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MLT-MLS Spring 2022 > Hematology Exam 2 > Flashcards

Hematology Exam 2 Flashcards

1
Q

Stain used to view blood smears and bone marrow

A

Wright’s Stain

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2
Q

Stain to view reticulocytes

A

New Methylene Blue

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3
Q

What type of stain is New Methylene Blue?

A

Supravital

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4
Q

Stain used to view iron

A

Prussian Blue

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5
Q

A normocytic, normochromic erythrocyte typically measures at how many microns?

A

7 microns

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6
Q

Central pallor of erythrocytes is typically __/__ of the cell

A

1/3

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7
Q

TRUE or FALSE

Even if only one or two cells are seen to have abnormalities (ex. echinocyte), you will make note of it on the differential.

A

FALSE

In order to be clinically significant, MOST abnormal morphology needs to be seen in every field.

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8
Q

DEFINITION:

Variation in size

A

Anisocytosis

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9
Q

DEFINITION:

Variation in shape

A

Poikilocytosis

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10
Q

DEFINITION:

Size of RBC

(indices)

A

Mean Cell Volume

(MCV)

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11
Q

DEFINITION:

Average weight of hemoglobin in red blood cell

(indices)

A

Mean Cell Hemoglobin

(MCH)

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12
Q

DEFINITION:

Average concentration of hemoglobin in each red blood cell

(indices)

A

Mean Cell Hemoglobin Concentration

(MCHC)

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13
Q

TRUE or FALSE

Spherocytosis is the only case that a smear would be called hyperchromic

A

TRUE

Otherwise it doesn’t ‘really’ exist (misnomer)

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14
Q

DEFINITION:

Pale blue-gray erythrocytes (Wright’s Stain)

A

Polychromasia

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15
Q

DEFINITION:

Pale blue-gray erythrocytes (New Methylene Blue Stain)

A

Reticulocytes

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16
Q

What is the size of most erythrocytes?

A

6-8 microns

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17
Q

What is the normal range for MCV?

A

80-100 fL

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18
Q

What do we typically compare RBCs to for reference on size?

A

The nucleus of a normal ‘resting’ lymphocyte

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19
Q

MCV>100 should typically show what type of RBCs under a microscope?

A

Macrocytes

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20
Q

What intracellular issue typically causes Macrocytes?

A

Impaired DNA synthesis in the nucleus

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21
Q

What is typically happening to cause macrocytes in the blood?

A

>1% of RBCs are being destroyed

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22
Q

Changes in membrane lipids causing the cell to spread-out (macrocytes) can be seen in which disease?

A

Liver disease

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23
Q

MCV<80fL should show what type of RBCs in a peripheral smear?

A

Microcytes

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24
Q

Intracellular cause of microcytes

A

Impaired hemoglobin synthesis

-Any deprivation of hemoglobin molecules will cause an increase in cell division, decreasing cell size.

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25
Q

Examples of impaired hemoglobin synthesis that will cause microcytes

(3)

A

-Thalassemia - involves globin chain

-Iron deficiency anemia (IDA)

-Lead poisoning - interferes with heme synthesis

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26
Q

RBC Shape:

  • Rod or oval
  • oval shape increases as cell matures
  • Hereditary or acquired condition
  • Defect in spectrin affecting the horizontal linkage of cell cytoskeleton
A

Ovalocytes

(Elliptocytes)

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27
Q

You can see ovalocytes (elliptocytes) for many reasons.

How many can you remember?
(6 given in lecture)

A

-Hereditary ovalocytosis (if majority are oval)

-Sickle cell anemia

-Iron deficiency anemia

-RBC enzyme deficiences

-Pernicious anemia as macro-ovalocytes

-Miscellaneous anemia (non-specific)

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28
Q

Another name for ovalocytes

A

Elliptocytes

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29
Q

Another name for sickle cells

A

Drepanocytes

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30
Q

Abnormal hemoglobin S causes this type of RBC shape

A

Sickle cell

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31
Q

This form of hemoglobin can cause the following:

  • Decreased solubility
  • Homozygous causes severe hemolytic anemia
  • Heterozygous have both normal and abnormal hemoglobin
  • Sickling occurs when oxygen tension decreases
A

Hemoglobin S

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32
Q

Drepanocytes are specific for which disease?

A

Sickle Cell Disease

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33
Q

TRUE or FALSE

You WILL report drepanocytes even if only a small number of them are seen

A

TRUE

Drepanocytes = Sickle cells

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34
Q

RBC Shape:

  • Small spherical cells with pointed irregular spaced projections radiating from cell tips
  • Tips may be bent back or are bulb-like
  • 3 or more blunt spicules of uneven length
  • Cells have no central pallor
A

Spur cells

AKA

Acanthocytes

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35
Q

An altered lipid content (increased cholesterol) can cause this RBC shape

A

Acanthocytes

AKA

Spur cells

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36
Q

When are acanthocytes most often observed in peripheral smears?

(4 given in lecture)

A

-Liver disease

-Congenital Abetalipoproteinemia (rare)

-Alcoholic liver disease

-Post-splenectomy

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37
Q

RBC Shape:

  • “Sea urchin”
  • 10-30 rounded spicules evenly placed over the surface of the erythrocyte
  • Spicules may be even, sharp, and random
A

Echinocytes

AKA

Burr/Crenated cells

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38
Q

When are echinocytes observed?

(5 ways given in lecture)

A

-Liver disease

-Uremia (increased blood urea due to kidney disease)

-Dehydration

-Peptic ulcers

-Pyruvate Kinase Deficiency

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39
Q

TRUE or FALSE

Burr cells are caused due to a change in the tonicity of the cell when there is an anion imbalance

A

FALSE

Burr cells occur due to a cation imbalance (sodium and potassium)

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40
Q

TRUE or FALSE

It isn’t necessary to call schistocytes unless you see a lot of them

A

FALSE

Always make note of schistocytes

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41
Q

RBC Shape:

  • Fragments are formed as RBC is abnormally desrtoyed
  • RBC may become damaged as it squeezes through small damaged vessel
A

Schistocytes

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42
Q

What were the 5 reasons given in lecture for why we might see schistocytes in a peripheral smear?

A

-Coagulation defects such as DIC

-Microangiopathic hemolytic anemia

-Heart-valve hemolysis

-Severe burns (heat damages spectrin in membrane)

-Uremia

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43
Q

The helmet cell, aka keratocyte, is a variant form of which abnormal RBC shape?

A

Schistocyte

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44
Q

Another name for Dacryocyte

A

Tear Drop Cell

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45
Q

RBC Shape:

  • Round cell with a single elongated or pointed extremity
  • Pear-shaped
A

Dacryocytes

AKA

Tear Drop Cell

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46
Q

What would cause us to see dacryocytes?

(4 ways given in lecture)

A

-Myelofibrosis (fibrous material in bone marrow)

-Extra-medullary hematopoiesis

-Enlarged spleen or removal of inclusion from a cell by the spleen (macrophages try to grab RBC but RBC escapes)

-Megaloblastic Anemia

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47
Q

RBC Color:

  • Central pallor >3microns
  • Due to impaired hemoglobin synthesis
  • Usually observed alongside microcytosis
  • Can be measured with MCH and MCHC
  • May be observed due to water artifact
A

Hypochromasia

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48
Q

RBC Color:

  • Term used to describe the blue-gray RBCs observed on Wright Stain
  • Normally will observe ~1% of RBCs looking this way
  • If increased number is observed, indicates the bone marrow is increasing output of cells
A

Polychromasia

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49
Q

Where are the highest number of polychromatic cells is observed?

(4 given in lecture)

A

-Post hemorrhage

-Hemolytic anemia

-Significant loss of RBCs

-Following treatment of iron deficiency anemia

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50
Q
  • Increased production of RBCs with no central pallor
  • Defect in membrane protein causing vertical disruption between transmembrane proteins and underlying cytoskeleton
  • Only cell described as hyperchromic
  • Decreased surface area to volume ratio
  • Causes extravascular hemolysis
  • MCHC >36%
  • MCV ~80fL
A

Spherocytosis

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51
Q

RBC Shape:

  • Cell loses part of its membrane from antibody or genetic defect
  • May be hereditary or due to an immune hemolytic anemia
  • ANY observed is considered clinically significant
A

Spherocytes

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52
Q

What is always considered clinically significant in a peripheral blood smear?

A

-Parasites

-Sickle cells

-Schistocytes

-Spherocytes

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53
Q

Abnormal RBC:

  • Bell shaped
  • Appear very thin and flat on smear
  • “Bull’s eye”
A

Target Cell

AKA

Codocyte

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54
Q

Another name for Target Cell

A

Codocyte

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55
Q

What causes codocytes?

A

A rearrangement of hemoglobin

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56
Q

This abnormal RBC has an increased cell membrane and surface area due to lipid alteration causing the cells to expand.

A

Codocytes

AKA

Target Cells

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57
Q

TRUE or FALSE

Codocytes cause decreased hemoglobin leading to thalassemia and severe cases of iron deficiency anemia

A

TRUE

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58
Q

What are some disorders that can cause an increase in membrane lipids leading to viewing codocytes on a peripheral smear?

(4 given in lecture)

A

-Liver disease (aquired)

Hemoglobinopathies such as:

-Sickle cell anemia

-Hemoglobin C disease

-Thalassemia

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59
Q

Abnormal RBC:

  • Cup shaped
  • “Kiss cell”
  • Often is an artifact
  • Central pallow is slit-shaped or rectangular
A

Stomatocytes

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60
Q

TRUE or FALSE

An electrolye imbalance causing potassium to be increased and sodium to be decreased can produce stomatocytes in a peripheral smear

A

False

the imbalance is from increased sodium and decreased potassium

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61
Q

TRUE or FALSE

Stomatocytes are observed in alcoholism

A

TRUE

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62
Q

RBC inclusion:

  • Remnants of nuclear material (DNA)
  • Small deep blue, round granule typically in the periphery of the cell
A

Howell-Jolly Body

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63
Q

Cause of Howell-Jolly Bodies

(2 reasons given in lecture)

A

-Accelerated or abnormal erythropoiesis

-Spleen not removing (pitting) piece of nucleus

Non-functioning spleen is the most common reason

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64
Q

Howell-Jolly Bodies are observed in which type of Megaloblastic anemias?

A

-B12 deficiency

-Folic acid deficiency

Faulty maturation of RBC precursors

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65
Q

TRUE or FALSE

Splenomegaly or splenectomy can cause Howell-Jolly bodies to be seen in peripheral blood smears

A

TRUE

non-functioning spleen is the most common reason we see Howell-Jolly Bodies

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66
Q

RBC inclusion:

  • Aggregates or clumped ribosomes containing RNA (denatured RNA)
  • Indicates altered or impaired hemoglobin synthesis
  • Granules are distributed throughout the RBC (either fine or coarse)
A

Basophilic stippling

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67
Q

What causes basophilic stippling granules to appear fine/small?

A

Thalassemia

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68
Q

What causes basophilic stippling granules to appear coarse?

A

Lead poisoning

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69
Q

RBC inclusion:

  • Collection of mitochondria and ribosomes that contain iron
  • Contain non-heme iron (Fe3+) that was not utilizedin hemoglobin production (due to ineffective iron metabolism)
A

Pappenheimer Bodies

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70
Q

RBC inclusion:

  • on Wright’s stain - subtle pale dots near periphery of cell
  • Typically appear in doublets or triplets
A

Pappenheimer Bodies

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71
Q

Confirmation stain for Pappenheimer bodies

A

Prussian Blue

or

Iron Stain

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72
Q

RBC inclusion:

This inclusion is seen in sideroblastic anemia

A

Pappenheimer bodies

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73
Q

Type of anemia:

  • Iron overload
  • Overabundance of iron metabolism causing iron to be stored in other places besides the liver and bone marrow
A

Sideroblastic anemia

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74
Q

When would we see pappenheimer bodies?

(3 possibilities discussed in lecture)

A

-Sideroblastic anemia

-Thalassemia

-Splenectomy

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75
Q

When using Prussian Blue stain, pappenheimer bodies are called ________________

A

Siderocytes

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76
Q

Definition:

Non-nucleated red blood cell in which particles of iron are visible with Prussian Blue stain

A

Siderocyte

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77
Q

Definition:

Nucleated red blood cell precursor that shows excessive iron granules with Prussian Blue stain

A

Sideroblast

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78
Q

Definition:

Nucleated red blood cell precursor with at least five granules that circle at least one third of the nucleus with Prussian Blue stain

A

Ringed Sideroblast

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79
Q

RBC inclusion:

  • Not seen with Wright Stain
  • Must use Supravital stain
A

Heinz Bodies

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80
Q

Types of supravital stains (2)

A

-New Methylene Blue

-Crystal Violet

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81
Q

RBC inclusion:

  • Composed of denatured or precipitated hemoglobin
  • Large round masses lying under or attached to the cell membrane
A

Heinz Bodies

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82
Q

RBC inclusion:

Observed in:

  • G6PD deficiency
  • Unstable hemoglobin, causing iron to be unprotected
  • Oxidizing drugs
  • Alpha thalassemia
A

Heinz Bodies

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83
Q

RBC inclusion:

  • Ring or figure 8 forms
  • Contain arginine-rich histone and non-hemoglobin iron
  • Thought to be remnants of spindle fibers, which form during mitosis
  • Very rare
A

Cabot Rings

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84
Q

RBC inclusion:

Observed in:

  • Severe anemias
  • Pernicious anemia
  • Dyserythropoiesis
A

Cabot Rings

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85
Q

RBC inclusion:

  • Oblong dark crystal
  • Not normally present in normal adult blood
  • Diagnostic
  • Abnormal hemoglobin crystallizes
A

Hemoglobin C Crystals

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86
Q

RBC inclusion:

  • Indicaties infectin with one of four species of parasite
  • Stages observed is dependent on type with ring forms being most common
  • Must be careful to not confuse with platelet on top of RBC
  • Always clinically significant even if only 1 is seen
A

Malaria

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87
Q

4 different species of Malaria

A

-P. malariae

-P. falciparum

-P. vivax

-P. ovale

(P = Plasmodium)

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88
Q

RBC inclusion:

  • Always abnormal in adult peripheral blood
  • Few are normally observed in newborn blood (2-24/100 WBC on newborn)
  • Typically a metarubricyte
A

Nucleated Red Blood Cell

-NRBC-

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89
Q

2 situations that would cause RBCs to clump

A

-Agglutination

-Rouleaux

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90
Q

Red Cell Distribution:

  • Random clumping of RBCs
  • Usually due to a cold antibody
  • MCV increases, RBC count decreases, MCHC >38%
A

-Agglutination

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91
Q

Red Cell Distribution:

These antibodies will stop agglutinating at 37C (Body temp)

A

IgG

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92
Q

Red Cell Distribution:

These antibodies will stop agglutinating at 25C (Room temp)

A

IgM

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93
Q

Red Cell Distribution:

What is suggested for agglutination?

A

Warm specimen to 37C

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94
Q

Red Cell Distribution:

  • Red blood cells look like stacks of coins
  • Due to elevated antibodies (globulins) or improper balance of proteins in serum
  • Thick parts of normal peripheral smears can look this way
A

Rouleaux

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95
Q

Red Cell Distribution:

An improper balance of these globulins/proteins would likely cause rouleaux on a peripheral smear

(3)

A

-IgG

-IgA

-Fibrinogen

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96
Q

Red Cell Distribution:

When could you encounter rouleaux?

(3)

A

-Multiple myeloma

-Liver disease

-Chronic inflammation

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97
Q

Types of RBCs that are diagnostic even if only a few are seen

(7)

A

-Schistocytes

-Sickle cells

-C crystals

-Malaria/other blood parasites

-Target cells if anemia is present

-Tear drops cells in some settings

-Spherocytes in some settings (severe burn)

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98
Q
  • Simple, non-specific screen for inflammation in hematology
  • Anticoagulated blood stands undisturbed for 1 hour
  • Distance in millimeter that RBCs will fall in one hour in a vertical tube of defined length
A

ESR

Erythrocyte Sedimentation Rate

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99
Q

Determines presence of anemia

A

Hemoglobin

and

Hematocrit

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100
Q

Cloud of negative charges found on RBC cell membrane

A

Zeta

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101
Q
  • Increased fibrinogen
  • In vivo rouleaux formation of cells
  • Anemia
  • Macrocytosis
  • Hypercholesterolemia
  • Hyperfibrinogenemia
  • Hypergammaglobulinemia
  • Leukemia
  • Diabetes Mellitus

How would all of the above affect an ESR?

A

Increase fall-out

(Settle faster)

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102
Q
  • Polycythemia
  • Sickle cells
  • Spherocytes
  • Leukocytosis

How would all of the above affect an ESR?

A

-Decrease Fall-Out

(settle slower)

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103
Q

Normal ESR values for Females and children

A

0-20 mm/hr

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104
Q

Normal ESR values for males

A

0-15 mm/hr

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105
Q

2 commonly used methods for ESR

A

Wintrobe

Westergren

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106
Q

ESR method:

  • Utilizes a 100mm column
  • Allows for increased sensitivity in detecting mildly elevated ESRs
A

Wintrobe method

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107
Q

ESR method:

  • Considered universal reference method
  • Uses 200mm column with 2.55mm internal diameter
  • Allows for the detection of highly elevated ESR
A

Westergren method

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108
Q

Increase or Decrease ESR:

Vertical slant

A

Falsely increase

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109
Q

Increase or Decrease ESR:

Temperature higher that room temp (25C)

A

Falsely increase

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110
Q

Increase or Decrease ESR:

Temperature lower than room temperature (25C)

A

Falsely decrease

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111
Q

Increase or Decrease ESR:

Bubbles

A

Falsely decrease

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112
Q

Increase or Decrease ESR:

Abnormal shapes such as sickle cell or spherocytes

A

Falsely decrease

(won’t rouleaux)

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113
Q

Increase or Decrease ESR:

Improper anticoagulants

(Sodium oxalate, potassium oxalate, and heparin)

A

Falsely increase

(causes RBCs to shrink)

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114
Q

Increase or Decrease ESR:

Concentration of anticoagulant

-tube not properly filled

A

Falsely increases

(causes cells to alter shape - spherocytes)

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115
Q

ESRs may be increased which cancers?

(2)

A

-Multiple myeloma

-Leukemia

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116
Q

Increase or Decrease ESR:

Hypercholesterolemia

A

Increased

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117
Q

Increase or Decrease ESR:

Viral or bacterial infection

A

Increased

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118
Q

Increase or Decrease ESR:

Rheumatoid arthritis

A

Increased during flare up

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119
Q

Increase or Decrease ESR:

Osteoarthritis

A

Increased

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120
Q

Increase or Decrease ESR:

Hyperfibrinogenemia

A

Increased

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121
Q

-Large pigmented protein that gives red cells their color

A

Hemoglobin

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122
Q

Components of hemoglobin

(3)

A

-Protoporphyrin Ring IX

-Tetramer of four polypeptide chains

-Ferrous iron

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123
Q

Function:

-Carries oxygen to tissue and brings CO2 back

A

Hemoglobin

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124
Q

Reference method for measuring hemoglobin

A

Cyanmethemoglobin

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125
Q

Measures all forms of hemoglobin except for sulfhemoglobin

A

Cyanmethemoglobin

126
Q

This form of hemoglobin can occur from antibiotics or pesticides

A

Sulfhemoglobin

127
Q

TRUE or FALSE

When measuring hemoglobin, Fe3+ is oxidized to Fe2+ by potassium ferricyanide to methemoglobin

A

FALSE

Fe2+ (ferrous iron) is oxidized to Fe3+ (ferric)

128
Q

Fe3+

A

Ferric iron

129
Q

Fe2+

A

Ferrous iron

130
Q

Normal reference range of hemoglobin for females

A

12 - 15 g/dL

131
Q

Normal reference range of hemoglobin for males

A

13.5 - 18 g/dL

132
Q

Normal reference range of hemoglobin for newborns

A

16.5 - 21.5 g/dL

133
Q

Normal reference range of hemoglobin for children

A

11 - 14 g/dL

134
Q
  • Non-specific turbidity
  • High WBC
  • Lipemia
  • Hemoglobin C and S

What do these do to hemoglobin measurement?

A

Falsely elevate

135
Q

Definition:

  • Expressed as a % of RBC of the whole blood volume
  • Percentage of whole blood occupied by red cells after packing by centrifugation
A

Hematocrit

AKA

Hct

AKA

PCV (packed cell volume)

136
Q

Calculation for automated hematocrit

A

Indirect Hct =

RBC x MCV
_____________

10

137
Q

What is the Rule of Three?

A

Hematocrit should be 3 times the hemoglobin +/- 3%

Hct = 3 x Hgb

138
Q

Reference range for hematocrit for females

139
Q

Reference range for hematocrit for males

140
Q

Reference range for hematocrit for newborns

141
Q

Indice that tells us the size or volume of an RBC

A

MCV

-Higher the number, larger the cell

142
Q

TRUE or FALSE

Agglutination can cause a falsely decreased MCV

A

FALSE

agglutination would falsely elevate the MCV

143
Q

In order to calculate MCV, you need to know what indices?

A

RBC and Hct

144
Q

MCV calculation

A

MCV (fL) =

Hct x 10
___________

RBC

145
Q
  • Average weight of hemoglobin per red blood cell
  • Usually 1/3 of MCV
  • Measured in pg (picograms)
A

Mean Cell Hemoglobin

MCH

146
Q

Reference range for MCH

A

26 - 34 pg

147
Q

Indices needed in order to calculate MCH

A

Hemoglobin and RBC

148
Q

Calculation for MCH

A

MCH (pg) =

Hgb x 10
__________

RBC

149
Q

How would hypochromasia affect MCH?

A

Decreased cellular hemoglobin content

150
Q

How would hyperchromasia affect MCH?

A

Increased cellular hemoglobin content

151
Q

What are 2 ways an MCH value could be altered?

A

Lipemic specimen

or

Cold agglutinin

152
Q
  • Indice that tells us the average hemoglobin concentration of each individual red blood cell in a sample
  • Usually corresponds with MCH
A

MCHC

Mean Cell Hemoglobin Concentration

153
Q

Reference range for MCHC

154
Q

How would hypochromasia affect MCHC?

A

Decreased MCHC

155
Q

How would hyperchromasia affect MCHC?

A

Increased MCHC

-too much hemoglobin for size of cell

156
Q

Indices needed in order to calculate MCHC

A

Hemoglobin

and

Hematocrit

157
Q

Calculation for MCHC

A

MCHC (%) =

Hgb x 100
____________

Hct

158
Q

Main function of RBCs

A

-Carry oxygen to tissues

-Bring CO2 back from tissues

159
Q

What part of an RBC is responsible for the transportation of O2 and CO2?

A

Hemoglobin

160
Q

What part of the RBC is responsible for making the ATP to be used for energy?

A

Mitochondria

161
Q

What do RBCs rely heavily on to produce ATP?

A

Anaerobic glycolysis

162
Q

4 pathways used to provide ATP for red blood cells

A

-Embden-Meyerhof Glycolytic Pathway

-Hexose Monophosphate Shunt aka Phosphogluconate (Oxidative Pathway)

-Methemoglobin Reductase Pathway

-Rapaport-Leubering Shunt/Pathway

163
Q

This pathway provides RBCs with 90% of their ATP

A

Embden-Meyerhof Glycolytic Pathway

164
Q

Pathway that maintains erythrocyte shape, flexibility, and membrane integrity

A

Embden-Meyerhof Glycolytic Pathway

165
Q

Enzyme utilized in Embden-Meyerhof Glycolytic Pathway

A

Pyruvate kinase

166
Q

This pathway provides RBCs 5-10% energy and is an oxidative pathway

A

Hexose Monophosphate Shunt

167
Q

What enzyme does the Hexose Monophosphate Shunt utilize?

A

Glucose-6-Phosphate-Dehydrogenase

G6PD

168
Q

This pathway protect against oxidative injury from toxic reducing oxidants such as certain antimalarial drugs or infections

A

Hexose Monophosphate Shunt

169
Q

If this pathway were defective, globin chains in the hemoglobin molecule would denature and precipitate as aggregates (Heinz bodies)

A

Hexose Monophosphate Shunt

170
Q

This pathway is an “off-shoot” of Embden-Meyerhof

-Maintains heme in the reduced ferrous (Fe3+)state which carries oxygen

A

Methemoglobin Reductase Pathway

171
Q

Enzyme utilized in the Methemoglobin Reductase Pathway

A

Methemoglobin reducatase

172
Q

If this pathway is defective/decreased, cyanosis occurs due to lack of oxygen binding

A

Methemoglobin Reductase Pathway

173
Q

This pathway uses 1 ATP and produces 2,3-DPG (aka 2,3-BPG) which affects the oxygen affinity of hemoglobin

A

Rapaport-Leubering Shunt/Pathway

174
Q

Enzymes utilized in the Rapaport-Leubering Pathway

A

Biphosphoglycerate mutase

and

Biphosphoglycerate kinase

175
Q

Composition of RBC

A

52% protein

40% lipid

8% carbohydrate

176
Q

What is responsible for providing strength to the lipid bilayer of an RBC?

A

Cholesterol

177
Q

TRUE or FALSE

Cholesterol and lecithin affect the surface area of RBCs which in turn affect their ability to carry oxygen

178
Q

These determine a red blood cells fluidity by maintaining differences in osmotic pressure, cation concentrations, and gas concentrations between external plasma and cytoplasm

A

Phospholipids

179
Q

Glycolipids embedded in the membrane that carry several important RBC antigens (A, B, H, and Lewis - blood bank)

A

Lipid matrix/ Phospholipids

180
Q

Predominant cytoskeletal (peripheral) protein in erythrocytes

181
Q

Protein that extends from outer surface to inner side of erythrocytes

A

Integral proteins

182
Q

Major glycoprotein that accounts for most of the sialic acid that gives erythrocytes their negative charge

A

Glycophorin

183
Q

Proteins that are limited to the cytoplasmic surface of erythrocytes

A

Peripheral proteins

184
Q

Major peripheral protein that:

  • Binds to other peripheral proteins and integral proteins
  • Forms skeleton and strengthens membrane to protect against shear forces
185
Q

TRUE or FALSE

The peripheral and integral proteins network for erythrocytes requires ATP

186
Q

Permeability of RBCs:

Intracellular- to - extracellular ratio for sodium

A

1 : 12

1 sodium inside for ever 12 outside

187
Q

Permeability of RBCs:

Intracellular - to - extracellular ratio for potassium

A

25 : 1

25 potassium inside for every 1 outside

188
Q

Increased amounts of this ion will cause cell rigidity, shrunken cells with membrane protrusions (echinocytes) and reduced deformability

189
Q

Purpose of sialic acid found on the surface of glycophorin A of red blood cell membrane

A

Produces a negative cell charge that causes the cells to repel each other (zeta potential)

190
Q

Molecule consisting of four globin protein chains containing a heme component nestled in a hydrophobic crevice

A

Hemoglobin

191
Q

A tetrapyrrole ring with ferrous iron in the center

192
Q

What percent of hemoglobin synthesis occurs during the nucleated stages of RBC maturation?

193
Q

What percent of hemoglobin synthesis occurs during the reticulocyte stage of RBC maturation?

194
Q

Tetramer of two pairs of unlike polypeptide chains

195
Q

How many globin chains does a hemoglobin molecule have?

A

4 chains

-each with its own heme group

196
Q

How many groups of heme are in a hemoglobin molecule?

A

4

-Each containing a protoporphyrin ring plus ferrous iron (Fe2+)

197
Q

Most common disease caused by defective hemoglobin development

A

Iron deficiency anemia (lack of iron)

198
Q

Diseases caused by defective hemoglobin (3)

A

-Thalassemia (defective globin chains)

-IDA (lack of iron)

-Sideroblastic anemia (lack of heme)

199
Q

__/__ of the body’s iron is bound to heme

200
Q

How much iron is needed daily for erythropoiesis?

A

20 - 25 mg

201
Q

__/__ of total body iron content is present as hemoglobin

202
Q

__/__ of total body iron content is present as tissue iron

203
Q

90% of tissue iron is storage iron known as?

204
Q
  • Partially degraded ferritin
  • Less metabolically available than ferritin
A

Hemosiderin

205
Q

Where is hemosiderin seen?

A

Liver

Spleen

Bone marrow

206
Q

When is hemosiderin increased?

A

Hemachromatosis

and

Iron Overload

207
Q

What percent of tissue iron is non-available?

208
Q

Iron that is lost each day, is replaced by the diet through which organ?

A

Intestines

209
Q

What is the average blood volume for a healthy adult?

A

4500 - 5000 mL

210
Q

Foods high in iron (4)

A

-Organ meats

-Wheat germ

-Brewer’s yeast

-Legumes

211
Q

Foods with a moderate level of iron (6)

A

-Muscle meats

-Fish

-Fowl

-Prunes

-Some green vegetables (spinach)

-Cereals (fortified)

212
Q

Low molecular weight compounds that can increase iron absorption

(3)

A

-Amino acids

-Fructose

-Ascorbic acid (Vitamin C)

213
Q

What decreases absorption of iron? (2)

A

-Phosphates

-Milk products (contains calcium phosphate)

Ex. Antacids

214
Q

What populations are most prone to iron deficiency anemia?

A

Women and children

215
Q

Where in the intestine is iron absorbed?

A

Duodenum of the jejunum

216
Q

This part of the cell produces heme

A

Mitochondria

217
Q

What influences the enzymatic steps of heme synthesis?

A

Erythropoietin and Vitamin B6

218
Q

Porphyrin synthesis starts with what 2 components?

A

Glycine and Succinyl Coenzyme A

219
Q

Protoporphyrin synthesis:

What does the combination of Glycine and Succinyl Coenzyme A form?

A

Aminolevulinic acid (ALA)

220
Q

Protoporphyrin synthesis:

What does Aminolevulinic acid become?

A

Porphobilinogen

221
Q

Protoporphyrin synthesis:

What does porphobilinogen become?

A

Coproporphyrinogen

222
Q

Protoporphyrin synthesis:

What does Coproporphyrinogen become?

223
Q

Protoporphyrin synthesis from start to finish

(be able to recognize)

A

Glycine + Succinyl Coenzyme A
→
Aminolevulinic Acid (ALA)
→
Porphobilinogen
→
Coproporphyrinogen
→
Protoporphyrinogen IX

224
Q

What does Protoporphyrinuria cause?

A

Werewolf sundrome

225
Q

Protoporphyrin IX + Ferrochelatase = ?

226
Q

Any block in the enzymatic pathway will result in the excess formation of a particular porphyrin. What is this referred to as?

A

Porphyrias

227
Q

Where will porphyrin accumulate in the body?

A

Brain

Liver

Bone marrow

(very toxic if in the brain)

228
Q

Protoporphyrin synthesis impairment will result in the accumulation of iron in the cytoplasm in the form of ________ aggregates

229
Q

Protoporphyrin synthesis impairment can cause the mitochondria to become encrusted with iron that will be visible around the nucleus of the RBC precursor.
If we saw these cells stained with Prussian Blue, what would they be called?

A

Ringed sideroblast

230
Q

Globin synthesis is directed by how many genetic loci per haploid genome?

231
Q

What are the 7 different types of globin chains?

A

Zeta

Epsilon

Gamma-A

Gamma-G

Delta

Beta

Alpha

232
Q
233
Q
234
Q
235
Q
236
Q
A

Gamma

-Remember Gamma has A and G

237
Q
238
Q

Which globin-like genes are on chromosome 16?

A

Zeta

Alpha-1

Alpha-2

239
Q

Which globin-like genes are on chromosome 11?

A

Epsilon

Gamma-G

Gamma-A

Delta

Beta

240
Q

Which globin genes are considered embryonic?

A

Zeta

Gamma

Epsilon

241
Q

These globin chains are produced up to 3 months following conception

A

Zeta and Epsilon

242
Q

Embryonic Hemoglobins:

Zeta2, Epsilon2

A

Hemoglobin Gower 1

243
Q

Embryonic Hemoglobins:

Alpha2, Epsilon2

A

Hemoglobin Gower 2

244
Q

Embryonic Hemoglobins:

Zeta2, Gamma2

A

Hemoglobin Portland

245
Q

Embryonic Hemoglobins:

Hemoglobin Portland

A

Zeta2, Gamma2

246
Q

Embryonic Hemoglobins:

Hemoglobin Gower 2

A

Alpha2, Epsilon2

247
Q

Embryonic Hemoglobins:

Hemoglobin Gower 1

A

Zeta2, Epsilon2

248
Q

Fetal hemoglobin contains which globin chains?

A

Alpha2, Gamma2

249
Q

This hemoglobin type has a high affinity for oxygen and by age 2 is less than 2% of total hemoglobin

A

Hemoglobin F

(Fetal hemoglobin)

250
Q

When does Beta chain production reach adult percentages?

A

Between 3-6 months postnatally

251
Q

Make up of normal adult hemoglobins

A

2 Alpha chains

2 non-Alpha chains - Beta, Delta, or Gamma

Hydrogen bonds

Salt bridges

252
Q

Polypeptide for Hemoglobin A

A

Alpha2, Beta2

253
Q

Alpha2, Beta2 makes what hemoglobin?

A

Hemoglobin A

254
Q

Polypeptide for Hemoglobin A2

A

Alpha2, Delta2

255
Q

Alpha2, Delta2 forms which hemoglobin?

A

Hemoglobin A2

256
Q

Polypeptide for Hemoglobin F

A

Alpha2, Gamma2

257
Q

Alpha2, Gamma2 forms which hemoglobin?

A

Hemoglobin F

AKA

Fetal Hemoglobin

258
Q

Normal % of Hemoglobin A in adults

259
Q

Normal % of Hemoglobin A in newborn - 2 years?

260
Q

Normal % of Hemoglobin A2 in adults

261
Q

Normal % of Hemoglobin A2 in newborns

262
Q

Normal % of Hemoglobin F in adults

263
Q

Normal % of Hemoglobin F in newborn to 2 years

264
Q

At birth, Hemoglobin F levels are what %?

265
Q

At 12 weeks, Hemoglobin F is at what %?

266
Q

Between 4-5 months, Hemoglobin F reaches what %?

A

1.1 - 5.3%

267
Q

As an adult, Hemoglobin F is found at what %?

268
Q

This comprises 33% of an RBC

A

Hemoglobin

269
Q

One of the most important controls of hemoglobin affinity for oxygen is which RBC organic phosphate?

A

2,3-diphosphoglycerate

AKA

2,3-biphosphoglycerate

270
Q

What does 2,3-DPG (2,3-BPG) do when part of the hemoglobin molecule?

A

Widens the space between beta chains, forming an anionic salt bridge and creating deoxyhemoglobin

271
Q

What happens to the hemoglobin molecule when 2,3-DPG (2,3-BPG) is absent?

A

The salt bridge is broken and the hemoglobin molecule will carry more oxygen - creating oxyhemoglobin

272
Q

Location that oxyhemoglobin occurs

A

In the lungs

273
Q

Amount of iron needed each day to replace iron lost by senescent RBCs

A

18.5 - 21 mg

274
Q

TRUE or FALSE

Increased oxygen affinity means the hemoglobin more readily gives up the oxygen

A

FALSE

Increased oxygen affinity means the hemoglobin does NOT readily give up oxygen

275
Q

TRUE or FALSE

Decreased oxygen affinity means hemoglobin releases oxygen more readily (hemoglobin has a low affinity for oxygen)

276
Q

If the Hemoglobin-Oxygen Dissociation Curve shows a more BASIC pH, it is noted as what type of shift?

A

Left Shift

277
Q

If the Hemoglobin-Oxygen Dissociation Curve shows a more ACIDIC pH, it is noted as what type of shift?

A

Right shift

278
Q

How is oxygen tension measured?

A

mmHg

millimeters of Mercury

279
Q

TRUE or FALSE

Oxygen affinity being decreased causes more oxygen to be released to the tissues. This causes a right shift.

280
Q

What causes a right shift in the hemoglobin-oxygen dissociation curve?

A

Hypoxia

Increased 2,3-DPG

Anemia

Acidosis

Fever

281
Q

TRUE or FALSE

Oxygen affinity being increased causes decreased amounts of oxygen being delivered to tissues. This causes a left shift.

282
Q

TRUE or FALSE

An increase in oxygen affinity causes a decrease in oxygen delivery

283
Q

What causes a left shift on the hemoglobin-oxygen dissociation curve?

A

Decreased 2,3-BPG

Alkalosis

Increased quantity of abnormal hemoglobin

Multiple transfusions (new blood/not as oxygenated)

Fetal hemoglobin (higher affinity for oxygen, so holds on to it)

284
Q

Definition:

Inadequate amount of oxygen at tissue level

285
Q

Definition:

Bluish color of skin due to presence of high amounts of deoxyhemoglobin in blood

286
Q

3 acquired nonfunctional hemoglobins

A

Carboxyhemoglobin

Methemoglobin

Sulfhemoglobin

287
Q

This acquired nonfunctional hemoglobins oxygen affinity is 200x greater than that of normal hemoglobin.

It can be fatal.

Smokers can have up to 12%

A

Carboxyhemoglobin

288
Q

This nonfunctional hemoglobin is incapable of combining with oxygen due to the iron being in the ferric state.

Increased levels are formed when exposed to certain oxidizing drugs or chemicals.

Infants are more susceptible due to HbF more readily converting to it.

A

Methemoglobin

289
Q

This nonfunctional hemoglobin is irreversible

A

Sulfhemoglobin

290
Q

This returns iron to bone marrow or liver

A

Transferrin

291
Q

What is the protoporphyrin ring broken down to?

A

Toxic bilirubin

292
Q

What carries toxic bilirubin from the breakdown of the protoporphyrin ring to the liver?

293
Q

What % of aged erythrocyte destruction occurs extravascularly?

294
Q

What % of erythrocyte destruction occurs intravascularly?

295
Q

Approximately what % of the total red cells are removed from circulation on a daily basis?

296
Q

TRUE or FALSE

Oxygen affinity is dependent on 2,3-BPG

297
Q

When are enzymes made in RBCs

A

When RBCs still have a nucleus

298
Q

Size of reticulocytes

299
Q

Purpose of haptoglobin

A

Prevents kidney damage by binding hemoglobin dimers after intravascular hemolysis occurs

300
Q

Hemoglobin synthesis occurs here

A

Nucleated red blood cells in the bone marrow

301
Q

What is involved in protein synthesis?

A

Transcription

Translation

and Codons

302
Q

Automated instruments use what indices to calculate hematocrit?

A

MCV and RBC

303
Q

What is urobilinogen the final breakdown product of?

A

Hemoglobin

304
Q

This abnormal RBC shape has an MCHC >36

A

Spherocytes

305
Q

Iron is stored as _______

306
Q

Iron is carried by __________ to the liver and bone marrow

A

Transferrin

(b/c trans = across or to the other side)

307
Q

Defective hemoglobin synthesis causes this disease

308
Q

Rule of 3

A

Hemoglobin x 3

+/-3

= Hematocrit

309
Q

Normal RDW range

A

11.5 - 14.5%

MLT-MLS Spring 2022 (14 decks)

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