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HEMA LECT1 > RBC MORPHOLOGY AND PHYSIOLOGY > Flashcards

RBC MORPHOLOGY AND PHYSIOLOGY Flashcards

1
Q

aka Red Blood Cells (RBC)

A

ERYTHROCYTES

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2
Q

Average Life Span of erythrocytes

A

120 days

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3
Q

RBC Reference values for males

A

4.0 – 5.2 x 10^12/L

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4
Q

RBC Reference values for females

A

3.6 – 5.6 x 10^12/L

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5
Q

RBC Reference values for newborns

A

5.0 – 6.5 x 10^12/L

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6
Q

Functions of erythrocytes

A
  • Oxygen transport
  • Removal of metabolic wastes
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7
Q

Size of RBC

A

6-8 um

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8
Q

T/F: RBC is nucleated

A

F (anucleated)

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9
Q

Thickness of RBC

A

1.5-2.5 um

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10
Q

Shape of RBC

A

Biconcave disc

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11
Q

Describe the cytoplasm of RBC

A

Salmon pink with central pallor area

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12
Q

Average volume of RBC

A

80-100 fL (90 fL)

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13
Q

Surface area of RBC

A

140 um^2

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14
Q

Ratio of RBC

A

Increased surface-to-volume ratio

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15
Q

During their intravascular lifespan, erythrocytes require _____ to maintain a number of _________

A

energy, vital cell functions

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16
Q

State the 7 energy-dependent RBC metabolism

A

(1) maintenance of glycolysis
(2) maintenance of the electrolyte gradient between plasma and red cell cytoplasm through the activity of adenosine triphosphate (ATP)-driven membrane pumps
(3) synthesis of glutathione and other metabolites
(4) purine and pyrimidine metabolism
(5) maintenance of hemoglobin’s iron in its functional, reduced, ferrous state
(6) protection of metabolic enzymes, hemoglobin, and membrane proteins from oxidative denaturation
(7) preservation of membrane phospholipid asymmetry.

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17
Q

What are the 4 pathways in RBC metabolism

A
  1. Embden-Meyerhof Pathway
  2. Hexose Monophosphate Shunt
  3. Methemoglobin Reductase Pathway
  4. Rapoport-Luebering Pathway
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18
Q

Anaerobic pathway of glucose metabolism

A

Embden-Meyerhof Pathway

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19
Q
  • Source of 90-95% of RBC requirement
A

Embden-Meyerhof Pathway

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20
Q

Embden-Meyerhof Pathway requires _____________ to produce ATP

A

glucose

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21
Q

Product of Embden-Meyerhof Pathway

A

o Lactate
o Pyruvate
o ATP

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22
Q

Hexose-Monophosphate Shunt is aka as what?

A

aka Pentose Phosphate Pathway, phosphogluconate pathway

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23
Q
  • Aerobic and oxidative pathway
A

Hexose-Monophosphate Shunt

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24
Q
  • Functionally dependent on Glucose-6-phosphate dehydrogenase pathway (G-6-PD)
A

Hexose-Monophosphate Shunt

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25
Q
  • Detoxifies accumulated peroxides
A

Hexose-Monophosphate Shunt

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26
Q

Hexose-Monophosphate Shunt produces _______________

A

reduced glutathione

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27
Q

reduced glutathione prevents ______

A

Prevents oxidative denaturation of hemoglobin

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28
Q

Maintains iron in the hemoglobin molecule in the Ferrous (Fe2+) state by the action of Methemoglobin reductase (cytob5r).

A

Methemoglobin-Reductase Pathway

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29
Q

what is (cytob5r)

A

Methemoglobin reductase

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30
Q

Action involved in Methemoglobin-Reductase Pathway

A

Methemoglobin reductase (cytob5r)

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31
Q
  • Third metabolic shunt
A

Rapoport-Luebering Pathway

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32
Q
  • Generates 2,3-bishosphoglycerate (2,3-BPG,2,3-DPG)
A

Rapoport-Luebering Pathway

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33
Q
  • Regulates affinity of hemoglobin to oxygen
A

Rapoport-Luebering Pathway

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34
Q

Rapoport-Luebering Pathway regulates ___________________________

A

affinity of hemoglobin to oxygen

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35
Q
  • A curve produced when pO2 and hemoglobin affinity to oxygen are plotted on a graph
A

OXYGEN DISSOCIATION CURVE

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36
Q

increased hemoglobin affinity to oxygen

A
  • Shift to the left
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37
Q

decreased hemoglobin affinity to oxygen

A

Shift to the right

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38
Q

4 FUNCTIONS OF RBC MEMBRANE

A
  1. It gives the RBC its shape
  2. It provides skeletal system for RBC
  3. It maintains Osmotic balance
  4. It facilitates transportation of gases
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39
Q
  • The increased surface-to-volume ratio allows RBC to stretch undamaged 2.5 times their resting diameter.
A

RBC MEMBRANE DEFORMABILITY

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40
Q
  • Increased cytoplasmic viscosity compromised its _______________
A

deformability

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41
Q
  • RBC membrane lipid component maintains its _______
A

strength and deformability

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42
Q

RBC Membrane consist of:

A

lipids, proteins, carbohydrates

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43
Q

percent of lipids in RBC membrane

A

40%

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44
Q

percent of proteins in RBC membrane

A

52%

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45
Q

percent of carbohydrates in RBC membrane

A

8%

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46
Q

Transmembrane

A

 Integral Proteins

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47
Q

Cytoskeletal/skeletal

A

 Peripheral Proteins

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48
Q
  • Responsible for the semi- permeability of the cell
A

RBC Membrane Lipids

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49
Q

2 Lipid Bilayer:

A

o Hydrophilic polar head group
o Hydrophobic nonpolar tail

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50
Q

o Hydrophilic polar head group includes what

A

 Phosphatidylcholine
 Sphingomyelin

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51
Q

o Hydrophobic nonpolar tail includes what

A

 Phosphatidylserine
 Phosphatidylethanolamine
 Phosphatidylinositol

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52
Q

confers tensile strength to the lipid bilayer.

A
  • Cholesterol
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53
Q

forms the glycocalyx with the integral proteins

A

Glycolipids

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54
Q
  • Penetrates the lipid bilayer
A

Integral Proteins

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55
Q
  • Has high sialic acid residue (zeta potential)
A

Integral Proteins

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56
Q

sialic acid residue (___________)

A

zeta potential

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57
Q

Functions of Integral Proteins

A

o Transport site
o Adhesion site
o Signaling receptors

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58
Q
  • Supports carbohydrate-defined blood group antigen
A

Integral Proteins

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59
Q
  • Located adjacent to the cytoplasmic membrane lipid layer
A

Peripheral Proteins

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60
Q
  • Provides lateral or horizontal membrane stability
A

Peripheral Proteins

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61
Q

Peripheral Proteins provides _____________ or ________ membrane stability

A

lateral or horizontal

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62
Q

principal proteins (25-30%)

A
  • Spectrin (α, ß)
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63
Q

o Responsible for the elasticity of the cell (with actin and protein 4.1)

A
  • Spectrin (α, ß)
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64
Q

percent of actin in peripheral proteins

A

(4.5%)

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65
Q

5 RBC anomalies

A
  1. Variation in size
  2. Variation in shape
  3. Color variation
  4. RBC inclusions
  5. Alteration in the RBC distribution on a peripheral blood smear
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66
Q
  • Variation in size
A

ANISOCYTOSIS

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67
Q

Anisocytosis with
>8 um
MCV: >100 fL
Seen in: Pernicious anemia, Liver cirrhosis, Aplastic anemia

A
  • Macrocyte
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68
Q

Anisocytosis with
MCV of >120 fL
Seen in: Pernicious anemia, Vitamin B12 and folic acid deficiency

A
  • Megalocyte
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69
Q

Anisocytosis with
<6 um
MCV: <60 fL
Seen in: IDA, Thalassemia, Hemolytic anemia, Sideroblastic anemia

A
  • Microcyte:
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70
Q

Mean Cell Volume (MCV):

A

80-100 fL

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71
Q

Ways to detect anisocytosis

A
  1. Using the nucleus of small lymphocyte in a peripheral blood
  2. Mean Cell Volume (MCV) value
  3. Red Cell Distribution Width (RDW) value
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72
Q

Red Cell Distribution Width (RDW) value:

A

o Index of anisocytosis
o Coefficient of variation of RBC volume
o Reference value (CV): 11.5-14.5%

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73
Q
  • Variation in color
A

ANISOCHROMIA

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74
Q
  • Reflects the hemoglobin content of RBC
A

ANISOCHROMIA

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75
Q

Describe normal RBC (Normochromia)

A

salmon-pink with central pallor area approx. 1/3 of the diameter.

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76
Q

o Central pallor area >1/3 of RBC diameter
o Usually microcytic

A
  • Hypochromia
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77
Q
  • Hyperchromia aka __
A

Spherocytes

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78
Q

aka Spherocytes
Lacks central pallor area

A
  • Hyperchromia
79
Q

GRADING OF HYPOCHROMIA

What is the central pallor area of +1

A

1/2 of RBC diameter

80
Q

GRADING OF HYPOCHROMIA

What is the central pallor area of +2

A

2/3 of RBC diameter

81
Q

GRADING OF HYPOCHROMIA

What is the central pallor area of +3

A

3/4 of RBC diameter

82
Q

GRADING OF HYPOCHROMIA

What is the central pallor area of +4

A

Thin rim of hemoglobin

83
Q

Three parameters of Anisochromia

A
  • Central Pallor Area
  • Mean Cell Hemoglobin (MCH)
  • Mean Cell Hemoglobin Concentration (MCHC)
84
Q

o Average weight of hemoglobin in an individual RBC

A
  • Mean Cell Hemoglobin (MCH)
85
Q

o Reference range (Normochromia) in Mean Cell Hemoglobin (MCH)

A

26-32 pg

86
Q

MCH

<26 pg

A

 Hypochromia

87
Q

MCH

> 32 pg

A

 Hyperchromia

88
Q

o Average concentration of hemoglobin in each individual RBC

A
  • Mean Cell Hemoglobin Concentration (MCHC)
89
Q

o Reference range (Normochromia) in * Mean Cell Hemoglobin Concentration (MCHC)

A

32-36 g/dL or %

90
Q

MCHC

<32 g/dL

A

 Hypochromia:

91
Q

MCHC

> 36 g/dL

A

 Hyperchromia

92
Q

RBC with different degrees of staining affinity

A

POLYCHROMASIA

93
Q
  • Slightly larger RBC with bluish tinge (Wright stain)
A

POLYCHROMASIA

94
Q

POLYCHROMASIA indicates:

A

reticulocytosis

95
Q

GRADING OF POLYCHROMASIA

Grading: Slight
Percentage of Polychromatophilic RBCs: ?

A

1%

96
Q

GRADING OF POLYCHROMASIA

Grading: 1+
Percentage of Polychromatophilic RBCs: ?

A

3%

97
Q

GRADING OF POLYCHROMASIA

Grading: 2+
Percentage of Polychromatophilic RBCs: ?

A

5%

98
Q

GRADING OF POLYCHROMASIA

Grading: 3+
Percentage of Polychromatophilic RBCs: ?

A

10%

99
Q

GRADING OF POLYCHROMASIA

Grading: 4+
Percentage of Polychromatophilic RBCs: ?

A

> 11%

100
Q
  • Variation is shape
A

POIKILOCYTOSIS

101
Q
  • Normal (Discocyte)
A

round biconcave shape

102
Q

What are the 17 examples of Poikilocytes

A

o Spherocytes
o Stomatocytes
o Acanthocytes
o Echinocytes
o Burr cells
o Ovalocytes
o Dacryocytes
o Knizocytes
o Keratocytes
o Schistocytes
o Blister cells
o Drepanocytes
o Degmacyte
o Leptocytes
o Biscuit cells
o Bronze elliptocytes
o Semilunar bodies

103
Q
  • Spherical RBC
  • No central pallor area
  • Decreased surface-to-volume ratio
A

Spherocytes

104
Q
  • Seen in:
    o Hereditary spherocytosis
    o Hemolytic anemia
    o Burns (microspherocytes)
A

Spherocytes

105
Q
  • aka Mouth cells
A

Stomatocytes

106
Q
  • Elongated RBCs with a slit-lit central pallor
A

Stomatocytes

107
Q

Stomatocytes is seen in:

A

o Rh null Syndrome
o Alcoholism
o Hereditary Stomatocytosis
o Electrolyte imbalance
o Severe liver disease
o Thalassemia minor
o Glutathione deficiency
o Infectious mononucleosis

108
Q
  • aka Thorn cells, Spur cells
A

Acanthocytes

109
Q
  • RBC with irregular spiculated surface (spike-like)
A

Acanthocytes

110
Q
  • Seen in:
    o Abetalipoproteinemia
    o Spur cell anemia
    o McLeod Syndrome
    o Liver cirrhosis
    o Hemangioma
    o Post-heparin administration
    o Neonatal hepatitis
    o Post-splenectomy
A

Acanthocytes

111
Q
  • RBCs with regularly spiculated surface
A

Echinocytes

112
Q
  • Seen in:
    o Artifactual drying of blood smear
    o Effects of salicylates or barbiturates
    o Bile acid abnormalities
    o Osmotic imbalance
A

Echinocytes

113
Q
  • aka Sea-Urchin Cells
A

Burr Cells

114
Q
  • RBC with regularly spiculated surface
A

Burr Cells

115
Q

Burr cells is seen in

A

o Uremia
o Acute Blood Loss
o Pyruvate Kinase deficiency
o Stomach Cancer

116
Q
  • Seen in:
    o Uremia
    o Acute Blood Loss
    o Pyruvate Kinase deficiency
    o Stomach Cancer
A

Burr Cells

117
Q
  • Oval-shaped RBC
A

Ovalocytes

118
Q

rod-, sausage-, cigar-shaped RBC; More elongated than ovalocytes

A
  • Elliptocytes
119
Q
  • Seen in Hereditary Elliptocytosis
A

Ovalocytes

120
Q

Hereditary Elliptocytosis examples

A

o Hemoglobin C disease
o Hemolytic anemia
o IDA
o Pernicious anemia
o Sickle cell trait
o Thalassemia

121
Q
  • aka Teardrop cells
A

Dacryocytes

122
Q
  • Pear-shaped or tear-shaped RBCs
A

Dacryocytes

123
Q
  • Seen in:
    o Primary myelofibrosis
    o Pernicious anemia
    o Homozygous Beta-thalassemia
    o Hemolytic anemia
    o Myelopthisic anemia
    o Myeloid metaplasia
A

Dacryocytes

124
Q
  • Resembles a pinched bottle
A

Knizocytes

125
Q

Knizocytes is seen in

A

o Hemolytic anemia
o Hereditary spherocytosis

126
Q
  • Partially deformed RBCs but not cut
A

Keratocytes

127
Q
  • Spiculated resembling two horns
A

Keratocytes

128
Q
  • Spindle-, half moon-shaped RBC
A

Keratocytes

129
Q

Keratocytes is seen in

A

o Disseminated Intravascular Coagulation

130
Q
  • aka schizocytes, helmet cells
A

Schistocytes

131
Q
  • Fragmented RBCs
  • Remains of ruptured blister cells
A

Schistocytes

132
Q
  • Seen in:
    o Prosthetic implants (artificial heart valve)
    o Uremia
    o Infantile pyknocytosis
    o Disseminated Intravascular Coagulation
    o Severe burns
    o Microangiopathic hemolytic anemia
    o Renal transplant rejection
A

Schistocytes

133
Q
  • Erythrocyte containing one or more vacuoles that resemble skin blisters
A

Blister Cells

134
Q

___ and ____ are produced in blister cells

A

Keratocytes and schistocytes

135
Q

blister cells are seen in:

A

o Pulmonary embolism in sickle cell anemia
o Microangiopathic hemolytic anemia

136
Q
  • aka Meniscocyte, Sickle cell
A

Drepanocytes

137
Q
  • Sickle-cell or crescent-shaped RBCs
A

Drepanocytes

138
Q
  • Results from gelation of polymerized deoxygenated Hemoglobin S.
A

Drepanocytes

139
Q

Two forms of Drepanocytes

A

o Oat-shape cells
o Irreversible Sickle Cell (ISC)

140
Q

 Crescent-shaped RBC with less pronounced projection

A

o Oat-shape cells

141
Q

 Crescent-shaped RBC with long projection

A

o Irreversible Sickle Cell (ISC)

142
Q
  • Seen in:
    o Sickle cell anemia
    o Hemoglobin SC disease
A

Drepanocytes

143
Q
  • aka Bite cells
A

Degmacyte

144
Q
  • RBC with one or more semicircular portions removed from the margin
A

Degmacyte

145
Q

Degmacyte is seen in:

A

oxidative-related hemolysis in G6PD deficiency

146
Q
  • aka Target cells, Mexican Hat Cells, Codocytes
A

Leptocytes

147
Q
  • RBC with centrally stained area with a thin outer rim of hemoglobin
A

Leptocytes

148
Q
  • Seen in:
    o Thalassemia
    o Lecithin-Cholesterol Acyltransferase deficiency
    o Hepatic disorder
    o Iron deficiency anemia
    o Hemoglobin C disease
    o Post-splenectomy
A

Leptocytes

149
Q
  • Folded RBC
A

Biscuit Cells

150
Q
  • Bipolar or central distribution of hemoglobin
  • Seen in Sickle cell anemia
A

Bronze Elliptocytes

151
Q

WHAT ARE THE 9 RBC INCLUSION

A
  • Basophilic stippling
  • Pappenheimer bodies
  • Howell-Jolly Bodies
  • Cabot Rings
  • Heinz Bodies
  • Hemoglobin H
  • Malarial stipplings
  • Babesia spp.
  • Bartonella spp.
152
Q
  • Punctuate stippling/punctuate basophilia
A

Basophilic Stippling

153
Q
  • Aggregated RNA
    o Blueberry Bagel Appearance
A

Basophilic Stippling

154
Q
  • Seen in:
    o Lead poisoning (Plumbism)
    o Arsenic poisoning
    o Pyrimidine-5’-nucleotidase deficiency
    o Anemia with impaired hemoglobin synthesis
    o Refractory anemias
    o Alcoholism
    o Megaloblastic anemia
A

Basophilic Stippling

155
Q
  • aka Siderotic granules (Supravital stain)
A

Pappenheimer Bodies

156
Q
  • Intraerythrocytic collections of iron
A

Pappenheimer Bodies

157
Q
  • Visualization in Pappenheimer Bodies
A

o Supravital stain
o Wright stain:

158
Q

Visualization

Siderotic granules
e.g., Iron stain, Perl’s reagent, Prussian Blue, New methylene blue

A

Supravital stain

159
Q

Visualization:

Pappenheimer bodies

A

Wright stain

160
Q
  • Seen in:
    o Sideroblastic anemia
    o Hemochromatosis
    o Hemosiderosis
A

Pappenheimer Bodies

161
Q
  • Remnants of nuclear chromatin (DNA)
A

Howell-Jolly Bodies

162
Q
  • Round, solid-staining, dark-blue to purple inclusion (1-2 um)
A

Howell-Jolly Bodies

163
Q
  • Visualization in Howell-Jolly Bodies
A

o Wright stain (reddish-blue or purple)
o Supravital stain
o Feulgen

164
Q
  • Seen in:
    o Megaloblastic anemia
    o Post-splenectomy
A

Howell-Jolly Bodies

165
Q
  • Remnants of microtubules from mitotic spindle
A

Cabot Rings

166
Q
  • Ring-, figure-eight-, loop-shaped inclusion
A

Cabot Rings

167
Q
  • Visualized using Wright stain (reddish-violet)
A

Cabot Rings

168
Q

cabot rings color in wright stain

A

reddish-violet

169
Q
  • Seen in:
    o Abnormal erythropoiesis
    o Pernicious anemia
    o Lead poisoning
A

Cabot Rings

170
Q
  • Ehrlich bodies
A

Heinz Bodies

171
Q
  • Denatures and precipitated hemoglobin
A

Heinz Bodies

172
Q

heinz bodies inclusions

A

0.2 to 2.0 um in size

173
Q

Heinz bodies is visualized in ___ or ___

A

crystal violet or brilliant cresyl blue

174
Q
  • Seen in:
    o Congenital hemolytic anemia
    o G6PD Deficiency
    o Drug-induced hemolytic anemia (phenacetin)
    o Hemoglobinopathies
    o Favism
A

Heinz Bodies

175
Q
  • Abnormal hemoglobin composed of 4 ß-globin chains
A

Hemoglobin H

176
Q

Precipitated hemoglobin H appearance

A

o Pitted-golf ball/raspberry appearance

177
Q

Hemoglobin H is visualized using

A

Supravital stain

178
Q
  • Seen in Hemoglobin H disease
A

Hemoglobin H

179
Q
  • Fine granular appearance in erythrocytes that harbor malarial parasites
A

Malarial Stippling

180
Q
  • Inclusion bodies resembling maltese cross
A

Babesia spp.

181
Q
  • Comma-shaped inclusion bodies
A

Bartonella spp.

182
Q

RBC MORPHOLOGY GRADING CHART

MORPHOLOGY:
* Polychromatophilia
* Helmet cells
* Dacryocytes
* Acanthocytes
* Schistocytes
* Spherocytes

GRADING: ?

A

1+ = 1-5 per field
2+ = 6-10 per field
3+ = >10 per field

183
Q

RBC MORPHOLOGY GRADING CHART

MORPHOLOGY:
* Poikolocytosis
* Ovalocytes
* Elliptocytes
* Burr cells
* Bizarre-shaped RBC
* Target cells
* Stomatocytes

GRADING: ?

A

1+ = 3-10 per field
2+ = 11-20 per field
3+ = >20 per field

184
Q

RBC MORPHOLOGY GRADING CHART

MORPHOLOGY:
* Sickle cells
* Basophilic stipplings
* Pappenheimer bodies
* Howell-Jolly bodies

GRADING: ?

A

If present = “POSITIVE”

185
Q
  • Stacking or coining pattern of erythrocytes due to abnormal or increased plasma proteins
A

ROULEAUX

186
Q
  • Seen in: hyperproteinemia, multiple myeloma, Waldenstrom macroglobulinemia, increased fibrinogen
A

ROULEAUX

187
Q

thicker area of blood smear

A

Artifactual (rouleaux)

188
Q

seen in thinner area of blood smear

A

True (rouleaux)

189
Q

GRADING
ROULEAUX

+1?

A
  • aggregates of 3-4 RBC
190
Q

GRADING
ROULEAUX

+2?

A
  • aggregates of 5-10 RBC
191
Q

GRADING
ROULEAUX

+3?

A
  • many aggregates with only few free RBCs
192
Q

Clumping of RBC with no pattern

A

AGGLUTINATION

193
Q
  • Occurs when RBC are coated with IgM antibodies and complement
A

AGGLUTINATION

194
Q

AGGLUTINATION IS SEEN IN:

A

cold autoimmune hemolytic anemia (cold agglutinin disease)

HEMA LECT1 (3 decks)

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