ERYTHROCYTE ABNORMALITY Flashcards
In______ anemia or polycythemia there is a true decrease or increase in the RCM, respectively.
absolute
Change in plasma volume causing changes in cellular components to cellular components
RELATIVE
- pregnancy and diseases associated with hyperproteinemia.
- dehydration
Relative anemia
Relative erythrocytosis
(^ plasma volume; normal RCM*)
Relative anemia
(v plasma volume; normal RCM)
Relative erythrocytosis
DECREASED HEMOGLOBIN
DECREASED NUMBER OF RED CELLS
ANEMIA
DECREASED HEMOGLOBIN
INCREASE HEMATOCRIT
INCREASE NUMBER OF RED CELLS
ERYTHROCYTOSIS AND POLYCYTHEMIA
DECREASE RBC CONCENTRATION
•___________
• Hypoproliferative disorders
• Maturation disorders
•____________
• Hemolytic disorders
• Blood loss
INEFFECTIVE/INSUFFICIENT
ERYTHROCYTE PRODUCTION
INCREASE RBC DESTRUCTION /
LOSS
The Categories of Anemia
HYPOPROLIFERATIVE ANEMIAS
MATURATION DISORDERS
HEMOLYTIC DISORDERS
ANEMIAS OF BLOOD LOSS
INCREASE RBC CONCENTRATION
ABSOLUTE ERYTHROCYTOSIS
Polycythemia vera
Erythremia
Primary
INCREASE RBC
CONCENTRATION
ABSOLUTE ERYTHROCYTOSIS
Secondary
_________
High altitude
Pulmonary disease
Cardiovascular disease
Alveolar hypoventilation
Hemoglobinopathy
Tobacco / carboxyhemoglobin
___________
Essential (idiopathic)
Renal disease
Extrarenal
Appropriate
Inappropriate
INCREASE RBC
CONCENTRATION
_______________
Dehydration
Gaisböck’s syndrome
Stress/ spurious
Tobacco
RELATIVE ERYTHROCYTOSIS
Functionally: decrease in the oxygen carrying capacity of the blood
Operationally: there is reduction in the hemoglobin content of blood
Anemia
Anemia is not a….
Not a disease but a manifestation of an underlying condition
• - most important for the assessment of anemia
JAUNDICE
• Hemoglobin concentration of 7-10
g/dL
May cause pallor of conjunctivae and nail beds
MODERATE ANEMIA
2.
• Hemoglobin concentration of <7g/dL
Produce:
• Tachycardia
• Hypotension
SEVERE ANEMIA
ANEMIA
Laboratory Diagnosis
COMPLETE
BLOOD COUNT (CBC)
Reticulocyte count
Peripheral Blood Smear
СВС
RBC Count
Hemoglobin Concentration
Hematocrit
WBC Count
Platelet Count
RBC Indices:
MCV, МСН, МСНС
most important
Measure average RBC volume in femtoliter (fL)
-Measure average weight of Hgb in a RBC in picograms (pg)
- Measure the average concentration of hemoglobin in each individual RBC in grams per liter (g/L)
MCV (Mean Cell Volume)
MCH (Mean Cell Hemoglobin)
МСНС (Mean Cell Hemoglobin
Concentration)
- Provided by automated blood cell analyzers
- An index of variation of cell volume in an RBC population
RED BLOOD CELL DISTRIBUTION WIDTH (RDW)
- Important tool to assess the bone marrow’s ability to increase RBC production in response to anemia
RETICULOCYTE COUNT
- Young RBCs that lack a nucleus but still contain residual RNA to complete production of hemoglobin
- Normally circulate in PB for 1 day
Reticulocytes
- Attention is given to the
RBC morphology (size, shape and inclusion bodies present
*Review of WBC and Plt show more generalized bone marrow problem leading to anemia
Peripheral Blood Film Examination
Normal RBC: Nearly uniform
Microcytic Cells:
Macrocytic Cells;
7-8um in diameter
<6um in diameter
> 8um in diameter
Abnormal variation in RBC volume or diameter
Herolytic, megaloblastic, iron deficiency anemias
Anisocytosis
Large RBC (>B um in diameter), MCV > 100 fL
Megaloblastic anemia
Myelodysplastic syndromes
Chronic liver disease
Bone marrow failure
Reticulocytosis
Macrocyte
Large oval RBC
Megaloblastic anemia
Oval macrocyte
Small RBC (<6 um in diameter), MCV < 80 fL
Iron deficiency anemia
Anemia of chronic inflammation
Sideroblastic anemia
Thalassemia/Hb E disease and trait
Microcyte
Abnormal variation in RBC shape
Severe anemia, certain shapes helpful diagnostically
Poikilocytosis
- Done when cause of anemia cannot be determined
- Help evaluate hematopoiesis
Bone Marrow Examination
- Indicated in pxs with:
- Unexplained anemia assoc with other cytopenias
- Fever of unknown origin
- Suspected hematologic neoplasm
Bone Marrow Examination
- Can determine infiltration of
BM with abnormal cells
Bone Marrow Examination
Bone Marrow Examination
- Important findings:
- Hypocellularity (Aplastic Anemia)
- Ineffective erythropoiesis and megaloblastic changes (B9/12 deficiency)
- Lack of iron in iron stains (IDA)
- Presence of fibrosis, granulomata, infectious agents, tumor cells
