease

A

Stomatocytes (Mouth cells)

92
Q

Obstructive liver disease

A

Stomatocytes (Mouth cells)

93
Q

Alcohol excess

A

Stomatocytes (Mouth cells)

94
Q

myelodysplastic syndromes

A

Stomatocytes (Mouth cells)

95
Q

hydroxyurea therapy

A

Stomatocytes (Mouth cells)

96
Q

Hereditary stomatocytosis

A

Stomatocytes (Mouth cells)

97
Q

With a central area or hb surrounded by a colorless ring and a peripheral ring of hb

A

Target Cells (Codocytes)

98
Q

bell-shaped or tall hat shaped

A

Target Cells (Codocytes)

99
Q

Increase in cholesterol & phospholipids.

A

Target Cells (Codocytes)

100
Q

Excess surface area to volume ratio

A

Target Cells (Codocytes)

101
Q

Hemoglobinopathies

A

Target Cells (Codocytes)

Heinz

PH

BS

102
Q

Thalassemia

A

Micro, Hypo/Anulo

Ellipto, Target Cells (Codocytes)

BS, PP

103
Q

Post-splenectomy

A

Target Cells (Codocytes)

Acanthocytes

Pappenheimer

Cabot

104
Q

Poikilocytes Secondary to TRAUMA
Two pathways of fragmentation are recognized:

A

Alteration of normal fluid circulation (DIC, TTP, MAHA) Intrinsic defects of the red cell (spherocytes, antibody altered red cells, inclusions)

105
Q

Schistocytes (Schizocytes)

Fragments of RBCs varying in shapes

A

Helmet cells
Triangular cells
keratocytes

106
Q

Schistocytes (Schizocytes) fragmentation due to:

A
  1. Exposure of cells to abnormal conditions
  2. Contact with fibrin strands or damaged endothelium.
  3. Intrinsic defects of RBCs
107
Q

Hemolytic anemias

A

Schistocytes (Schizocytes)

Keratocytes, Bite Cells, Degmacytes

108
Q

erythrocytes with a pair of spicules or ‘horns’ surrounding a gap in the cell outline.

A

Keratocytes, Bite Cells, Degmacytes

109
Q

Results from removal of a Heinz body from a cell by splenic macrophages; or when an erythrocyte is caught on a fibrin strand.

A

Keratocytes, Bite Cells, Degmacytes

110
Q

G6PD deficiency

A

Keratocytes, Bite Cells, Degmacytes

Heinz

111
Q

Half-moon/ crescent cells; large pale- pink staining ghost of the RBC

A

Semilunar bodies

112
Q

Frequently observed in malaria and in other conditions causing overt hemolysis

A

Semilunar bodies

113
Q

Overt hemolysis

A

Semilunar bodies

114
Q

Pear-shaped with a single elongated point

A

Teardrop Cells (Dacrocytes)

115
Q

Cuased by squeezing & fragmentation during splenic passage

A

Teardrop Cells (Dacrocytes)

116
Q

Myelofibrosis

A

Teardrop Cells (Dacrocytes)

117
Q

Presence of inclusion bodies

A

Teardrop Cells (Dacrocytes)

118
Q

Myelophthisic anemia

A

Ellipto

Teardrop Cells (Dacrocytes)

119
Q

Pernicious anemia

A

Teardrop Cells (Dacrocytes)

120
Q

B-thalassemia

A

Teardrop Cells (Dacrocytes)

121
Q

Smaller than spherocytes

A

Microspherocytes & Pyropoikilocyte

122
Q

Also lack central

A

Microspherocytes & Pyropoikilocyte

123
Q

Results from repeated fragmentation of red cells & from thermal damage to cell membrane

A

Microspherocytes & Pyropoikilocyte

124
Q

Severe burns

A

Spherocyte
Microspherocytes & Pyropoikilocyte

125
Q

Hereditary pyropoikilocytosis

A

Microspherocytes & Pyropoikilocyte

126
Q

Other appearances related with hemolysis

A

Blister cell

127
Q

with thinned portion

A

Blister cell

128
Q
  • appear like pinched bottle
A

Knizocytes

129
Q
  • distorted red cells
A

Pyknocytes

130
Q

Thin and elongated with pointed ends.

A

Drepanocytes/Sickle cells

131
Q

Polymerization of hemoglobin

A

Drepanocytes/Sickle cells

132
Q

Sickle cell anemia

A

Ellipto

Drepanocytes/Sickle cells

133
Q

With one or more fingerlike, blunt-pointed projections that protrude from the cell membrane leaving a pale area at the opposite end

A

Hb SC crystal

134
Q

Hexagonal; Both ends are blunt

A

Hb CC crystal

135
Q

Formed within the membrane

A

Hb CC crystal

136
Q

Helmet cells Grading

A

1+ = 1 to 5/field
2+ = 6 to 10/field
3+ = >10/field

137
Q

Teardrop RBC Grading

A

1+ = 1 to 5/field
2+ = 6 to 10/field
3+ = >10/field

138
Q

Acanthocytes Grading

A

1+ = 1 to 5/field
2+ = 6 to 10/field
3+ = >10/field

139
Q

Schistocytes Grading

A

1+ = 1 to 5/field
2+ = 6 to 10/field
3+ = >10/field

140
Q

Spherocytes Grading

A

1+ = 1 to 5/field
2+ = 6 to 10/field
3+ = >10/field

141
Q

Ovalocytes Grading

A

1+ = 3 to 10/field
2+ = 11 to 20/field
3+ = >20/field

142
Q

Elliptocytes Grading

A

1+ = 3 to 10/field
2+ = 11 to 20/field
3+ = >20/field

143
Q

Burr cells Grading

A

1+ = 3 to 10/field
2+ = 11 to 20/field
3+ = >20/field

144
Q

Bizarre-shaped RBC Grading

A

1+ = 3 to 10/field
2+ = 11 to 20/field
3+ = >20/field

145
Q

Target cells Grading

A

1+ = 3 to 10/field
2+ = 11 to 20/field
3+ = >20/field

146
Q

Stomatocytes Grading

A

1+ = 3 to 10/field
2+ = 11 to 20/field
3+ = >20/field

147
Q

Sickle cells Grading

A

Grade as positive only

148
Q

Pappenheimer bodies Grading

A

Grade as positive only

149
Q

Howell-Jolly bodies Grading

A

Grade as positive only

150
Q

Basophilic stippling Grading

A

Grade as positive only

151
Q

Large (1 to 3 um), single or multiple small, round, oval or serrated, purplish inclusions on RBC periphery (distorts the membrane)

A

Heinz Bodies

152
Q

Results from precipitation of hemoglobin

A

Heinz Bodies

153
Q

G-6-PDH deficiency anemia

A

Heinz Bodies

Kerato

154
Q

Red cell injury due to chemical insult or under oxidant stress

A

Heinz Bodies

155
Q

hemoglobinopathies and thalassemia major

A

Heinz Bodies

156
Q

Unstable hemoglobin syndromes

A

Heinz Bodies

157
Q

Small greenish-blue inclusion bodies

A

Hb H Inclusions

158
Q

Precipitation of hb H

A

Hb H Inclusions

159
Q

Seen in Hb H disease

A

Hb H Inclusions

160
Q

Small, coarse round granules

A

Howell-Jolly Body

161
Q

deep blue or red-purple

A

Howell-Jolly Body

162
Q

appears singly & is eccentrically located.

A

Howell-Jolly Body

163
Q

Nuclear remnants

A

Howell-Jolly Body

164
Q

What is meant by karyorrhexis

A
165
Q

+ with Feulgen & Methyl Green Pyronin stains

A

Howell-Jolly Body

166
Q

accelerated or abnormal erythropoiesis

A

Howell-Jolly Body*

Macro/giganto/megalo

BS

167
Q

megaloblastic anemia

A

Howell-Jolly Body

BS

Cabot

Ellipto

168
Q

small (2-3 um) faint blue coccoid bodies that aggregate in small clusters at the periphery of the cell.

A

Pappenheimer Bodies Siderotic granules

169
Q

Unused Iron deposits

A

Pappenheimer Bodies Siderotic granules

170
Q
  • Sometimes may appear as Ringed sideroblast
A

Pappenheimer Bodies Siderotic granules

171
Q

sideroblastic anemia

A

Pappenheimer Bodies Siderotic granules

Micro

Dimorphic

172
Q

Thalassemias

A

Ellipto

Target

Pappenheimer Bodies Siderotic granules

BS

173
Q

hemoglobinopathies

A

Pappenheimer Bodies Siderotic granules

Target

Heinz

BS

174
Q

Alcoholism

A

Pappenheimer Bodies Siderotic granules

Macro/ G/ M

175
Q

Post-splenectomy

A

Acantho

Target

Pappenheimer Bodies Siderotic granules

BS

176
Q

Dark blue granules, uniform and evenly distributed

A

Basophilic Stippling

177
Q

Coarse: much more outlined and easily distinguished

A

Basophilic Stippling

178
Q

Punctate: coalescing into smaller forms

A

Basophilic Stippling

179
Q

Aggregates of ribosomes and mitochondrial remnants

A

Basophilic Stippling

180
Q

defective or accelerated heme synthesis, (lead or other heavy metal poisoning, thalassemia & hemoglobinopathies; Megaloblastic anemia)

A

Basophilic Stippling

181
Q

Pyramidine-5-nucleotidase deficiency

A

Basophilic Stippling

182
Q

Diffuse

A

Basophilic Stippling

183
Q

Clumping of RBCs

A

Agglutination

184
Q

Presence of antibodies

A

Agglutination

185
Q

Cold agglutinin

A

Agglutination

186
Q

Autoimmune Hemolytic Anemia

A

Agglutination

Sphero

187
Q

Linear alignment of RBCs appearing as stack of coins

A

Rouleaux

188
Q

Increased concentration of globulin

A

Rouleaux

189
Q

Multiple myeloma

A

Rouleaux

190
Q

Waldenstroms macroglobulinemia

A

Rouleaux

191
Q

Rouleaux Grading

A

1+= aggregates of 3 to 4 RBCs
2+ = 5 to 10 RBCs
3+= numerous aggregates with only few free RBCs
Slight
Moderate
Marked
1-2 Slight
3-4 Moderate
≥5
Marked

192
Q

Basophilic stipplig Grading

A

1 stippled RBC every other field
1-2
3 or more

193
Q

iron deficiency during therapy

A

Dimorphic RBC

194
Q

combined Vit. B12 /folate and iron deficiency

A

Dimorphic RBC

195
Q

decrease in heme synthesis

A

Hypochromic

Anulocyte

196
Q

defect in globin chain synthesis

A

Hypochromic

Anulocyte

197
Q

Variation Red Cell Size

A

Normocyte

Microcyte

Macrocyte

Gigantocyte/ Megalocyte

Dimorphic RBCs

198
Q

Variation in Hemoglobin Distribution

A

Normochromic

Hypochromic/Anulocyte

Spherocytic (Hyperchromic)

Polychromasia (Reticulocytes)

199
Q

Poikilocytes Secondary to MEMBRANE ABNORMALITIES

A

Ovalocytes (Elliptocytes

Spherocyte

Burr cell

Acanthocytes

Stomatocytes (Mouth cells)

Target Cells (Codocytes)

200
Q

Poikilocytes Secondary to TRAUMA

A

Schistocytes (Schizocytes)

Keratocytes, Bite Cells, Degmacytes

Semilunar bodies

Teardrop Cells (Dacrocytes)

Microspherocytes & Pyropoikilocyte

201
Q

Other appearances related with hemolysis:

A

Blister cell

Knizocytes

Pyknocytes

202
Q

Poikilocytes & Crystals Secondary to Abnormal Hemoglobin Content

A

Drepanocytes/Sickle cells

Hb SC crystal

Hb CC crystal

203
Q

Abnormal Hemoglobin Precipitation

A

Heinz Bodies

Hb H Inclusions

204
Q

Abnormal Red Cell Distribution

A

Agglutination

Rouleaux

205
Q

Developmental Inclusions

A

Howell-Jolly Body

Pappenheimer Bodies Siderotic granules

Basophilic Stippling

Cabot Rings

HEMA 1 LEC (15 decks)

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