RBC AND ANEMIA Flashcards
process of blood formation
hematopoiesis
process of RBC formation
where does it take place?
erythropoiesis
bone marrow
process of WBC formation
leukopoiesis
process of PLT formation
thrombopoiesis
total population of RBC inside the body
erythron
total population of RBC in circulation only
RBC mass
dynamics of RBC creation and destruction
erythrokinetics
graveyard of RBC
spleen
production of defective erythroid precursors
ineffective erythropoiesis
how does RBC die in effective erythropoiesis?
defective RBC precursors often undergo apoptosis
examples of ineffective erythropoiesis (4)
vfts
vitamin B12 deficiency
folate deficiency
thalassemia
sideroblastic anemia
type of anemia for vitamin B12 deficiency and folate deficiency
macrocytic, normochromic anemia
type of anemia for thalassemia and sideroblastic anemia
microcytic, hypochromic anemia
decrease in the number of erythroid precursors in the BM
insufficient erythropoiesis
examples of insufficient erythropoiesis (3)
IDA
renal disease
acute leukemia
type of anemia for IDA
microcytic, hypochromic anemia
type of anemia for renal disease and acute leukemia
normocytic, normochromic anemia
immature hematopoietic cell that is committed to a cell line but cannot be identified morphology
progenitor cells
examples of progenitor cells
BFU-E (bust forming unit)
CFU-E (colony forming unit)
immature hematopoietic cell that is morphologically identifiable as belonging to a given cell line
precursor cells
examples of precursor cells
rubriblast, prorubricyte
earliest marker of erythroid differentiation; transferrin receptor
CD71
meaning of CD
clusters of differentiation
transport protein of iron in the plasma
transferrin
chief stimulatory cytokine for RBC; major hormone that stimulates the production of erythrocytes
erythropoietin (EPO)
primary organ and cell source of EPO
kidney
peritubular interstitial cells
primary target cells of EPO
BFU-E and CFU-E
3 major effects of EPO
- early release of retics from BM
- reduce the time needed for cells to mature in BM
- preventing apoptosis
artificial way to induce RBC production using EPO
blood doping
hormone produced by pituitary gland that directly stimulates erythropoiesis
growth hormone
prolactin
hormone produced by testes/ovaries that indirectly stimulates erythropoiesis
testosterone
estrogen
the hormone that suppresses production of EPO
estrogen
T or F.
it takes about 21 to 30 days for the BFU-E to mature to an erythrocyte, of which approximately 7 days are spent as recognizable precursors in the bone marrow
18-20 days
6 days
RBC precursors (all stages)
rubriblast prorubricyte rubricyte metarubricyte reticulocyte
3 RBC naming
rubriblast, normoblast, erythroblast
1st RBC stage
rubriblast/ pronormoblast/ proerythroblast
2nd RBC stage
prorubricyte/ basophilic normoblast/erythroblast
3rd RBC stage
rubricyte/ polychromatophilic normoblast/erythroblast
4th RBC stage
metarubricyte/ orthochromatic normoblast/erythroblast
5th RBC stage
reticulocyte
6th RBC stage
mature erythrocyte
supravital stains for retics:
brilliant cresyl blue
new methylene blue
t or f. if you use wright stain, the reticulocyte will change its name
true
polychromatophilic erythrocyte
diffusely basophilic erythrocyte
rubriblast characteristics
nucleoli: 1-2
cytoplasm: basophilic
N:C ratio: 8:1
RBC basophilia (color) correlation
cytoplasmic basophilia = ribosomal RNA
RBC eosinophilia (color) correlation
cytoplasmic eosinophilia = hemoglobin
last RBC stage with nucleolus
prorubricyte
this is where hemoglobinization starts
prorubricyte
prorubricyte gives rise to:
4 rubricytes
prorubricyte characteristics
nucleoli: 0-1
coarser chromatin
absence of nucleoli
N:C ratio: 6:1
rubriblast gives rise to:
2 prorubricytes
rubricyte gives rise to:
2 metarubricytes
last RBC stage capable of mitosis
rubricyte
first RBC stage in which cytoplasm becomes pink
rubricyte
lymphocyte vs rubricyte
lympho
nucleus: crushed velvet
cytoplasm: sky blue
rubri
nucleus: checkerboard
cytoplasm: muddy/gray
rubricyte N:C ratio
4:1
RBC precursor that has the same color with mature RBC
metarubricyte
last RBC stage with nucleus
metarubricyte
other names of metarubricyte
nucleated RBC
pyknotic erythroblast
acidophilic normoblast
enveloped extruded nucleus of RBC
pyrenocyte
which WBC engulfs the extruded nucleus of metarubricyte
macrophage
small fragment of the extruded nucleus left in the RBC
howell-jolly bodies
who removes howell-jolly bodies?
splenic macrophages
in which RBC stage hemoglobin is first synthesized?
prorubricyte
last immature RBC stage
reticulocyte
what do reticulocytes contain?
residual RNA
t or f. spends 2 to 3 days in the bone marrow and 1 day in the peripheral blood before developing into a mature RBC
true
last stage of hemoglobin synthesis
reticulocyte
type of retic:
polychromatic macrocyte, seen in increased RBC production
shift cells
type of retic:
macroreticulocyte, seen in severe conditions (hemolytic anemia)
stress reticulocytes
metarubricyte N:C ratio:
1:2
mature RBC characteristics
shape: biconcave
color: salmon pink
life span: 120 days
number of RBC produced from each rubriblast:
16
normal ratio of RBC to WBC
600:1
normal ratio of RBC to PLT
15:1
is not a disease; a consequence of having a disease
anemia
3 factors to dx anemia
low number of RBCs
low hemoglobin
low hct
first consideration for anemia
hemorrhage
common site for clinically significant bleeding
GIT bleeding
2nd consideration for anemia
hemolysis
3 mechanism of hemolysis
- shortened RBC survival not explained by bleeding
- destruction of RBC before 120th day
- can occur intravascularly or extravascularly
3rd consideration for anemia
decreased RBC production
disease associated with insufficient erythropoiesis
kidney disease, nutritional deficiencies
two methods of classifying anemia
- morphological
2. pathological
which blood parameters do we base on for morphological classification?
- mean corpuscular volume
2. mean corpuscular hemoglobin concentration
normal or decreased retics, normocytic, normochromic anemia examples (2)
aplastic anemia
renal disease
increased retics, normocytic, normochromic examples (5)
ppseo
PNH PCH sickle cell disease enzyme deficiencies other hemolytic anemias
rare, potentially deadly bone marrow failure syndrome
aplastic anemia
characteristics of aplastic anemia (4)
prbd
- pancytopenia
- reticulocytopenia
- bone marrow hypocellularity
- depletion of HSC
2 classification of aplastic anemia:
acquired
inherited
most common aplastic anemia
acquired aplastic anemia (AAA)
idiopathic or secondary
secondary acquired aplastic anemia causes
chemicals insecticides benzene EBV chloramphenicol*
most common inherited aplastic anemia
fanconi anemia
fanconi anemia characteristics (6)
cam ssa
- chromosome instability disorder
- aplastic anemia, cancer susceptibility
- macrocytic
- skeletal abnormalities
- skin pigmentation
- abnormalities of the eyes, kidneys, and genitals
paroxysmal nocturnal hemoglobinuria other name:
marchiafava-micheli syndrome
cause of PNH (2)
- decay-accelerating factor or CD55
2. membrane inhibitor of reactive lysis or CD59
tests for PNH (3)
- ham’s acidified serum test
- sugar water test/ sucrose hemolysis test
- flow cytometry (confirmatory)
disease associated with microcytic, hypochromic anemia (5)
thalassemia anemia of chronic infection iron deficiency anemia lead poisoning sideroblastic anemia
microcytic, hypochromic anemia characteristics (lab)
mcv and mchc are low
most common anemia among hospitalized patients
anemia of chronic inflammation/disease
central feature of anemia of chronic inflammation
sideropenia
- decreased serum iron despite having high iron stores
- macrophages hog iron because of inflammation
acute phase reactants that contribute to anemia of chronic inflammation
(3)
flh
ferritin
lactoferrin
hepcidin
master regulatory for systemic iron metabolism
hepcidin
what does hepcidin inactivates?
ferroportin
protein that transports iron from tissue to blood
ferroportin
most common anemia
iron deficiency anemia
possible causes of IDA (5)
blood loss nutritional deficiency increased iron demand GIT malignancy hookworms
IDA clinical features (5)
fkgpp
fatigue, weakness, pallor koilonychia glossitis pica pagophagia
most sensitive test for IDA
serum ferritin test
develop when the production of protoporphyrin or the incorporation of iron into protoporphyrin is prevented
sideroblastic anemia
nucleated RBC precursor with cytoplasmic iron granules
sideroblast
anucleated RBC with iron granules
siderocyte
hallmark of sideroblastic anemia
ring sideroblasts
indirect measure of transferrin concentration in the plasma
total iron binding capacity
amount of protoporphyrin rings not bound to urine
free erythrocyte protoporphyrin
heme is made up of?
protoporphyrin ring + iron
mechanism of lead poisoning
inhibits:
ferrochelatase (heme synthetase)
pyrimidine-5’-nucleotidase (RNA catabolizer in retics) > basophilic stippling
megaloblastic anemia (3) vfa
vitamin B12 deficiency
folate deficiency
acute erythroleukemia
non megaloblastic anemia (3)
labm
liver disease
alcoholism
BM failure
hypersegmented neutrophils are only seen in?
megaloblastic anemia
macrocyte shapes in megaloblastic and non megaloblastic anemia
megaloblastic = oval
non megaloblastic = round
vitamin B12 deficiency may be caused by (4)
- inadequate intake
- pregnancy
- D. latum infection
- lack of intrinsic factor
causes of lack of intrinsic factor (3)
- gastrectomy > removes parietal cells
- H. pylori infection > destroys parietal cells
- pernicious anemia > autoantibodies against parietal cells and intrinsic factors
folate deficiency may be caused by (3)
- inadequate intake
- pregnancy
- renal dialysis
differentiate folate vs B12 deficiency
folate holoTC assay: normal
B12 holoTC assay: decreased
