RBC Anomalies (Part 6) Flashcards
(96 cards)
1
Q
increased number of red cells with VARIATION in SIZE
A
ANISOCYTOSIS
2
Q
Diameter of normal RBCs (normocytes)?
A
7-8 µm
(usually seen when MCV is 80-100 fL)
3
Q
Four ways to detect anisocytosis:
A
- Using the NUCLEUS of a small lymphocyte in a peripheralblood smear (PBS)
- Using the MCV value
- Using the RDW value
- Using the RBC histogram
4
Q
Larger than normal RBCs (diameter > 8.0 µm)
A
Macrocytes
5
Q
Associated with impaired DNA SYNTHESIS
BIGGER than the nucleus of lymphocyte
A
Macrocytes
6
Q
Macrocytes are seen when value of MCV is?
A
> 100 fL
7
Q
Smaller than normal RBCs (diameter < 7.0 µm)
A
Microcytes
8
Q
Associated with DEFECTIVE HEMOGLOBIN FORMATION
SMALLER than the nucleus of lymphocyte
A
Microcytes
9
Q
Microcytes are seen when the MCV value is?
A
< 80 fL
10
Q
Normal erythrocyte = ?
A
= NUCLEUS of SMALL LYMPHOCYTE
11
Q
The average volume of individual RBCs?
A
MCV
12
Q
Formula of MCV?
A
Hct / RBC count x 10
13
Q
Reference range of MCV?
A
80-100 fL
(Should be consistent with the PBS)
14
Q
↓MCV = ?
Normal MCV = ?
↑MCV = ?
A
↓MCV = MICROcyte
Normal MCV = NORMOcyte
↑MCV = MACROcyte
15
Q
Regardless of the SIZE, the RDW is always __________ in Micro/Macrocytic.
A
INCREASED
16
Q
A calculated index (from the RBC histogram) given by hematology analyzers to help identify ANISOCYTOSIS and provide information about its DEGREE (or how severe it is)?
A
Red Cell Distribution Width (RDW)
17
Q
Most recent hematology analyzers have provided two methods to calculate the RDW:
A
- RDW-CV (coefficient of variation)
- RDW-SD (standard devitation)
18
Q
Based on BOTH the width of the RBC distribution curve and the mean RBC size?
A
RDW-CV
19
Q
Based on the actual measurement of the width of the RBC distribution curve in fL (femtoliters)?
A
RDW-SD
20
Q
⭐️ RDW-CV reference range for ADULTS:
A
11.5% to 14.5%
21
Q
⭐️ RDW-SD reference range in ADULTS?
A
39 - 46 fL
22
Q
EARLIEST method provided by the hematology analyzers to measure red cell variations?
A
RDW-CV
23
Q
DEPENDENT on the WIDTH of the DISTRIBUTION CURVE and the MCV that is MORE COMMON in the Philippines
A
RDW-CV
24
Q
WIDTH of the curve is measured at the point that is 20% ABOVE the baseline
NOT influenced by the MCV
A
RDW-SD
25
BETTER and MORE RELIABLE measure of erythrocyte variability, specifically in
HIGHLY ABNORMAL conditions?
RDW-SD
26
RDW Reference range for newborns?
14.2% to 19.9%
RDW is MARKEDLY INCREASED in newborns but gradually, the value will decrease until it reaches adult levels by 6 MONTHS of age.
27
If the RBC histogram is ________ than normal, the RDW would be _____________.
WIDER
ABNORMAL
28
Examples of conditons with their MCV and RDW values:
See *INDEX 2*
29
A visual display of CELL SIZE (X-axis) and CELL FREQUENCY or the number of cells
(Y-axis)
Blood cell histogram
30
provided by many high-volume instruments to provide size distribution of the different cell populations
RBC histogram
31
Automated hematology analyzers produce histograms for?
RBCs, WBCs, and platelets
32
TWO parameters calculated from RBC histogram?
MCV & RDW
33
Instruments being used count those cells with volume sizes as RBCs?
Between 36 fL to 360 fL in size
34
RBC histogram can measure cells as small as?
24 fL
(However, cells that are counted in the 24 to 36 fL range are NOT included in the RBC count)
35
LEUKOCYTES are present in the diluted fluid containing RBCs, but their numbers are statistically ____________ in the count.
INsignificant
36
If the leukocyte count is significantly _________, the RBC histogram will be affected.
ELEVATED
37
RBC Histogram:
Shift to the RIGHT = ?
MACROcytic
38
RBC Histogram:
Shift to the LEFT = ?
MICROcytic
39
RBC histogram curve is BIMODAL = ?
There are TWO POPULATIONS of RBCs in the sample.
40
Illustrations [Figures] showing RBC histogram examples:
See * INDEX 3 *
41
Cases that may cause a BIMODAL distribution curve?
1. Blood transfusion (when NORMOcytic DONOR erythrocytes are transfused to a RECIPIENT with MICROcytic red cells)
2. Cold agglutinin disease
3. Hemolytic anemia with SCHISTOCYTES present (+)
42
A WIDER or FLATTENED curve on a histogram indicates?
MORE VARIATION in the SIZE of the cells
(The cell population is NOT homogeneous.)
43
General term for a VARIATION in the NORMAL COLORATION?
“ANISOCHROMIA”
by Turgeon
44
NORMAL RBC have central pallor of?
approximately 1/3 the diameter
45
may also mean the occurrence of HYPOCHROMIC cells and NORMOCHROMIC cells in the same blood smear
Anisochromia
46
may be found in SIDEROBLASTIC ANEMIAS, also in a HYPOCHROMIC ANEMIA after transfusion with normal cells and some weeks after IRON THERAPY for iron deficiency anemia
Anisochromia
47
Central pallor of Hypochromic cells?
>1/3 of diameter
48
Hypochromic cells are usually ______________.
MICROCYTIC
“Pag maliit, maputla”
49
⭐️ GRADING OF HYPOCHROMIA:
1+ Area of central pallor = ?
2+ Area of central pallor = ?
3+ Area of central pallor = ?
4+ = ?
1+ Area of central pallor = 1/2 of diameter
2+ Area of central pallor = 2/3 of diameter
3+ Area of central pallor = 3/4 of diameter
4+ = Thin Rim of Hemoglobin ⭐️
50
RBC with a THIN RIM of HEMOGLOBIN and a large, CLEAR CENTER?
Anulocyte
51
Another name for Anulocyte?
GHOST CELL
or
PESSARY CELL
52
Anulocyte is observed in what type of anemia?
IRON Deficiency Anemia
(severe cases)
53
HYPERchromic cells are usually ____________.
SPHEROCYTES
54
RBCs that lack central pallor even though they lie in a desirable area for evaluation?
HYPERchromic cells
55
These RBCs are actually caused by a shape change?
HYPERchromic cells
56
This occurs whem MCHC is HIGH?
True HYPERchromia
57
3 key clinical manifestations of Hereditary Spherocytosis?
1. Splenomegaly
2. Anemia
3. Jaundice
58
Hereditary Spherocytosis:
DAT = ?
MCV = ?
MCH = ?
MCHC = ?
DAT (direct antiglobulin test) = NEGATIVE ❗️
MCV = Normal to Low
MCH = Normal
MCHC = SLIGHTLY INCREASED (35-38 g/dL)
59
⭐️ REMEMBER:
The immune disorders that HAVE spherocytes also are usually characterized by a _____________.
POSITIVE (+) result on DAT
60
Other tests for H. Spherocytosis?
1. Autohemolysis test
2. OFT (osmotic fragility test)
3. EMA Binding Test (Eosin-5’-maleimide)
61
HS results:
Autohemolysis test = ?
OFT = ?
EMA Binding Test = ?
Autohemolysis test = GREATLY INCREASED (but can be corrected with either glucose or ATP)
OFT = INCREASED osmotic fragility
(NOT diagnostic of HS; old confirmatory test)
EMA Binding Test = ↓ fluorescence (flow cytometry)
62
CONFIRMATORY TEST for HS?
EMA Binding Test
63
larger than normal red cells with bluish tinge (Wright's stain)?
Polychromatophilic erythrocytes
64
Large numbers of Polychromatophilic erythrocytes are associated with?
1. DECREASED BC survival
2. hemorrhage
3. erythroid hyperplastic marrow
65
The BLUISH TINGE on polychromatophilic erythrocytes is caused by the presence of?
Residual RNA
66
⭐️ GRADING OF POLYCHROMASIA
Slight = ?
1+ = ?
2+ = ?
3+ = ?
4+ = ?
Slight = 1%
1+ = 3%
2+ = 5%
3+ = 10%
4+ = >11%
67
(↑) increased number of red cells with variation in SHAPE?
POIKILOCYTOSIS
68
Almost SPHERICAL in shape
LACKS the central pallor
SPHEROCYTE
69
Associated conditions to SPHEROCYTE?
✓ Hereditary spherocvtosis
✓ Autoimmune hemolytic anemia
✓ Burns
✓ ABO HDN
✓ following transfusion of stored blood
70
🍁 Natural RBC death can result also to
SPHEROCYTIC red cells
71
⭐️ REMEMBER:
Spherocytes may be WRONGLY reported if one examines the ____________ of the blood film because the red blood cells in the said area LACK CENTRAL PALLOR.
feathered edge
72
ELONGATED RBCs with a “slit-like” central pallor (may be considered as an artifact)
STOMATOCYTE
"Puto"
73
⭐️ Other name of STOMATOCYTE?
MOUTH CELL
“Puto”
74
STOMATOCYTES are considered to be significant if?
ALL FIELDS should have MULTIPLE MOUTH CELLS and only an artifact if there are few seen / field
75
⭐️ Associated conditions to STOMATOCYTES?
✓ Rh Deficiency Syndrome (⭐️BB)
✓ Alcoholism
✓ Electrolyte imbalance
✓ Severe liver diseases
✓ Overhydrated hereditary stomatocytosis
✓ Dehydrated hereditary stomatocytosis (Hereditary Xerocytosis)
76
MOST COMMON form of stomatocytosis?
Dehydrated hereditary stomatocytosis (Hereditary Xerocytosis)
77
Hereditary Xerocytosis is characterized by the presence of?
XEROCYTES
(appears to have PUDDLED at one end; half-light, half-dark)
78
RBCs with IRregularly spiculated surface?
ACANTHOCYTE
“Rambutan”
79
Other name for ACANTHOCYTE?
THORN CELL
or
SPUR CELL
80
⭐️ Associated conditions to ACANTHOCYTE?
✓ Abetalipoproteinemia ⭐️
✓ McLeod Syndrome
✓ Pyruvate kinase deficiency
✓ Hepatic hemangioma
✓ Neonatal hepatitis
✓ After heparin administration
✓ Post-splenectomy
✓ Cirrhosis of the liver with
associated hemolytic anemia
81
Other name for Abetalipoproteinemia?
Bassen-Kornzweig Syndrome
and
Hereditary Acanthocytosis
82
Abetalipoproteinemia is characterized by?
DEFECTIVE apo B synthesis
83
In Abetalipoproteinemia, these lipoproteins are NOT found in PLASMA?
VLDL , LDL , and Chylomicrons
84
RBCs with regularly spiculated surface (even in size)?
BURR CELL
“Fita”
85
Other name for BURR CELL?
Echinocytes
“Fita”
86
Associated conditions to ECHINOCYTES?
✓ Uremia
✓ Pyruvate kinase deficiency
87
In Echinocytes, Uremia is characterized by?
✓ MARKED (↑) in plasma urea and other nitrogenous waste products
✓ Generalized edema
✓ Acidemia
✓ electrolyte imbalance (K+ elevation)
✓ NORMOcytic, NORMOchromic Anemia
✓ Uremic Frost (dry skin)
✓ Foul breath
✓ “URINE-like” sweat
88
Oval-shaped RBCs?
OVALOCYTE
89
Associated condition/s to OVALOCYTE?
Hereditary Ovalocytosis
90
Other name for Hereditary Ovalocytosis?
Southeast Asian ovalocytosis
91
Elliptical (CIGAR-shaped) RBC?
ELLIPTOCYTE
92
Associated conditions to ELLIPTOCYTE?
✓ Hereditary Elliptocytosis
✓ Thalassemia
93
Other name for Thalassemia?
Hereditary Leptocytosis
94
PEAR-shaped or TEARDROP shaped RBCs?
DACRYOCYTE
95
Other name for DACRYOCYTE?
Teardrop cells
96
Associated conditions to DACRYOCYTE?
✓ Primary Myelofibrosis (PMF)
✓ Megaloblastic Anemia
✓ thalassemia
✓ myelophthislc anemia
✓ after Heinz body formation induced by drug ingestion
✓ tuberculosis
✓ tumor metastasized to the bone marrow
✓ some hemolytic anemias
