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POM HAEMATOLOGY > Red Blood Cells > Flashcards

Red Blood Cells Flashcards

1
Q

What do all blood cells originate from?

A

pluripotent haemopoietic stem cells in the bone marrow

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2
Q

What is haemopoiesis?

A

the formation and development of blood cells

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3
Q

Where does foetal haematopoeisis start?

A

The yolk sac

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4
Q

Which bones in children does haematopoiesis occur in?

A

All bones

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5
Q

Which bones in adults does haematopoiesis occur in?

A

Long bones - femur, pelvis, sternum

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6
Q

What are the two characteristics of haematopoietic stem cells?

A

They can self renew
- some daughter cells remain as HSCs
- therefore the pool of HSCs are not depleted

They can differentiate to mature progeny
- other daughter cells follow a differentiation pathway

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7
Q

What are the two cells that HSC differentiate into?

A

Common Lymphoid Progenitor and Common Myeloid Progenitor

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8
Q

What does the common myeloid progenitor cell differentiate into?

A

Megakaryocyte

erythrocyte

Mast cell

Myeloblast

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9
Q

What do megakaryocytes break into?

A

platelets

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10
Q

What do myeloblast differentiate into?

A

Granulocytes= basophils, neutrophils, eosinophils

Monocytes

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11
Q

What do monocytes become?

A

macrophages

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12
Q

What do common lymphoid progenitor cells differentiate into?

A

Natural killer cells (large granular lymphocyte)
Small lymphocyte

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13
Q

What do small lymphocytes differentiate into?

A

T lymphocytes
B lymphocytes

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14
Q

Do you understand/ remember the diagram of the stem cell hierarchy?

A
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15
Q

What are the sites of haemopoiesis from zygote (you know what I mean) to birth?

A

Yolk sac
- generation of HSC (mesoderm)
- 3 weeks
- primitive

Liver
- HSC maintenance
- HSC expansion
- Liver takes over at 6-8 weeks gestation
- It becomes the principle source of blood in foetus until shortly before birth

Bone marrow
- Haemopoiesis in children occurs in almost all bone
- In adults it mainly occurs in the bone marrow, especially the pelvis, femur and sternum
- Bone marrow starts developing haematopoietic activity at roughly 10 weeks gestation

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16
Q

What is the intravascular life span of red blood cells and what is their major function?

A

120 days
oxygen transport

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17
Q

What is the intravascular life span of platelets and what is their major function?

A

10 days
haemostasis

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18
Q

What is the intravascular life span of monocytes and what is their major function?

A

several days
defence against infection by phagocytosis and killing of micro-organisms

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19
Q

What is the intravascular life span of neutrophils and what is their major function?

A

7-10 hours
defence against infection by phagocytosis and killing of micro-organisms

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20
Q

What is the intravascular life span of eosinophils and what is their major function?

A

a little shorter than neutrophils
defence against parasitic infection

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21
Q

What is the intravascular life span of lymphocytes and what is their major function?

A

very variable lifespan
Humoral and cellular immunity

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22
Q

How are haematopoietic stem cells and progenitor cells distributed?

A

Haemopoietic stem cells and progenitor cells are distributed in an ordered fashion within the bone marrow amongst mesenchymal cells, endothelial cells and the vasculature with which the HSCs interact

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23
Q

What regulates haemopoiesis?

A

A number of genes, transcription factors, growth factors and the microenvironment
- disruption of this regulation can disturb the balance between proliferation and differentiation, and may lead to leukaemia or bone marrow failure

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24
Q

what are haemopoietic growth factors?

A

Glycoprotein hormones which bind to cell surface receptor
- they regulate proliferation and differentiation of HSCs
- regulate function of mature blood cells

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25
Q

Give examples of haemopoietic growth factors.

A

Erythropoiesis (red cell production): ERYTHROPOIETIN

Granulocyte and monocyte production: G-CSF, G-M CSF, cytokines e.g. interleukins

Megakaryocytopoiesis and platelet production: THROMBOPOIETIN (TPO)

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26
Q

Describe Lymphoid differentiation.

A
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27
Q

Describe Myeloid differentiation.

A
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28
Q

What are erythroids.

A

Cells concerning RBCs/ erythrocytes.

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29
Q

Where does erythropoiesis occur?

A

Bone Marrow

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30
Q

What are the overall major cells made from haemopoiesis: differentiation from stem cells?

A
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31
Q

What is erythropoeisis?

A

Development of RBCs

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32
Q

How is a red blood cell formed, starting from the common myeloid progenitor?

A

The common myeloid progenitor can give rise to pro-erythroblasts

This in turn gives rise to erythroblasts

Then erythrocytes

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33
Q

What happens as differentiation progresses?

A

Self renewal and lineage plasticity decreases

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34
Q

What stains RNA content?

A

New methylene blue

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35
Q

What are the types of erythroblasts?

A

early–> intermediate–> late erythroblasts

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36
Q

What stage of a RBC is higher RNA content seen in the peripheral blood?

A

reticulocytes

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37
Q

What are reticulocytes?

A

immature young RBC, that circulate in the blood for 1-4 days before maturing into erythrocytes
- Reticulocytes have no nucleus, but lots of RNA to complete the production of haemoglobin (as they mature in the blood)

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38
Q

What is needed for erythropoiesis?

A

iron
Folic acid
Vitamin b23
Erythropoietin

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39
Q

What is erythropoietin?

A

a growth factor

glycoprotein synthesised in response to hypoxia- so there is a demand supply feedback loop

erythropoietin stimulates the bone marrow to produce more RBCs

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40
Q

What is HAEM iron also known as?

A

Ferrous iron - fe2+= animal derived, best absorbed form

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41
Q

What is non-HAEM iron also known as?

A

Ferric iron - fe3+= in food and requires action of reducing substances (e.g., ascorbic acid, vitamin C) for absorption

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42
Q

What affect do phytates have on iron absorption?

A

They reduce it

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43
Q

What organs is excess iron toxic to?

A

Heart and liver

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44
Q

Iron absorption is tightly controlled because it can be toxic, how much is absorbed from the diet a day?

A

1-2mg

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45
Q

How is absorption of iron carefully regulated?

A

Absorption of iron from the gut and release of storage iron is blocked by hepcidin (secreted by liver in response to high storage iron)

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46
Q

Where is ferroportin found?

A

In duodenum enterocytes

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47
Q

How do we lose iron if it is high?

A

Higher iron leads to HEPCIDIN release, which blocks ferroportin, so iron cannot leave the enterocytes. Therefore when the enterocyte is destroyed so is the iron stored within it

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48
Q

What does inflammation do to Hepcidin?

A

Increases hepcidin, and therefore can lead to anaemia of inflammation as there is not enough iron in the blood as it is all being kept within the enterocytes

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49
Q

What are the pro-inflammatory cytokines?

A

IL-1, TNFa, IL-6, IFNy

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50
Q

Why do we need vitamin B12?

A

They are needed for dTTP synthesis - thymidine, needed for DNA synthesis

Integrity of the nervous system

51
Q

Why do we need folic acid?

A

They are needed for dTTP synthesis - thymidine, needed for DNA synthesis

Homocysteine metabolism

52
Q

Due to them affecting DNA synthesis, vitamin B12 and folic acid deficiency affects all rapidly dividing cells, which are?

A

Bone marrow: cells can grow but are unable to divide normally

Epithelial surfaces of mouth and gut

Gonads

53
Q

What can a Vitamin B12 and Folate deficiency cause?

A

Megaloblastic erythropoiesis - this is because the cells keep dividing but lack the DNA
Macrocytic (RBCs large size)

54
Q

Where is folic acid absorbed?

A

in the small intestine

55
Q

Name three sources of Folate

A

Green leafy vegetables, cauliflower and Brussels sprouts

56
Q

When do requirements of folate increase?

A

pregnancy
increased red cell production e.g., sickle cell anaemia, other haemolytic anaemias

57
Q

Name three sources of B12

A

Meat, fish, clams

58
Q

What does B12 combine with so it can be absorbed?

A

Intrinsic factor which is made in the gastric parietal cells

59
Q

What is the order of absorption of vitamin B12?

A

1) Stomach
- B12 combines with intrinsic factor (IF) made in the gastric parietal cells

2) Small intestine
- B12-IF binds to receptors in the ileum

3) Vitamin B12 deficiency may result from:
- Inadequate intake e.g. veganism
- Inadequate secretion of IF: pernicious anaemia (autoimmune disorder)
- Malabsorption e.g. coeliac disease, surgery
Lack of acid in stomach (achlorhydria)

60
Q

What causes vitamin B12 deficiency

A

Inadequate intake, pernicious anaemia and malabsorption

61
Q

What does iron deficiency cause?

A

microcytic (RBCs small size)
anaemia of chronic disease/ inflammation

62
Q

What can cause iron deficiency?

A

increased loss (blood loss)
Reduced intake
Increased requirement

63
Q

What is pernicious anaemia?

A

This is where your body does not make IF therefore the B12 cannot bind and therefore cannot be absorbed

64
Q

Why do red blood cells have a life span of 120 days?

A

When they move through capillaries and blood vessels, the walls bend and stretch meaning they get damaged

65
Q

Where are the red blood cells destroyed?

A

Spleen

66
Q

What are the RBCs broken down into?

A

HAEM and globin

67
Q

What does the HAEM part of the RBC after it is destroyed?

A

Gets broken down into bilirubin

68
Q

How is bilirubin excreted

A

In bile

69
Q

Why is bile important

A

Contains bile salts which are needed for the emulsification of fats so they can be absorbed

70
Q

What are the three types of granulocytes

A

Neutrophil, basophils and eosinophil

71
Q

What does hypochromia mean?

A

Too little haemoglobin so pale

72
Q

What is a polychromatic RBC?

A

One that is too red due to too much haemoglobin

73
Q

What are target cells?

A

When you have an accumulation of haemoglobin in the area of central pallor

74
Q

What causes the presence of target cells?

A

Jaundice, liver disease, hyposplenism

75
Q

What does anisocytosis mean

A

Variation in size

76
Q

What does poikilocytosis mean

A

Variation in shape

77
Q

What causes sickle cells?

A

Due to the polymerisation of HbS which forms tachtoids that distort the shape of the RBC

78
Q

What is the mutation that causes sickle cell disease? SICKLE CELL SIX GIVES ME A CRISIS

A

Charged glutamic acid residue at positive 6 in beta Hb gene is replaced by uncharged valine

79
Q

“Normal” Hb is determined by many things like..

A

Gender and physiological status eg altitude

80
Q

What type of distribution fo Hb concentrations show?

A

Gaussian distribution

81
Q

An infant with sickle cell anaemia (HbSS) develops symptoms of fatigue and pain. Blood tests reveal anaemia with thrombocytopenia. Examination reveals a mass on the left-hand side of his abdomen. Given this information, what could be the most likely explanation for his symptoms?

A

Pooling of blood in the spleen - spleenic sequestration

82
Q

What is Crohn’s Disease?

A

inflammatory bowel disease which often involves ulcer formation in the mucosal layer of the intestines.

83
Q

How can Crohn’s disease lead to iron-deficiency anaemia?

A

Crohn’s disease can lead ulcer formation in the stomach, meaning internal bleeding can occur. This may result in iron-deficiency anaemia due to blood loss

84
Q

What regulates the proliferation and differentiation of Haematopoietic stem cells?

A

Haematopoietic growth factors

85
Q

A 28-year old female has some tests carried out following a full blood count that subsequently reveal that she is folate deficient. What changes in the red blood cells would you expect to see.

A

Macrocytic cells

86
Q

What are haematopoietic growth factors?

A

Glycoprotein hormones which bind to cell surface receptors
Regulate proliferation and differentiation of HSCs
Regulate function of mature blood cells

87
Q

What is the haematopoietic growth factor which influences red cell production?

A

Erythropoietin

88
Q

What are the haematopoietic growth factors which influence granulocyte and monocyte production?

A

G-CSF, G-M CSF, cytokines e.g. interleukins

89
Q

What are three causes of microcytic anaemia?

A

Iron deficiency
Pregnancy
Childhood

90
Q

What are three causes of macrocytic anaemia?

A

(B12/folate deficiency)- alcohol excess, pregnancy, vegan diet

91
Q

What are the two main functions of iron?

A

Oxygen transport in haemoglobin

Mitochondrial proteins
- cytochromes a, b and c: for production of ATP
- cytochrome P450 for hydroxylation reactions (e.g., drug metabolism)

92
Q

What are side effects of iron deficiency?

A

Hypochromic (pale), microcytic (small), red cells

Spoon shaped nails: koilonychia

Glossitis and angular stomatitis (shiny tongue)

93
Q

How much iron does the normal western diet contain?

A

10-20mg per day

94
Q

Why is ferric iron not as easily absorbed?

A

and requires action of reducing substances (e.g. vitamin C) for absorption

95
Q

How does anaemia of chronic disease/inflammation occur?

A

Pro-inflammatory cytokines such as IL-1, TNF-alpha, IL-6 and IFN-gamma work to decrease EPO production, and increase hepcidin - increased hepcidin means less iron absoprtion in the gut as hepcidin binds to ferroportin, meaning iron is unable to leave theenterocytes and therefore is destroyed when the entoercytes die

96
Q

When is hepcidin released?

A

Released from the liver in response to high storage iron

97
Q

What can cause a deficiency in B12?

A

inadequate intake e.g. veganism
- inadequate secretion of IF: pernicious anaemia (an autoimmune disorder)
Malabsorption e.g. coeliac disease
lack of acid in stomach (achlorhydria)

98
Q

During what situations do the requirements for folic acid increase?

A

During pregnancy and during red cell production

99
Q

What three things does erythrocyte function depend on?

A

Integrity of the membrane
Haemoglobin structure and function
Cellular metabolism

a defect in any of these results in shortened erythrocyte survival (haemolysis)

100
Q

What structures helps to maintain the integrity and shape of the red cell?

A

The red cell membrane - made of lipid bilayers which is supported by proteins and contains transmembrane proteins

101
Q

What is special about the red cell membrane (3 things)?

A
  • Erythrocytes are biconcave in shape, aiding manoeuvrability through small blood vessels to deliver oxygen
  • The membrane is made up of a lipid bilayer supported by protein cytoskeleton and contains transmembrane proteins

*These maintain the integrity, shape and elasticity/ deformability of the red cell

102
Q

What are the transmembrane proteins found in red cell membrane?

A

Band 3 and rhesus

103
Q

What are the skeletal proteins found in red blood cells membrane?

A

Spectrin and junctional

104
Q

What does a disruption to vertical linkages in the red blood cell membrane cause?

A

Hereditary Spherocytosis

105
Q

What are the vertical linkages usually disrupted in spherocytosis?

A

ankyrin/ spectrin

106
Q

How is spherocytosis passed on?

A

autosomal dominant

107
Q

Describe spherocytes.

A

Spherocytes are cells that are approximately spherical in shape
They therefore have a round, regular outline and lack central palor
They result from the loss of cell membrane without the loss of an equivalent amount of cytoplasm
So the cell is forced to round up
RBC become less flexible and are removed prematurely by the spleen

108
Q

Disruption of horizontal linkages in red cell membrane produces…

A

Hereditary elliptocytosis
- it may also occur in iron deficiency

109
Q

How does deficiency in G6PD affect red cells?

A
  1. G6PD is an important enzyme in the HMP shunt
  2. The HMP shunt is involved in metabolism of glutathione which protects the red cell from oxidant damage
  3. Therefore deficiency of G6PD causes red cells to be vulnerable to oxidant damage
110
Q

What protects the red cells from oxidant damage?

A

Glutathione

111
Q

What does G6PD deficiency cause?

A

G6PD deficiency usually causes intermittent, severe intravascular haemolysis as a result of infection or exposure to an exogenous oxidant

112
Q

What are examples of extrinsic oxidants?

A

foodstuff, e.g., broad beans, chemicals, drugs

113
Q

What are episodes of intravascular haemolysis associated with the appearance of?

A

considerable numbers of Irregularly contracted cells/ ‘bite cells’

114
Q

What are bite cells?

A
  • These irregular in outline but are smaller than normal cells and have lost their central pallor
  • They usually result from oxidant damage to the cell membrane and to the haemoglobin
    Haemoglobin is denatured and forms round inclusions known as Heinz bodies, which can be detected by a specific test
115
Q

Explain more of glucose-6-phosphate dehydrogenase (G6PD) deficiency.

A
  • X-linked inheritance: the gene for G6PD is on the X chromosome so affected individuals are usually hemizygous males (occasionally homozygous females)
  • Distribution parallels malaria: selective advantage, resistance to falciparum malaria
116
Q

What is polycythaemia?

A

High concentration of RBCs in blood
- blood is therefore thicker
- less able to travel through vessels
- and towards organs

117
Q

What is increased with polycythaemia?

A

Hb, RBC, and Hct increased compared with normal subjects of the same age and gender

118
Q

What is pseudo polycythaemia?

A

reduced plasma volume

119
Q

What is true polycythaemia?

A

increase in total volume of red cells in the circulation

120
Q

What are the 4 causes of polycythaemia?

A

Blood doping or overtransfusion

Appropriately increased erythropoietin

Inappropriate erythropoietin synthesis or use

Independent of erythropoietin

121
Q

What is an example of appropriately increased erythropoietin?

A

polycythaemia can result from the action of erythropoietin that is appropriately elevated
e.g., as a result of hypoxia
- in some situations such as at altitude this may be beneficial

122
Q

When might there be inappropriate erythropoietin synthesis or use?

A

Renal or other tumour inappropriately secretes erythropoietin
- this is not surprising since this is a major site of erythropoietin production

123
Q

When is there polycythaemia independent of erythropoietin?

A

This condition is an intrinsic bone marrow disorder called polycythaemia vera

It is classified as a myeloproliferative disorder

Polycythaemia can lead to ‘thick blood’– more technically known as hyperviscosity, which can lead to vascular obstruction/ thrombosis

Blood can be removed (venesection) to reduce the viscosity
Drugs can be given to reduce bone marrow production of red cells

POM HAEMATOLOGY (11 decks)

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