Red Blood Cells

Question 1

Sites of production throughout the life

Answer 1

Embryo - Yolk sac during 3rd week
Liver - chief site from 3rd month til late pregnancy
Bone marrow - begins 4th month and is sole source in normal term baby
Spleen, lymph node, thymus - small
Infants, children - all skeleton active
Adults - axial skeleton

Question 2

Increased demand can cause

Answer 2

Fatty marrow to become active
7-8 fold increase possible
Extramedullary hematopoiesis can occur

Question 3

Common origin for cells we are talking about

Answer 3

Hematopoietic pluripotent stem cell

Question 4

Stems cells have

Answer 4

Capcity for self-renewal as well as giving rise to committed stem cells

Question 5

Earliest precursors can

Answer 5

Actively divide but NOT self replicate

Question 6

Erythroid pathway

Answer 6

BFU-E - burst forming unit
CFU-E - colony forming unit
Stem cell factor and IL3,6 are grwoth factors
EPO affects

Question 7

Normal adult bone marrow

Answer 7

1:1 ratio of fat to cells

Children have more cells, elderly may have less

Question 8

When might marrow be more cellular

Answer 8

Stress, megaloblastic anemia and hemolytic anemias, and other dz

Question 9

Aplastic anemia marrow appearance

Answer 9

Hypocellular with decreased precurosors and patients have low blood counts

Question 10

Myeloid to erythroid ratio is

Answer 10

3:1

Question 11

Red cell devleopment results in

Answer 11

Decreased size and loss of nucleus…increasing redness of cytoplasm

Question 12

B-12 and folate importance

Answer 12

Needed for DNA replication…def cause arrest during S phase and death during maturation (ineffective erythropoiesis)

Question 13

B-12 and folate cell appearance

Answer 13

Hypercellular marrow, hypersegemented neutrophils, cytoplasmic asyncrhony and macrocytic megaloblastic cells

Question 14

Iron importance

Answer 14

Used to form heme or stored as ferritin…sideroblastic anemia is ferritin accumulation in mitochondria

Question 15

Normal hemoglobin structure

Answer 15

4 globin chains and heme molecule
Adult has 2 alpha and 2 beta
Fetal has 2 alpha and 2 gamma
A2 has 2 alpha and 2 delta

Question 16

Anemia

Answer 16

Decreased red cells

Question 17

Polycythemia

Answer 17

Increased red cells
Primary - myeloproliferative disorders
Secondary - to increased erythropoietin

Question 18

Measurement of hemoglobin, hematocrit and RBC count

Answer 18

Hemoglobin - spectrophotometry
Hematocrit - calculated or spun value
RBC count - electrical impedence

Question 19

MVC, MHC, MCHC, RDW

Answer 19

Mean cell volume
Mean cell hemoglobin
Mean cell hemoglobin concentration
Red cell distribution width

Question 20

MCV equation and how to read RDW and MCV

Answer 20

Width - RDW
Peak - MCV

MCV = (HCT*10)/RBC

Question 21

Special equation

Answer 21

RBCMCV=Hct10

Question 22

MCH vs MCHC

Answer 22

MCH= (Hb*10)/RBC 
MCHC = (Hb*100)/HCT

MCHC more helpful because takes into account cell size

Question 23

Newborns have

Answer 23

Higher hemoglobin and hematocrit…decreases during childhood then rises again

Question 24

Reticulocyte count and interpretation

Answer 24

Could seem elevated in anemia even if insufficienct because there are fewer RBCs….Convert to mature RBCs in 1 day unless shift (2)

Question 25

Corrected reticulocyte count and why correct?

Answer 25

=(retic%*hct%)/(45*1) Corrects for anemia since there are fewer RBCs

Question 26

Reticulocyte production index and interpretation

Answer 26

Corrected reticulocyte count/2 2 or less - hypoproliferative anemias 3 or more - hemolytic anemia

Question 27

Reticulocyte index with types of anemias

Answer 27

Can't tell with erythropoiesis Elevated in hemolytic Decreased in hypoproliferative

Question 28

Anisocytosis and when we see

Answer 28

Variation in size Sideroblastic anemia Increased RDW

Question 29

Microcytosis and when we see

Answer 29

Small size Low MCV Iron def and thalassemia Also often hypochromatic (decreased MCHC) Normochromic microcytic sometimes seen in hemolytic anemias

Question 30

Macrocytosis and when we see

Answer 30

High MCV | Folate, B12 def

Question 31

Hypochromia and when we see

Answer 31

Often with microcytosis MCV, MCH, and MCHC all decreased Often with microcytosis

Question 32

Hyperchromia and when we see

Answer 32

Increased Hb content Large macrocytic may have increased MCH but MCHC is normal True hyperchromia (MCHC increased) is associated with spehrocytosis

Question 33

POlychromasia and when we see

Answer 33

Use Wright's stain...hemolysis and recent blood loss

Question 34

Poikilocytosis

Answer 34

Variations in shape

Question 35

Elliptocyte and ovalocytes and when we see

Answer 35

If mostly elliptocyte - hereditary elliptocytosis Maccroovalocytes - B12 and folate def Ellipto in small numbers - iron def, thalassemias, hemoglobinopathies

Question 36

Target cells and when we see

Answer 36

Thalassemias, hemoglobinopathies, iron def, and oher hypochromic states Also with liver dz and after splenectomy

Question 37

Spherocytes and when we see

Answer 37

Have less SA/membrane, increased MCHC, and increased fragility Hereditary speherocytosis and some types of hemolysis (warm antibody immune hemolysis)

Question 38

Schistocytes and when we see

Answer 38

Hemolytic conditions like microangiopathic hemolytic anemia

Question 39

Echinocytes and when we see

Answer 39

Artifact or hyperosmolairty/renal failure

Question 40

Acanthocytes and when we see

Answer 40

Liver dz and post-splenectomy

Question 41

Teardrop cells and when we see

Answer 41

Myeloproliferative dz, megaloblastic anemias, and thalassemias

Question 42

SIckle cells

Answer 42

Polymerize into rigid crystal when exposed to decreased oxygen or pH

Question 43

Hwoell-Jolly Bodies and when we see

Answer 43

Remnants of nucelar chromatin | Splenectomy, megaloblastic anemia, abnormal erythropoiesis, or severe hemolytic anemias

Question 44

Heinz bodies and when we see

Answer 44

Denatured hemoglobin | G6PD

Question 45

Basophilic stippling and when we see

Answer 45

Disorders of hemoglobin synthesis (like thalassemia) Blue granules (RNA) Reticulocytes

Question 46

Pappenheimer bodies and when we see

Answer 46

Sideroblasdtic anemias and splenectomy | Fewer number than stippling

Question 47

Normoblasts and when we see

Answer 47

Normal in fetus and young | Pathologic denoting excess demand on marrow (hemolytic disease like erythroblastosis fatalis or transfusions)

Question 48

Rouleax formation and when we see

Answer 48

Stack of coins with increased plasma protein like plasma cell myeloma