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Biochemistry > RBC Assessment In Anemia > Flashcards

RBC Assessment In Anemia Flashcards

1
Q

What hormone is principle in growth and maturation of erythroid cells?

A

erythropoietin

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2
Q

What produces erythropoietin and how is it regulated?

A

. Kidneys in response to tissue hypoxia

. Renal O2 levels regulate production

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3
Q

Erythropoiesis

A

. Multipotent stem cells mature into burst-forming units-erythroid (BFU-E)
. Single BFU-E produces colony of >1000 rbcs
. Blast cell maturation takes 3-5 rounds of cell division (cells become smaller each round)

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4
Q

Chromatin in immature blood cells

A

Delicate, fine, and speckled

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5
Q

What happens to chromatin in rbcs as they mature?

A

Become coarse, clumped, and compact

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6
Q

Effects of erythropoietin

A

. Binding + activating specific receptors on RBC progenitors in bone marrow to generate inc. BFU-E
. Signal transduction via erythropoietin receptor prevents apoptosis of erythroid cells to permit further proliferation and differentiation into mature rbcs
. Stimulate release of reticulocytes from marrow into circulation (reticulocytosis)

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7
Q

Reticulocytes

A

. Larger than rbcs from having ribosomes, mitochondria, and mRNA still
. Parts used to synthesize more Hb

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8
Q

Maturation time of reticulocytes

A

72 hours (48 in marrow, 24 in circulation)

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9
Q

Percentage of reticulocytes in normal blood

A

0.5-1.5%

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10
Q

Need what components to have effective erythropoietin effects?

A

. Responsive marrow
. 1+ kidney
. Adequate nutrition (adequate Hb synthesis and cell division)

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11
Q

Anemia condition or disease?

A

. Condition NOT DISEASE

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12
Q

Signs and symptoms of anemia

A

. Pallor skin/mucous membranes/nail beds
. Dizzy
. Ease of fatigue

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13
Q

red cell concentration and average number

A

. (RBC)
. Conc. Of erythrocytes in whole blood
. Avg: 5x10^6/uL

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14
Q

Hb concentration and average

A

. (HGB)
. Conc. Hb in whole blood
. Avg: 15gm/100mL

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15
Q

Hematocrit and average

A

. (HCT) or (PCV)
. Volume percentage of whole blood occupied by red cells
. Avg: 45%

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16
Q

Rule of 3 in CBC

A

. For healthy persons :
. RBC (millions) x3 = HGB (gm%)
. HGB (gm%) x3 = HCT (volume %)

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17
Q

What were corpuscular indices good for?

A

Assessing CBC of anemic individual and develop morphological classification of anemia

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18
Q

Mean corpuscular volume and reference range

A

. Volume of avg erythrocyte
. MCV = (HCT/RBC)x10
. 80-100 fl (normocytic RBCs)

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19
Q

Micro cystic RBC

A

MCV< 80fl

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20
Q

Macrocyclic RBCS

A

MCV> 100

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21
Q

Mean corpuscular Hb and reference range

A

. Quantity of Hb in avg erythrocyte
. MCH = (HGB/RBC)x10
. 26-32 pg range

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22
Q

Mean corpuscular Hb concentration and reference range

A

. Concentration of Hb in avg erythrocyte
. MCHC=(HGB/HCT)x100 OR (MCH/MCV)x100
. 31-37% (normochromic)

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23
Q

Hypochromic RBCs

A

MCHC<31

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24
Q

T/F MCHC cannot exceed reference range

A

T, conc. Is max that is soluble

25
Q

Red cell distribution width and normal range

A

. RDW
. measure of variation in RBC volume
. Calculated as coefficient of variation for RBC size
. 11-15% range

26
Q

RDW with anisocytosis and what is anisocytosis

A

. Increased

. Unusual cell size

27
Q

RDW with poikilo-cytosis and what that is

A

. Increased

. Unusual cell shape

28
Q

RDW with anemia

A

. Elevated when anemia is from nutritional deficiencies

29
Q

Observed reticulocytes count and reference range

A

. OR
. % of erythrocytes that are reticulocytes
. OR = (# reticulocytes/# RBCs)x100
, index of production of mature RBCs by bone marrow
. 0.5-1.5% range

30
Q

Calculation of corrected reticulocytes count

A

. (CR)
. Reticulocytes count adjusted to reflect what it would be for normal red cell conc. Of hematocrit
. CR = OR x patient’s HCT/ mean HCT
Mean HCT = 45%

31
Q

OR in anemia

A

. Reticulocytes percentage not reflective of actual reticulocytes production because each reticulocytes is diluted into fewer mature RBCs
. Corrected by CR

32
Q

When is Hb, HCT, and RBC count reduced?

A

. If red cell mass is decreased or plasma volume is increased

33
Q

WHen is Hb, HCT, and RBC count increased?

A

. Plasma volume decreases (hemoconcentration)

34
Q

Causes for impaired erythropoiesis

A

. Dec erythropoietin production
. Dec bone marrow mass
. Dec Hb synthesis

35
Q

What is CR increased in anemia?

A

Premature red cell loss

36
Q

If anemic and normal CR, what does that mean?

A

Impaired erythropoiesis

37
Q

What does impaired Hb synthesis cause?

A

. Microcytic, hypochromic anemia

. Reduces production of erythrocytes decreases MCV and MHC of those made

38
Q

Most common cause of impaired Hb synthesis?

A

Chronic Fe deficiency

39
Q

How does impaired DNA synthesis effect RBC production?

A

. Insufficient DNA slows blasé cell division but not protein synthesis
. Resultant erythrocytes have more Hb (inc. MCH) but erthrocyte production dec.
. Results in macrocytosis from more proteins in cell

40
Q

Common cause of impaired DNA synthesis of RBC DNA?

A

Vit. B12 or folate deficiency

41
Q

How is anemia classified?

A

. By RBC morphology and pathogens is

42
Q

HGB low means ____

A

Anemia is present

43
Q

Type of anemia if CR high

A

Anemia due to premature RBC loss (RBC destruction or acute blood loss but normocytic, normochromic)

44
Q

Type of anemia is CR is normal

A

Anemia. Due to insufficient RBC production

45
Q

Anemia type if MCV is normal?

A

. Anemia due to loss of bone marrow stem cells or loss of bone marrow stimulation (insuff. Erythropoetin from kidney disease) or due to chronic disease
. Still normocytic, normochromic

46
Q

Anemia type if MCV is high

A

Anemia from impaired DNA synthesis
. FOlate/B12 issue
. Macrocytic, normochromic

47
Q

anemia type if MCV is low

A

Anemia due to impaired HGB synthesis (Fe deficiency, thalassemia)
. Microcytic, hypochromic

48
Q

Common cause/mechanism for microcytic anemia

A

. Chronic GI blood loss, dietary deficiency, genetic Hb alteration

49
Q

Common cause/mechanism of normocytic anemia

A

. Infection, inflammation, malignancy
. Premature RBC destruction or acute blood loss
. Anemia of inflammation (AOI) aka anemia of chronic disease

50
Q

Macrocytic anemia common cause/mechanism

A

Malabsorption, inadequate diet, alcoholism

51
Q

Anemia of inflammation

A

Associated w/ inflammation, malignancy, or infection
. Takes 1-3 months to develop
. Mild to moderate in severity (HCT 30-40%)
. Indices normocytic but microcytic under severe conditions

52
Q

Factor deficiency anemia

A

. Commonly seen in popular due to Fe, vit. B12, or folate deficiency

53
Q

How to confirm Fe deficiency

A

Specific testing for serum Fe levels

. Total iron binding capacity (TIBC), transferrin saturation, ferritin levels

54
Q

B12 deficiency common symptoms

A

. Fatigue, pallor, 50% patients have glossitis and 45% neurological symptoms (diminished vibratory sensation and proprioception) that can be irreversible

55
Q

B12 deficiency in elderly

A

. Clinical manifestation are subtle

. Insufficiency dietary intake and malabsorption

56
Q

folate deficiency can result from _____

A

. Inadequate dietary intake, defective absorption, impaired utilization, or combo

57
Q

Difference between folate deficiency and vit B12 deficiency

A

B12 has neuro issues and folate deficiency does not

58
Q

Increase in homocysteine shows ____

A

Tissue folate deficiency

59
Q

Normal methylmalonic acid level means ____

A

Folate deficiency, rise in MMA means vit. B12

Biochemistry (64 decks)

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