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hematology > lecture 5-6 > Flashcards

lecture 5-6 Flashcards

1
Q

how does a mature RBC look like?

A
  • RBC has a biconcave disc shape
  • thickness at the periphery is 1 1⁄2 times the center
  • this shape allows it to have a greater surface area for gas exchange
  • has a diameter of around 7-7.5 u
  • saturated with Hb
  • normal RBC cannot contain more Hb than it has
  • RBC appears dark at the edges and lighter in
    the center
  • light area in the center is called central pallor
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2
Q

why are the edges of an RBC dark in color?

A

due to the presence of hemoglobin

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3
Q

The biconcave disc shape of an RBC helps it in what function?

A

gas exchange

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4
Q

normochromic is when the RBC has a normal size (T/F)

A

false

normocytic

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5
Q

normal sized RBCs are known as:

A

normocytic

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6
Q

normal Hb content in an RBC is known as:

A

normochromic

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7
Q

what is anisocytosis?

A

variation in the size of RBC(s)

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8
Q

when there is minimal variation in the size of RBCs it is referred to as anisocytosis (T/F)

A

false, significant variation

normally there is minimal variation in size of RBCs (not anisocytosis)

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9
Q

in what diseases do we find anisocytosis?

A
  • present in erythroid disorders/ erythropoetic diseases (altered red cell production)
  • in all anemias

it is not characterisitic of any disease

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10
Q

what is microcytosis? MCV=?

A
  • RBC size smaller than normal
  • MCV < 80fl
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11
Q

microcytosis is found in what type of diseases?

A
  • fe deficiency anemia
  • thalassemia
  • hereditary sideroblastic anemia
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12
Q

what is sideroblastic anemia?

A
  • lack of RBCs
  • abnormal utilization of iron during erythropoesis
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13
Q

what is macrocytosis? MCV=?

A
  • RBC larger than normal
  • MCV > 100fl
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14
Q

macrocytosis is encountered in what type of conditions?

A
  • megaloblastic anemia
  • newborn babies
  • active erythropoeisis
  • liver diseases (chronic) alcoholism
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15
Q

what are hypochromic RBCs? what happens to its central pallor?

A
  • Hb content lower than normal
  • central pallor becomes larger
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16
Q

hypochromic anemia is found in what type of diseases?

A
  • fe deficiency anemia
  • thalassemia
  • hereditary sideroblastic anemia
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17
Q

what cells have no central pallor?

A
  • spherocytes (RBCs smaller than normal)
  • polychromatophilic RBCs (RBCs larger than normal)
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18
Q

what is polychromatophilic RBC? what color is it and why?

A
  • early or immature non-nucleated RBCs with ribosomes and RNA
  • color is slightly bluish (due to the presence of RNA which is acidic and takes up methylene blue)

stained with a regular romanowsky stain

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19
Q

wright stain fixates cells since it contains alcohol (T/F)

A

true

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20
Q

brilliant cresyl blue is a potent reducing agent (T/F)

A

false, oxidizing

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21
Q

wright stain gives ____ color while brilliant cresyl blue gives a ____ color

A
  • diffuse grayish-blue color
  • deep blue color
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22
Q

polychromatic cells are fixated or not? and what stain do we use?

A
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23
Q

reticulocytes are fixated cells or not? and what stain do we use?

A
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24
Q

polychromasia will not be detected unless reticulocyte count is above __%

A

above 2%

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25
Q

what is polychromasia? and why does it happen?

A
  • a disorder where we have an abnormally high nb of immature RBCs
  • RBCs are prematurely released from the bone marrow during blood formation
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26
Q

polychromatic cells = reticulocytes = ?

A

stippled RBCs

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27
Q

what are basophilic stipplings? and in what disease do we find them?

(include its color, stain, location….)

A
  • inclusions of aggregated damaged ribosomes (pathologic precipitation of ribosomes)
  • fine or coarse deep blue to purple staining
  • stained with wright and giemsa
  • appears in immature RBCs
  • found in chronic hemolytic anemias
  • implicated in cases of lead poisoning (heavy metal toxicities)
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28
Q

what is poikilocytosis?

A

presence of abnormally shaped RBCs

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29
Q

what are some examples of poikilocytosis?

A
  1. ovalocytes, elliptocytes, cigar shaped RBCs
  2. stomatocytes
  3. tear drop cells (pear-shaped)
  4. sickle cells
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30
Q

what are the most common abnormal RBC shapes?

A

ovalocytes, elliptocytes, cigar-shaped RBCs

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31
Q

ovalocytes, elliptocyte, cigar-shaped RBCs are associated with what type of diseases?

A
  • fe deficiency anemia
  • thalassemia
  • megaloblastic anemia

these cells may be normally present in small numbers

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32
Q

what is megaloblastic anemia?

A
  • is a form of macrocytic anemia
  • happens when your BM produces stem cells that make abnormally large RBCs
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33
Q

megaloblastic anemia is a type of __anemia

A

vitamin deficiency anemia

happens when u dont have enough vitamin b12 and/or vitamin B9 (folate)

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34
Q

what makes the cigar-shaped RBCs slightly different from ovalocytes and elliptocytes?

A

they are a bit longer and thinner

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35
Q

what do we call the condition when the majority of RBCs are ovalocytes, elliptocytes, or cigar shaped RBCs?

what %?

A

congenital ovalocytosis or elliptocytosis

95%

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36
Q

Congenital ovalocytosis and elliptocytosis conditions are inherited. what is the type of gene?

A

autosomal dominant gene

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37
Q

in congenital elliptocytosis there are 2 cases, what are they?

A
  • 95% of the cases are benign and have no disease + these cells function normally
  • 5% of the cases show a condition of hemolytic anemia
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38
Q

what makes a stomatocyte an abnormal cell?

its abnormal shape characteristic

A

it has an elongated (mouth-like) central pallor

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39
Q

__% of RBCs may be stomatocytes in a normal smear

A

3%

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40
Q

what do we call the condition where we have an increased number of stomatocytes?

A

congenital stomatocytosis

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41
Q

what are the 2 cases of congenital stomatocytosis?

A
  • 95% of the cases are harmless
  • 5% have hemolytic anemia
42
Q

in what conditions do we see stomatocytes?

diseases, etc..

A
  • liver disease (cirrhosis)
  • alcoholism
  • artifact of preparation
43
Q

what abnormal RBC shape could be considered as an artifact of preparation?

A

stomatocytes

44
Q

1) tear-drop cells may be encountered in what type of conditions? 2) and if they are very numerous?

A
  1. in variety of anemias
  2. myelofibrosis
45
Q

what is myelofibrosis?

A

BM becomes full of fibrous tissue

46
Q

what characteristics to sickle cells have?

(shape)

A
  • deformed RBCs
  • shape of a sickle or cresent
47
Q

what conditions are sickle cells associated with?

A
  • HbS (sickle hemoglobin)
  • sickle cell anemia
48
Q

what makes crenated RBCs abnormal?

(shape/ structures…etc)

A

they have blunt spicules evenly distributed over the surface of an RBC

49
Q

what is the cause of crenated RBCs?

A

faulty drying of the blood smear

50
Q

what are the characteristics of acanthocytes?

(shape and others..)

A
  • have irregularly spaced projections (5 finger-like projections/ distortions)
  • have decreased survival time
51
Q

acanthocytes are found in a condition known as:

A

acanthocytosis or abetaliproteinemia

absence of beta lipoprotein from RBC membrane

52
Q

what conditions (associated with abnormally shaped RBCs) are inherited?

A
  • congenital elliptocytosis
  • acanthocytosis
  • spherocytosis

acanthocytosis and spherocytosis could be acquired as well

53
Q

acanthocytosis could be associated with a number of acquired conditions, what are they?

A
  • alcoholic cirrhosis
  • malabsorption states
54
Q

what are the characteristics of spurr and burr cells?

A
  • uniformly spaced, pointed projections
  • smaller
  • more numerous (6-10)
55
Q

what is another name for spurr and burr cells?

A

echinocytes

56
Q

echinocytes are characteristic of which type of disease?

A
  • liver disease
  • kidney failure
57
Q

what types of abnormal cells are associated with liver disease?

A
  • stomatocytes
  • acanthocytes (alcoholic cirrhosis)
  • echinocytes
  • target cells (increased surface area associated with free cholesterol)
58
Q

why echinocytes must be differentiated from crenated RBCs?

A

since echnocytes and crenated RBCs look similar in shape however echinocytes are associated with liver disease & kidney failure while crenated RBCs are due to an error in drying the smear

59
Q

what are schistocytes?

A

fragmented RBCs

60
Q

what conditions are schistocytes associated with?

A
  • hemolytic anemia (especially intravascular hemolytic anemia)
  • ineffective erythropoeisis (destruction of RBCs in the BM or blood vessels)

contain fibrin threads

61
Q

what special appearance do schistocytes have that help in diagnosis?

A

triangular or helmet-like appearance

62
Q

in schistocytes, hemolytic anemia occurs secondary to :______

A

intravascular coagulation

63
Q

how cells become target cells?

A
  1. when you decrease the volume, leaving surface area constant
  2. when you increase surface area, leaving volume constant
    * RBC membrane will undergo folding/ have wrinkles
    –> will look like a target
64
Q

if you increase the internal volume of the cell, the RBC membrane will undergo folding (T/F)

A

false, decrease

65
Q

what condition causes the cell to wrinkle?

(decrease in volume)

A

any condition which removes Hb

66
Q

what diseases are associated with target cells?

(RBCs with decreased volume only)
add specific examples of each

A
  • anemias due to decrease in heme synthesis (fe-deficiency anemia)
  • anemias due to decrease in globin synthesis (hemoglobinopathies: thalassemia or sickle cell anemia)
67
Q

what are 2 examples of hemoglobinopathies?

A
  1. thalassemia
  2. sickle cell anemia
68
Q

how do free cholesterol lead to the formation of target cells?

A
  • RBC membrane is rich in free cholesterol
  • this cholesterol exchanges freely with the
    free cholesterol in plasma
  • higher the free cholesterol in plasma => the more cholesterol is taken up by the RBC membrane => the bigger is the membrane => the RBC becomes a target cell
  • Free cholesterol in the body is taken up by the liver
  • in the liver, it is esterified
  • liver would excrete esterified cholesterol
  • In severe liver disease, the esterification of cholesterol is depressed
  • free cholesterol in the blood increases formation of target cells
69
Q

what are spherocytes?

A
  • small RBCs
  • have no central pallor
  • appear darker in color
70
Q

what are spherocytes associated with?

A
  • spherocytosis (in association with ABO or Rh incompatibility)
  • hemolysis due to rigidity of the membrane
71
Q

what is diserythropoeisis?

A

abnormality in nuclear membrane resulting in bilobed or multilobed erythroblasts

72
Q

what is a dimorphic picture/appearance?

A
  • heterogeniety in the size of RBCs
  • 2 distinct populations
73
Q

where can we find dimorphic picture?

A
  • in partially treated fe deficiency
  • mixed deficiency anemias (folate/B12 and iron together)
  • following red cell transfusion
  • sideroblastic anemia
74
Q

what are rouleaux? and how are they formed?

A
  • stacked/clumped groups of RBCs
  • presence of high levels of circulating acute-phase proteins which increase red cell stickiness
75
Q

what does the presence of rouleaux indicate?

A

indicator that the patient has high ESR

(infections, autoimmune conditions, chronic inflammation, myeloma)

76
Q

what are howell-jolly bodies?

A

round, purple staining nuclear fragments

77
Q

in what condition do Howell-jolly bodies appear?

(include diseases)

A
  • when we have chromosomal breakage
  • spleen is not present or its function is impaired
  • some hemolytic anemias (thalassemia)
  • megaloblastic anemia
78
Q

what is the relation between howell-jolly bodies and the spleen?

A
  • RBC passes through the spleen
  • spleen removes the HJB
  • RBC pass out without it

if we see HJB in peripheral blood => spleen not present/ impaired

79
Q

what are cabot rings?

A
  • purple staining
  • threadlike filaments
  • shape of a ring or figure of (8)
  • nuclear remnants
  • derived from the microtubules of the mitotic spindle
80
Q

cabot rings are seen in what conditions?

A
  • thalassemia
  • megaloblastic anemia
  • disturbed erythropoiesis
81
Q

what type of inclusion is derived from microtubules of the mitotic spindle?

A

cabot rings

82
Q

what rbc inclusions are seen in similar conditions?

A
  • howell-jolly bodies
  • cabot rings
83
Q

what are HbC crystals?

(include its color)

A
  • elongated crystals
  • blunt ends
  • darkly stained in color
84
Q

what conditions are HbC crystals associated with?

A

hemoglobin C HbC disease

85
Q

what is HbC disease?

A
  • blood disorder
  • develops bcz RBCs do not contain enough water & are too rigid
  • break down earlier than they should leading to mild anemia
86
Q

what are pappenheimer bodies?

(location inside the cell, color, stain, content…)

A
  • small, irregular, dark staining granules
  • near the periphery of an RBC
  • stained with wright and giemsa
  • stain positively for perls’ prussian blue stain (for iron) –> iron content

normally, no more than 3 iron particles are noted in developing RBCs

87
Q

what is another name for siderotic granules?

A

pappenheimer bodies

88
Q

in what condition do siderotic granules appear?

A
  • sideroblastic anemia
  • refractory anemias
  • spleen not present
  • severe disturbance of Hb synthesis (pathologic sideroblasts are present in BM)
89
Q

what is the relation between peppenheimer bodies and the spleen?

A
  • spleen normally removes these inclusions (without destroying the cells)
  • after splenectomy, they are visible on blood film
90
Q

what inclusions are associated with the spleen?

A
  • howell-jolly bodies
  • pappenheimer bodies
91
Q

an erythrocyte positive for siderotic iron granules in a prussian blue stain is known as:

A

siderocyte

92
Q

a normoblast positive for siderotic iron granules in a prussian blue stain is known as:

A

sideroblast

93
Q

what inclusions are stained with wright and giemsa?

A
  • basophilic stippling
  • pappenheimer bodies
94
Q

what are heinz bodies?

(include stains)

A
  • clumps of denatured Hb
  • stained with supravital stain
  • in romanowsky stain, appears as a pale focal area within the RBC
95
Q

what are heinz bodies also known as?

A

bite cells

shaklon mtl kedshin l RBCs

96
Q

what is peripheral hemoglobinization? what inclusion is it associated with?

A
  • associated with heinz bodies
  • they are pale focal areas within the RBCs due to clumps of denatured Hb from the periphery
97
Q

what are heinz bodies associated with?

A
  • G6PD deficiency
  • exposure to certain drugs or oxidants

deficiency in G6PD can cause hemolytic anemia

98
Q

what are Hb H inclusions?

(color, stain,..)

A
  • bluish green granules
  • precipitates of beta globin chains
  • stained with supravital stain
99
Q

what are Hb H inclusions associated with?

A

Hb H disease

100
Q

what inclusions are stained with supravital stains?

A
  • heinz bodies
  • Hb H inclusions
101
Q

what inclusion is a precipitate of beta globin chains?

A

Hb H inclusions

hematology (10 decks)

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