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Medical conditions associated with red blood cell abnormalities
a general increase in RBC's
a general decrease in RBC's
storage form of iron in tissue
Disorders in production of myelod stem cells
what are the four aspects of RBC evaluation
The color of an RBC depends on what?
the amount of Hgb
any variation in size due to deficiency in the raw material; associated with increased RDW.
Normal RDW range.
an RBC that is, <6 microns, MCV is <80fL, and seen in Iron deficiency, Thalassemia, Lead Poisoning, and sideroblastic anemia.
An RBC that is >8 microns, MCV is 99fL, and seen in liver disease, megaloblastic process, hypothyroidism, Chemotherapy and newborns.
RBC's have decreased Hgb, increased central pallor, and MCHC is <32%.
RBC's decreased surface-to-volume ration, decreased to absent central pallor, increaed Hgb, MCHC is >36%, usually spherical, not biconcave.
This refers to the entire red cell morphology in the scanned area of a peripheral smeal.
Grading scale for RBC morphology
An RBC that has an irreversible defect or loss of the cell membrane resulting in no central pallor.
This abnormality is seen in hereditary spherocytosis, immune hemolytic anemia, and post transfusion.
These are also called crenated, or burr cells and may be artifact in origin.
True forms of this abnormality occur in small numbers and have unevenly spaced spicules.
These abnormalities are associated with uremia, heart disease, dehydration, and untreated hypothyroidism.
These are RBC's with 3-12 blunt, irregularly spaced spicules that result from LCAT enzyme deficiency.
These cells have contain excess cholesterol and are associated with abetalipoproteinemia, pyruvate kinase deficiency, zieve's syndrome, and vitamin E deficiency.
These abnormalities also called dacrocytes are pair shaped and associated with thalassemia and iron deficiency.
These are RBC's that have been caught in fibrin strands in circulation and fuses together to create a vacuole that resembles a blister.
These cells are formed when the spleen bites off large RBC inclusion like Heinz bodies. They are associated with G6PD and pulmonary emboli. also called bite cells.
these cells, also called codocytes, may be artificially induced on a slide or caused by excess membrane cholesterol.
This abnormality is associated with liver disease, thalassemia, Hgb C, and iron deficiency anemia.
These cells have been transformed by hemoglobin polymerization into a ridged and inflexible crescent shape. also called a drepanocyte.
These are extreme fragmentations of RBC's that have been split, cut or cloven due to trauma to the cell membrane.
This abnormality is associated with DIC, hemolytic anemia, heart valve surgery, and severe burns.
The name for these abnormalities is used interchangeably but one is more egg shaped while the other is more pencil shaped.
These abnormalities are belived to be a result of mechanical weakness or fragility of the membrane skeleton.
This abnormality is associated with thalassemia and the megaloblastic process
This abnormality is associated with hereditary elliptocytosis and iron deficiency anemia
These cells have an oval or rectangular central pallor as the result of membrane defect or artifactual origin; they are associated with acute alcoholism and hereditary stomatocytosis.
in a stomatocyte cause by membrane defect how will the central pallor appear?
slit like area of pallor appear shaded.
if artifactual in origin how will the central pallor appear in a stomatocyte?
slit like area of pallor
RBC's arranged in stacks like coins due to abnormal protein coating on the cell's surface.
This is associated with multiple myeloma, waldentrom's macroglobulinemia, and chronic inflammatory disorders.
This is when RBC's are clumped and results from Ab-Ag interaction associated with cold agglutinins and paroxysmal cold hemoglobinuria.
This is a round purple staining body seen single or doubly in peripherary of cell membrane that is normally pitted by the spleen.
This inclusion is associated with splenectomy, megaloblastic anemia, thalassemia, hemolytic anemia, and sickle cell anemia
howell jolly bodies
These are small irregular, magenta colored inclusions seen in periphery of cell usually in clusters.
these inclusions are referred to as siderotic granules if stained with prussian blue which is the confrimation test.
These inclusions consist of nonheme iron, resulting from excess of available iron throught the body.
These inclusions are associated with sideroblastic anemia, sickle cell anemia, thalassemia and splenectomy.
This is a coarse or diffuse blue staining body that consists of percipitated ribosomes that occurs when smear is drying.
this inclusion is associated with thalassemia, lead poisoning, alcoholism, and megaloblastic anemia.
This is a purple thread-like loop that is remnants of microtubules found in stippled cells.
This inclusion is associated with megaloblastic anemia, post splenectomy,and homozygous thalassemia.
This inclusion is aggregates of precipitated hemoglobin only seen in crystal violet stain or cresyl blue.
This inclusion is associated with G6PD deficiency under oxidative stress and alpha thalassemia.
this is the most common protozoal infection, contracted thru mosquito bites.
This is caused by four species fo plasmodium that invade RBC's.
This parasite may be mistaken for platelets.
This parasite is caused by infection thru tick bites, organism is called babesia microti.
Condition in which there is reduced oxygen delivery to the tissues
what are three things anemia may result from?
destruction of RBC's
Excessive blodd loss
decreased production of red cells
what is classification of anemias based on?
what are the three types microcytic hypochromic anemias?
Iron deficiency anemia
anemia of chronic diseases
This is a microcytic hypochromic anemia that develops in 3 stages, it is acquired and prgessive.
iron deficiency anemia
what are the three stages that lead to iron deficiency anemia?
iron depletion (w/o anemia)
iron deficient erythropoiesis (w/ mild anemia)
Iron deficiency anemia develops (w/severe anemia)
this anemia occurs in:
decreased iron intake
increased iron utilization
loss of iron
iron deficiency anemia
Which type of anemia will result in weakness and dyspnea, increased TIBC, and decreased Hgb and retics.
iron deficiency anemia
This is a microcytic, hypochromic anemia that in sex linked and congenital.
what is the cause of primary sideroblastic anemia?
what is the cause of secondary sideroblastic anemia?
toxins or drugs
This microcytic hypochromic anemia will cause dismorphic RBC's, decreased TIBC, and increased serum iron and ferritin.
hereditary sideroblastic anemia
This microcytic hypochromic anemia will cause dismorphic RBC's basophilic stippling and ringed sideroblasts.
acquired sideroblastic anemia
This anemia is associated with infections, and autoimmune disorders.
anemia of chronic disorders.
This anemia is caused by a failure of kidneys to produce erythropoetin, or a renal disease that leads to chemical imbalance or uremia
anemia of chronic renal problems.
This anemia may cause burr cells due to uremia and hemolysis due to mechanical trauma or adverse metabolic environment.
anemia of chronic renal problems
This anemia is associated with diseases of the thyroid, pituitary, adrenals, and gonads which produce hormones for erythropoiesis.
anemia of endocrine diseases.
Macrocytic normochromic anemia is also know as what?
This anemia has defective nuclear maturation caused by impared DNA synthesis due to Vit B12 and folic acid deficency
macrocytic normochromic anemia
This Anemia is seen in strict vegetarians, fish tapeworm, and pernicious anemia patients.
macrocytic normochromic anemia
The lab findings in this anemia are slight ovalocytosis and tear drops, abnormal schilling test, increased MCV, and hypersegmented neutrophils in more than 98% of cases.
macrocytic normochromic anemia
This anemia is a failure of bone marrow to produce blood cells.
the congenital form of aplastic anemia is known as what?
The Lab findings of this anemia include pancytopenia, normocytic normochromic RBC's, polychromasia, and decreased retic count, Hgb, and Hct.
This is a group of anemia characterized by increased destruction of RBC's.
This is the most common hereditary hemolytic anemia in northern europe.
This hemolytic anemia is due to defective spectrin, it causes jaundic durring hemolytic episodes and is diagnosed in early childhood.
In this hemolytic anemi RBC's are spherical instead of biconcave which makes them hyperpermeable to sodium.
Lab finding of this hemolytic anemia include spherocytes, an MCHC >36% in 50% of cases, and osmotic fragility is increased.
This anemia is caused by a defective cytoskeleton, 90% have no clinical, 10% have symptoms similar to spherocytosis.
The Lab findings of this anemia are elliptocytes and increased reticulocytes.
This hemolytic anemia is characterized by a sodium potassium imbalance that causes RBC's to swell.
The lab finding of this hemolytic anemia are stomatocytes, MCV increased, and MCHC decreased.
This is the most common RBC enzyme disorder that is generally seen in black populations.
This hemolytic anemia is harmless unless exposed to oxidative stress such as antimalarial drugs and fava beans.
The lab finding of this Hemolytic anemia include heinz bodies, basophilic stippling, and hemoglobinuria.
In this hemolytic anemia deficiency in PK causes reduced ATP and RBC's become fragile.
pyruvate kinase (PK) deficiency
This anemia results from infection and causes a loss of self recognition of individual's own RBC's, auto-antibody's are produced against own RBC's,
autoimmune hemolytic anemia
What are the three types of auto immune hemolytic anemia?
Warm agglutinin auto-immune hemolytic anemia (WAIHA)
Cold Agglutinin auto-immune hemolytic anemia (CAIHA)
Paroxysmal cold hemoglobinuria (PCH)
This very rare hemolytic anemia involves antibodies with optimal serological activity at 37
C has Lab findings of schistocytes and Retculocytes.
This Hemolytic anemia involves antibodies with optimal serological activity at 4
C, (also seen at 25-31
C, and has lab findings of rouleaux formation and RBC agglutination.
This is the least common of the AIHA and is seen almost exclusively in children.
This animia involves anti-P which attaches to RBC's at low temperatures and as body temp increases it causes RBC hemolysis that results in severe and rapid anemia
what is the test for PCH?
This Hemolytic anemia is caused a blood type incompatiblity betwen the mother and fetus.
Hemolytic Disease of Newborns (HDN)
In HDN administration of this drug prior to a fetal-maternal hemorrhage can prevent the other from producing anti-D.
What is it called when rhogam is administered prior to a fetal-maternal hemmorhage?
Rhogam is usually given when durring pregnancy to D-negative mother
at 28 weeks
again within 72hrs of birth.
This fairly rare hemolytic anemia has an insidious onset, the RBC membrane is abnormal, and is confired by the HAM's test.
Proximal Nocturnal Hemolysis (PNH)
This Hemolytic anemia's Lab findings are hematuria (worst in the morning), leukopenia, thrombocytopenia, and slight macrocytosis.
Proximal Nocturnal Hemolysis (PNH)
This anemia is caused by drugs that lead to immune complex formation, autoimmunity, or membrane modification.
drug induced IHA
This anemia has lab findings of extravascular hemolysis, spherocytosis and a positive DAT test.
Drug induced IHA
This is a diverse group of conditions that shorten RBC survial such as infections, mechanical damage or chemical and physical agents. Lab findings are dependent on causative factor.
This anemia is caused by a sudden loss of blood in a short period of time.
acute blood loss anemia
In acute blood loss anemia reticulocytes will increase ____ days after blood loss and peak at ______ days.
this anemia is caused by a loss of small quantities of blood over a long period of time.
chronic blood loss anemia
This is synthesized in mitochondria and contains iron.
This is synthesized in ribosomes and is twisted along the heme group, each has an exact number and sequence of amino acid.
what are the four types of globin?
This hemoglobin consists of two alpha chains, and two beta chains and is 95-97% of all hemoglobin.
This hemoglobin consists of two alpha chains and two delta chains and is 2-3% of all Hgb.
This Hemoglobin consists of 2 alpha chains and two gamma chains and is 1-2% of all hemoglobin.
Anemias characterized by a structural defect in the hemoglobin.
what type of Hgb chain defects are usually clinically significant?
alpha or beta
what type of Hgb chain defects are usually not clinically significant?
gamma and delta
these are hgb structural defects due to amino acid substitutions.
qualitative structural defects
These are hgb structural defects due to impared production of the globin chain.
quantitative structural defects
what are the types of qualitative structural defects.
What are the types of quantitative structural defects?
Beta Thalassemia (major and minor)
This is due to substitution of amino acid valine for glutamic acid on the 6th position of beta chain, also known as sickle cell.
This condtion leads to chronic hemolytic anemia, decreased O2 causes RBC's to sickle and become rigid, sickle cells plug small vessels in joints and abdomen.
Sickle Cell Anemia
in this conditon sickle cells, target cells, howell-jolly bodies, and NRBC's are seen along with a positive sickle cell. electrophoresis shows no Hgb A, 80% or more Hgb S, and 1-20% Hgb F.
Sickle Cell anemia
In this condition no sickle cells will be in the smear unless in crisis, sickle cell test is positive and electrophoresis shows 60% Hgb A and 40% Hgb S.
Sickle cell Trait
This is the substitution of lysine for glutamic acid on the 6th position of beta chain mostly in black populations.
in this conditon 50-90% target cells are seen, increased retics are noted as well as Hgb C crystals, electrophoresis shows no Hgb A, 95% Hgb C plus A2, and <7% Hgb F.
Hgb C disease
In this condtion there are no clinical symptoms and electrophoresis shows 60% Hgb A and 40% Hgb C plus A2.
Hgb C trait
This condition mostly seen in blacks has symptoms like sickle cell and is caused by two abnormal beta chains, Hgb S and Hgb C.
This condition will have Target cells, Hgb C crystals, Folded RBC's, and sickle cells. electrophoresis will show 50% Hgb S and 50% Hgb C.
This is the substitution of lysine for glutamic acid at the 26th position of beta chain, mostly seen in south east asia.
This condition has mild anemia and moderate target cells, electrophoresis shows 95-97% Hgb E plus A2 and 3-5% Hgb F.
Electrophoresis of this condition will show 70% Hgb A and 30% Hgb E plus A2
Hgb E trait
This is the decreased production of one globin chain that causes decreased production of normal hemoglobin.
In this condition the beta chain is decreased or absent, and excess A2 causes apoptosis of red cell precursors which leads to ineffective erythropoiesis.
This is a homozygous state that occurs in people of Mediterranean decent and causes severe anemia.
Symptoms of this conditon are splenomegaly, retarded growth and mongoloid facial features.
Lab findings of this condition include basophillic stippling, many target cells, howell jolly bodies, pappenheimer bodies, NRBC's and increased Retic count.
In this condition Alpha chains are reduced or absent and there is an excess of Fetal and beta chains.
In this condition Beta chains form stable nonfunctional tetramers.
what are some stable nonfunctional tetramers seen in alpha thalassemia?
: 4 beta chains
: 4 Gamma Chains
Absence of all alpha chains is ___________.
incompatible with life
which type of thalassemia occurs in the uterus
Who is ID of alpha thalassemia minor important to? why?
Women of childbearing years or pregnant of mediterranean decent.
at risk for hydrop fetalis
prevent unnecessary treatment of Iron deficency anemia
This is a chronic life shortening myeloproliferative disorder involving all bone marrow elements, characterized by an increase in RBC mass and Hgb concentration.
what are the types of polycythemia?
this is a chronic disease with insidious onset, symptoms are headaches, epistaxis, myocardial infarction, thrombosis, splenomegaly, hepatomegaly, and erythromelalgia.
Lab findings of this condition are an elevated RBC count, Hgb, and Hct. thrombocytosis, leukocytosis, decreased erythopoesis, and increased red cell mass.
in polycythemia vera this must be seperated from a true increase in red cell mass.
This condition is caused by hypoxic situations such as COPD, cyanosis and CHF, and an excess production of erythropoietin causes an increase in RBC's.
This condition is also known as hypoxic erythrocytosis.
this condition has an increased red cell mass, increased erythropoietin, and a normal plt/WBC count.
In this condtion an increased Hct is secondary to a decrease in plasma volume.
This condition is seen in acute and subacute dehydration and also middle aged men with a history of smoking, hypertension, and obesity.
This test measures the ability of the RBC's to take up fluid without lysing, it is used to diagnose hemolytic anemias specifically spherocytosis.
osmotic fragility test
in this test whole blood is added to saline dilutions which lyses RBC's Hgb is measured.
osmotic fragility test
what is an effective measure of erythrocyte susceptibility to hypotonic damage?
the presence or absence of hemolysis
In normal RBC's
inital hemolysis occurs at:
complete hemolysis occurs at:
: 0.45% NaCl
: 0.30% NaCl
initial hemolysis occurs at:
Complete heolysis occurs at:
: 0.65% NaCl
: 0.45% NaCl
In this test lysing agent and sodium dithionate is added to RBC to release Hgb and reduce Hgb S which forms turbid crystals.
Sickle cell test
This test is used to determine the different types of Hgb present in blood.
What is the specimen of choice for Hgb electrophoresis?
EDTA whole blood
using cellulose acetate at pH 8.4 Hgb migration pattern is:
Using citrate agar pH 6.0-6.2 migration pattern is: