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RBC Flashcards

1
Q

Hematopoietic Tissues

A
  • Childhood
    – Up to the age of puberty, all bone marrow is red and hematopoietically active
  • Adult (~18 years of age)
    – Vertebrae, ribs, sternum, skull, pelvis, and proximal epiphyseal regions of the humerus and femur
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2
Q

Hematopoiesis

A
  • Stem cells
    • CFU (colony forming unit)

* BFU (burst forming unit)

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3
Q

Erythrocyte

A

• An anucleate cell, which is the vehicle for the transportation of hemoglobin. The function of hemoglobin is the transportation of oxygen and carbon dioxide

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4
Q

Normoblastic Maturation

A

• Pronormoblast (proerythocyte)
• Basophilic normoblast (early erythroblast)
• Polychromatophilic normoblast (late erythroblast)
• Orthrochromatic normoblast (normoblast)
• Reticulocyte

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5
Q

Erythropoietin

A

• A hormone which affects the production of increased numbers of red cells
• Glycoprotein
• Produced mainly in the kidney ***

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6
Q

Erythropoietin: Action

A
  • Induces committed progenitor cells in the marrow to proliferate and differentiate into pronormoblasts
  • Shortens the generation time of normoblasts
  • Promotes early release of reticulocytes into the circulation ***
  • Result: normoblastic erythroid hyperplasia
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7
Q

Erythropoietin Levels

A

• Elevated
– Anemia
– hypoxia

• Decreased
– Polycythemia vera
– Chronic renal failure

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8
Q

Erythron

A

The combined population of erythrocytes and their precursors, whether mature or immature, in blood, bone marrow, or extravascular spaces

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9
Q

Reticulocyte Count

A
  • Reticulocytes: occupy an intermediate position between NRBC and mature RBC. They remain in circulation for 1 day until they mature
  • Detected with special stains
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10
Q

Reticulocyte Count

A

• The absolute reticulocyte count is determined by multiplying the reticulocyte
percentage by the red cell count

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11
Q

Reticulocyte Production Index

A

• Corrected for increased circulating reticulocyte life span or decreased RBC

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12
Q

Bone Marrow Examination

A

• Specimen
– Biopsy
– Aspirate

• Stains
– Iron
– Wright-giemsa
– Wright
– Hematoxylin eosin (H&E)

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13
Q

Bone Marrow Evaluation

A

• Cellularity
– Varies with age and site

• Distribution of cells
– Estimate
– Enumeration: counting

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14
Q

Bone Marrow Evaluation

A
  • Myeloid:Erythroid ratio
    – Ratio of total # of granulocyte precursors to total # of red cell precursors
  • Increased: Erythroid hypoplasia, infection, myelogenous leukemia
  • Decreased: erythroid hyperplasia, depressed granulopoiesis
  • Megakaryocytes: number
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15
Q

Bone Marrow Evaluation

A

• Number and location of lymphoid aggregates
• Presence or absence of iron
• Presence or absence of rare or abnormal cells
• Structure of bone

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16
Q

Basic Hematologic Tests

A

Hemoglobin
Hematocrit
Erythrocyte Count
Wintrobe Indices

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17
Q

Hemoglobin

A
  • Conjugated protein which is the transport vehicle for oxygen and carbon dioxide
    • Measured spectrographically
  • Reference range:
    – Males: 14 – 18 g/dl
    – Females: 12 – 16 g/dl
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18
Q

Hematocrit

A
  • The ratio of the volume of erythrocytes to that of whole blood
  • Methods:
    – Automated: calculated from MCV and RBC – HCT = MCV x RBC
  • Reference range
    – Males: 41- 53 %
    – Females: 36 – 46%
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19
Q

Erythrocyte Count (RBC)

A
  • Expressed as # of cells per unit volume of whole blood

* Automated
– Electrical impedance – Light Scattering

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20
Q

Wintrobe Indices

A

MCV
MCH

MCHC

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21
Q

Mean Cell Volume (MCV)

*** checking anemia

A
  • The average volume of the red cells

* MCV = HCT/RBC. **
• Measured in femtoliters (10-15 )
• Reference range: 76 – 96 fl

22
Q

Mean Cell Hemoglobin (MCH)

A

• The content (weight) of hemoglobin of the average red cell
• MCH = HGB/RBC. *****
• Reference range: 27 – 33 pg
• Picogram = 10-12 grams

23
Q

Mean Cell Hemoglobin
Concentration (MCHC)

A

• The average concentration of HGB in a given volume of packed red blood cells.
• MCHC = HGB/HCT
• Reference range: 30 –35 g/dl

** HCT - no plasma, no wbc, no platelets

24
Q

Red Cell Distribution Width (RDW)

A

• Measure of the variability of MCV distribution
• Increased in conditions with large variation in red cell size
• Early indicator of iron deficiency. **

25
Leukopoiesis
• The maturation of leukocytes from pleuripotential stem cells in the bone marrow • Granulopoiesis: generation of granulocytes • Monocytes • Lymphocytes
26
Granulocyte and Macrophage Colony Stimulating Factors
• Glycoprotein factors which react with specific receptors on stem cells to direct their differentiation into committed stem cells
27
CSF-GM (Colony Stimulating Factor-Granulocyte-Monocyte)
• Plays a role in granulopoiesis analogous to that of erythropoietin in erythropoiesis • Produced in endothelial cells in the bone marrow **** • Concentration dependent effect – Low concentrations—monocytes – High concentrations--granulocytes
28
Stages of Granulocyte Maturation
• Myeloblast • Promyelocyte • Myelocyte • Metamyelocyte • Band forms • Segmented neutrophil
29
Cytoplasmic Granules
• Primary granules – Appear initially in promyelocytes – Stain magenta • Secondary granules – Appear in myelocytic stage – Small, difficult to see with light microscopy – Pale pink to gray
30
Laboratory Tests
* WBC – # white blood cells/mm3 – Includes all types of white cells * Differential Count – Percentage of each cell type is determined * Bone Marrow
31
White Cell Disorders
Leukocytosis | Leukemoid Reaction
32
Leukocytosis
• An increase in the total WBC above the upper limit of the reference range – Neutrophilia: increase in neutrophils – Eosinophilia: increase in eosinophils – Monocytosis: increase in monocytes – Lymphocytosis: increase in lymphocytes
33
Neutrophilia
• The primary factors influencing the neutrophils count are – Rate of inflow of cells from the bone marrow – Proportion of neutrophils in the marginal and circulating pools – Rate of outflow (or destruction) from the blood
34
Physiologic Neutrophilia
• Exercise • Stress • Epinephrine
35
Pathologic Neutrophilia
• Infection • Toxic • Tissue destruction or necrosis • Hematologic disorders • Inflammatory disorders
36
Eosinophilia
* Allergic disorders • Parasitic infections • Hematologic : CML • Hypereosinophilic syndrome – Persistent eosinophilia with no known cause * Drugs : digitalis, sulfonamides
37
Basophilia
• Myeloproliferative disorders CML
38
Neutropenia
* A reduction of the absolute neutrophil count | * Causes – Bone marrow: lack of production – Ineffective granulopoiesis – Decreased survival/increased destruction
39
Leukemoid Reaction
Neutrophilic
40
Leukemoid Reaction
• Definition: an excessive leukocytic response. It includes: – Leukocytosis of 50 x 109 /L or higher with a shift to the left – Lower counts, even below normal, with considerable numbers of immature forms
41
Neutrophilic Leukemoid Reaction
* Hemolysis • Hemorrhage • Malignancy with bone marrow involvement * Infections • Severe burns • Hodgkin’s Disease
42
Differentiation From Leukemia
* Lack of eosinophilia and basophilia of CML | * Presence of more mature granulocytic forms
43
Leukoerythroblastic Reaction
• Circulating normoblasts accompanied by a neutrophilic leukemoid reaction • Major causes – Metastatic carcinoma involving the bone marrow – Sickle cell anemia
44
Lymphocytic Leukemoid Reaction
* Extremely high counts of normal appearing lymphocytes may occur in pertussis * Atypical lymphocytic leukemoid reaction – Infectious mononucleosis
45
Abnormal WBC Morphology
Auer Rods Toxic Granulation Dohle Inclusion Bodies Hypersegmentation
46
Auer Rods
• Linear or spindle-shaped red-purple inclusions in blasts or promyelocytes • Usually seen only in pathologic conditions – AML (acute myelogenous leukemia) **** • Derivative of azurophilic granules
47
Toxic Granulation
• Dark blue to purple cytoplasmic granules • Peroxidase positive • Found in severe infections or other toxic conditions ****
48
Dohle Inclusions Bodies
* Small oval inclusions in the peripheral cytoplasm of neutrophils which stain pale blue with Wright’s stain * Remnants of free ribosomes or rough endoplasmic reticulum * Frequently accompanies toxic granulation ***
49
Hypersegmentation
* Normal neutrophils have 2 – 5 lobes connected by a thin chromosome strand * Hypersegmentation occurs if : – > 5% of neutrophils have 5 lobes or more – Or if 1% of neutrophils have 6 or more lobes – Seen in megaloblastic anemia -> vt B 12 & folate defi,
50
Pelger – Huet Anomaly ( not responsible for)
• Autosomal dominant • Failure of normal segmentation of granulocytic nuclei • Most nuclei are band shaped or bilobed
51
Hematopoietic Tissues
• Embryo – Third week: yolk sac – Third month: liver • Fetal – Fourth month: bone marrow • Birth – The bone marrow is virtually the sole source of blood cells

Pathology (15 decks)

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