Red blood cells App

Question 1

Evaluation of RBCs

Answer 1

Evaluation of Red Blood Cells

1. Number (RBC)
2. Size (MCV)
3. Hemoglobin content (MCH, MCHC)
4. Shape (poikilocytosis)
5. Variation in size (anisocytosis, RDW)
6. Color (polychromasia)
7. Inclusions
8. Precursor cells (nucleated RBCs)
9. Pattern

MCH (mean corpuscular hemoglobin) is the weight of hemoglobin in RBCs and MCHC is MCH relative to the volume of RBCs. If MCHC is elevated, that means our RBCs are hyperchromic.

Question 2

Coulter principle for RBCs

Answer 2

• particles suspended in a conductive electrolyte solution are drawn through small aperture.
• if a DC current is applied, we can create a sensing zone where every particle that passes throuhg displaces a certain amount of saline which changes the impedence of the sensing zone proportional to the size of the particle -> measured voltage is proportional to cell volume.

Question 3

Answer 3

Observation: hypochromia, microcytosis, moderate poikilocytosis
Deduction/conclusion: iron deficiency anemia due to blood loss. There is not enough reticulocytes because of an inability to make heme

Question 4

Answer 4

Observation: macrocytic, hypersegmentation of neutrophils, NO polychromasia
Deduction: this should be a RBC production problem
Conclusion: megaloblastic anemia liekly from a B12 or folic acid deficiency. Both of those causes look identical in a blood smear but neurological symptoms leads to a B12 deficiency

Question 5

Answer 5

Observation: likely an elevated MCHC->RBCs are slightly spherocytic->spherocytosis, polychromasia, hyperchromic
Deduction(s): hereditary spherocytosis or warm agglutinin -> Coombs test
Conclusion:
splenomegaly points more toward warm agglutinin
sclera ictera-> yellowing of sclera -> excess free bilirubin from hemolysis

Question 6

Answer 6

Observation: elliptical, normocytic (maybe slightly hypochromic)
Deduction/Conclusion: hereditary elliptocytosis due to cytoskeleton issue
-not particularly symptomatic, qualitative problem in cytoskeleton. differs from hereditary pyropoikilocytosis by thermal stability test

Question 7

Answer 7

Observation: spur cells with howell-holly bodies from asplenia
Deduction/Conclusion: acanthocytosis due to increase in cholesterol in outer membrane

Question 8

Answer 8

Observation: burr cells
Deduction: could be pyruvate kinase deficiency, but more likely due to chronic renal disease
Conclusion: hemolysis leads to bilirubin leads to jaundice

Question 9

Answer 9

Observation: schicstocytes (fragmentation)
Deduction: thrombocytopenia
Conclusion: microangiopathic hemolytic anemia

Question 10

Answer 10

sickle cells, howell jolly bodies from functional asplenia, sclera ictera
-sickle cell anemia, Priapism - occurs die to this during episodes

Question 11

Answer 11

target cells ->excess membrane/hemoglobin deposition
-HgSC -> almost wants to be sickle cells but cant

Question 12

Answer 12

beta thalassemia likely due to extramedullary erythropoiesis. cyprus, homozygous beta thalassemia. lifelong transfusions required, distinguish between this and alpha thalassemia by measuring HgA2, which is elevated only in beta thalassemias

Question 13

Answer 13

tear drop cells -> seemingly sheared during exit from bone marrow -> fibrosis of bone marrow
-leukoblastosis -> immature WBC, meaning bone marrow problem

Question 14

Answer 14

hemoglobin will be normal on a cbc

Question 15

Answer 15

malaria