RBC 3 Flashcards
define hemolysis
lysis/destruction of erythrocytes, releasing hemoglobin
what are the two types of hemolysis? what is the difference between them?
intravascular: happens when complement is activated due to antibodies on the surface of RBCs causing assembly of a membrane attack complex and lysis of the RBC, causing hgb to leak into the plasma
extravascular: RBCs are phagocytized by immune cells such as macropahges. it can be self antigens OR foreign antigens that “flag” the RBC
if you see ghost cells on a blood smear, what is this indicative of?
intravascular hemolysis (the ghost cell is just the membrane that is left over from RBC lysis)
hemoglobinuria and hemoglobinemia are indicative of what?
intravascular hemolysis: the hgb is IN the plasma causing hemoglobinemia and it will eventually be filtered by the kidney causing hemoglobinuria. this does not happen in extravascular hemolysis because the hgb is not in the plasma, it is within cells
in a more chronic case of intravascular hemolysis, you could see what on bloodwork?
hyperbilirubinemia and bilirubinuria: the body cannot contain how much hemoglobin is being broken down and it is having trouble excreting it, so there is excess bilirubin in the blood and bilirubin present in the urine
what is the most common form of hemolysis?
extravascular is much more common than intravascular
where does extrvascular hemolysis usually happen?
in the spleen, liver, bone marrow, lymphoid tissue, anywhere there are macrophages!
does hyperbilirubinemia and bilirubinuria happen with intravascular hemolysis, extravascular hemolysis, or both?
both, but it takes some time in both cases for this to happen. In a case of extravascular hemolysis it is usually present at presentation, and for intravascular it will develop more with time and may or ay not be present at initial presentation of the patient
if you see this on a peripheral blood smear what should you think of?
extravascular hemolytic anemia, you can see the macrophage has phagocytized a few RBCs and they are in the cytoplasm
if you see these on a blood smear what should you think of?
these are ghost cells, which are indicative of intravascular hemolysis
is hemolysis usually regenerative or non regernative?
regernative unless it is very accute
would you see polychromasia/reticulocytosis on a blood smear if the anemia was caused by hemolysis?
yes, it is usually regernative so you should see polchromatophils/reticulocytes
what is the “clinical” word for the appearance of hyperbilirubinemia? Why does this happen sometimes with hemolysis?
icterus
with hemolysis there is accelerated breakdown of RBCs, and hyperbilirubinemia happens when hemolysis overwhelms the ability of the liver to take up, conjugate, and/or excrete bilirubin
at what level of bilirubin in the blood would you be able to see an icteric patient in front of you?
more than 25-35 micromol/L
there are 7 causes from lecture for hemolytic anemia. list them
- immune mediated (IMHA)
- oxidative damage/exposure to oxidixing agent
- infectious agents
- fragmentation of RBCs (DIC, cardiac valvular disease)
- inherited RBC metabolic defects
- hypophosphatemia
- neoplasia
pneumonic: I only impersonate foxes in harsh Nigeria
what types of cells are these? what do they indicate?
spherocytes, indicative of extravascular hemolysis
what cells are these, what are they indicative of, and what is the logic behind them lookin like that?????
they are heinz bodies in RBCs, and they are indicative of hemolytic anemia of oxidative damage. oxidative damage to hemoglobin causes percipitation of denatured globin of the denatured portion of hemoglobin and this forms heinz bodies in the cells
what are these cells called, and what are they indicative of?
these are eccentrocytes, indicative of hemolytic anemia of oxidative damage, specifically lipid peroxidation of the RBC membrane
