Erythrocyte Disorders Flashcards by Khienja Gonzaga

derived from the Greek word “anaimia” meaning “without blood”

Anemia

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is a decrease in the oxygen carrying capacity of the blood (functional definition)
is defined operationally as a reduction in the hemoglobin content of blood that can be caused by a decrease in RBCs, hemoglobin, and hematocrit
should not be thought of as a disease but rather as a manifestation of an underlying disease or deficiency

Anemia

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1.Increase in heart rate, respiratory rate, and cardiac output

Redistribution of blood flow from skin and viscera to heart, brain, and muscle

Anemia caused by sudden loss of blood volume:

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Decrease in hemoglobin-oxygen affinity by increasing the production of 2,3-biphosphoglycerate
Increase in EPO production by kidneys

Anemia caused by slow loss of blood:

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-refers to the production of erythroid precursor cells that are defective
- these defective precursors often undergo apoptosis

Ineffective erythropoiesis

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megaloblastic anemia, thalassemia, sideroblastic anemia

Ineffective erythropoiesis

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-refers to the decrease in the number of erythroid precursor in the bone marrow

iron deficiency anemia, renal disease, aplastic anemia, acquired pure red cell aplasia, infection

Insufficient erythropoiesis

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most important among the RBC indices
a measure of the average RBC volume in fL
key in the morphologic classification of anemia

Mcv

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index of variation of cell volume in a red blood cell population
the coefficient of variation of RBC volume expressed in percentage

Rdw

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an important tool to assess the bone marrow’s ability to increase RBC production in response to anemia
determines whether an anemia is due to an RBC production defect or to a shortened survival defect

Reticulocyte count

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serves as a quality control to verify the results produced by automated analyzers

Peripheral Blood Smear/film

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may help in establishing the cause of anemia

Bone marrow aspiration and biopsy

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valuable if an inappropriately low reticulocyte count and a microcytic anemia are present

Iron studies

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helpful in investigating a macrocytic anemia with a low reticulocyte count

Serum vitamin B12 and serum folate assays

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can differentiate autoimmune hemolytic anemias from hemolytic anemias due to other causes

DAT direct antiglobulin test (

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Degree of hemoglobinization

Normochromia
Hypochromia
Hyperchromia

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Central pallor is 1/3 of the red cell diameter

Normochromia

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Central pallor is >1/3 of the red cell diameter

Hypochromia 1+

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Central pallor is >2/3 of the red cell diameter

Hypochromia 2+

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Central pallor is 3 quarter of the red cell volume

Hypochromia 3+

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Thin rim of hemoglobin is left

Hypochromia 4+

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Decreased or absent central pallor

Hyperchromia

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variation in red cell size

Anisocytosis

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-characterized by an MCV of less than 80 fL with small RBCs (less than 6μm)
-are caused by conditions that result in reduced hemoglobin synthesis

Microcytic anemia

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IDA, chronic inflammatory states, sideroblastic anemia, lead poisoning

Defective heme synthesis : microcytic anemia

Thalassemia, Hb E disease

Defective globin synthesis: microcytic anemia

TAILS

Microcytic anemia

-characterized by an MCV in the range of 80-100 fL - develop due to premature destruction and shortened survival of RBCs

Normocytic anemia

Immune and nonimmune RBC injury

Extrinsic causes

- characterized by an MCV greater than 100 fL with large RBCs (greater than 8 μm) - arise from conditions that result in megaloblastic and nonmegaloblastic red cell development

Macrocytic anemia

are caused by conditions that impair synthesis of DNA

Megaloblastic anemia

are related to membrane changes owing to disruption of the cholesterol-phospholipid ratio

Nonmegaloblastic anemia

measures red cell immaturity; correlates with reticulocyte count (%)

Polychromasia

RBC/ 10 hpf 0-1 1-3 4-6 >6

Normal Slight Moderate Marked

% retic 1-2% 2-4% 4-6% >6%

Normal Slight Moderate Marked

1% 3% 5% 10% 11%

Grade Slight 1+ 2+ 3+ 4+

variation in red cell shape

Poikilocytosis

Acanthocyte synonym

Spur cell

2-10 pointed projections of various lengths and irregular spacing

Acanthocyte Spur cell

Abetalipoproteinemia Pyruvate kinase deficiency Alcohol intoxication Post-splenectomy

Acanthocyte Spur cell

Contains one or more vacuoles that resemble a blister on the skin

Blister cell

Burr cell synonym

Echinocyte Crenated RBC

10-30 pointed projections evenly distributed around the cell

Burr cell Echinocyte Crenated RBC

Post-splenectomy patients with enzyme anomalies Artificial drying

Burr cell Echinocyte Crenated RBC

Narrow and elongated, resembling a rod or cigar shape

Elliptocyte Pencil cell

IDA Hereditary elliptocytosis

Elliptocyte Pencil cell

Fragment in which the volume is close to normal

Keratocyte Horned cell or Helmet cell

G6PD deficiency

Keratocyte Horned cell Helmet cell

Narrow band of hemoglobin across the center of the cell

Knizocyte Pinch bottle cell

Oval or egg-like appearance

Ovalocyte Elliptocyte

Thalassemia syndromes Myelodysplastic syndromes

Ovalocyte Elliptocyte

Fragment in which cellular volume is reduced

Schistocyte Schizocyte

MAHA Microangiopathic hemolytic anemia

Schistocyte Schizocyte

Crescent-shaped with at least one end that is pointed

Sickle cell Drepanocyte

Sickle cell anemia

Sickle cell Drepanocyte

Compact and round: has lost its area of central pallor

Spherocyte

Hereditary spherocytosis

Spherocyte

Central slit-like opening resembling a mouth

Stomatocyte

Stomatocytosis

Stomatocyte

Contains a central bull’s eye surrounded by a clear ring and then an outer red ring

Target cell Codocyte

LCAT deficiency Thalassemia

Target cell Codocyte

Resembles a tear

Teardrop cell Dacryocyte

Myelofibrosis

Teardrop cell Dacryocyte

Red blood cell inclusions

Howell-Jolly body Pappenheimer body Basophilic stipplings Cabot ring Heinz body

DNA: nuclear or chromosomal remnant

Howell-Jolly body

Non-heme iron

Pappenheimer body

Altered RNA

Basophilic stipplings

Mitotic spindle remnant

Cabot ring

Not visible

Heinz body

Denatured hemoglobin

Heinz body

Multiple, uniform, dark dots distributed evenly throughout the cell

Basophilic stipplings

Clusters or small blue coccoid bodies located at the periphery of the cell

Pappenheimer body

Single, occasionally double, rarely multiple red purple coccoid bodies

Howell-Jolly body

QUALITATIVE RED CELL ABNORMALITIES

1. Degree of hemoglobinization 2. Anisocytosis - variation in red cell size 3. Polychromasia - measures red cell immaturity; correlates with reticulocyte count (%) 4. Poikilocytosis - variation in red cell shape 5. Red blood cell inclusions 6. Red blood cell indices