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What is the normal size of a RBC?
- -6-8 microns
- -about the size of small lymphocyte
- -MCV is 80-99fl
What is the size of a microcyte?
Microcyte are seen in what?
- -Sideroblastic anemia
- -Lead poisoning
- -Iron defiency
What are the size of macrocytes?
Macrocytes are seen in what?
- -Liver disease, post-splenectomy
- -Megaloblastic process, hypothyroidism
- -chemotherapy & newborns
Poikilocytosis refers to what?
-the entire red cell morphology in the scanned area if a peripheral smear
What are the grades for Poikilocytosis(variation in shape)?
Grade 1+ to 4+
this cell is small, hyperchromic , has no central pallor, reduced surface-to-volume ratio, its irreversible, due to abnormality of the cell membrane(defect or loss of cell membrane)
This is also called crenated or burr cells?
Echinocytes are __-__ even evenly spicules distributed?
Echinocytes may be artifact in origin due to what?
specimen contamination (bad drying)
Echinocytes are associated w/ what?
- -uremia(waste in blood from kidney)
What is the size of Acanthocyte?
- -RBC's w/ 3-12 irregularly spaced spicules
- -spicules vary in length and are blunt rather pointed
What is another name for tear drop?
this cell RBC is pulled into one spicule (pear shaped), inclusion body left RBC, spleen take a bite or RBC?
A tear drop is associated w/what?
- -Iron defiency
- -Thalassemia syndrome
What is another name for helmet cells?
bite cells or Keratocyte
this cell has distinctive projections surrounding an empty space in the RBC w/ 2 distinctive projection surround an empty space.
In helmet cells fragmentation occurs by what?
pitting mechanism of spleen(removes inclusion)
Helmet cells are formed when what?
spleen bites off large RBC inclusion like Heinz bodies
Helmet cells are associated w/ what?
- -G6PD deficiency
- -Pulmonary emboli
Another name for Target cell are what?
this may be artificially induced on smear and appears bell shaped(using electron microscope), hypochromic( decreased hemoglobin)
Another name for drepanocyte is what?
this cell is sickle or crescent shape w/ pointed projections at one or both ends of the cell
sickle cell or hemoglobin S
this cell is oval or rectangular central pallor
this cell may result of membrane defect(slit appears shaded) and may be artifactual in origin (slit like area of pallor)
Stomatocyte is associated w/ what?
- -hereditary stomatocytosis
- -acute alcoholism
this cell is round, purple staining bodies seen in Wright's stain
Howell-Jolly bodies are remnants of ____?
Howell-jolly bodies seen in ____ or ____ in peripherary of cell membrane?
this cell is small irregular, magenta colored inclusions seen in periphery of cell
Pappenheimer bodies are usually seen in what?
- -seen in wright's stain
- -referred to as siderotic granules if stained w/ Prussian blue (confirmatory test)
Pappenheimer bodies consist of what?
nonheme iron, resulting frome excess of available iron thoughout the body
describe the basophilic stippling
- -coarse or diffuse blue staining bodies
- *seen wright's stain
- -consist of precipitated ribosomes
- -occurs when smear is drying
- *does not occur in vivo
the cabot's ring looks like what?
- purple thread like loops
- *seen in wright's stain
this cell is remnants of microtubule from mitotic spindle( found in stippled cells and appear in a figure 8 pattern), and abnomal erythopoisis
this cell aggregates of denatured precipitated hemoglobin, not seen wright's stain(use crystal violet stain or brilliant cresyl blue)
What is the Etiology of iron deficiency anemia?
acquired and progressive
this anemia is deffiency in pregnancy, chronic blood loss, infancy, women in child bearing yrs
Iron deficiency anemia
What are the 3 stages of iron deficiency anemia?
- -iron depletion w/ anemia
- -iron deficiency erythropoiesis w/ mild anemia
- -iron deficiency anemia develops w/ severe anemia
Iron deficiency anemia occurs in what?
- -inadequate absorption
- -decreased iron intake
- *meat poor diet
- -increased iron utilization
- *growth spurts
- -loss of iron
The morphological of iron deficiency anemia is what?
- -mild to moderate anisopoiklocytosis (target cells)
Sideroblastic anemia are acquired by what?
- -secondary ...drug or toxin induced -anti TB drugs-alcolism-lead poisonig-antimicrobial-anti parkinsons drug
What are the laboratory features for a sideroblastic anemia?
- dimorphic RBCs
- -microcytic, hypochromic
- -normocytic, normochromic
- anisopoikilocytosis (ringed sideroblasts)
What are the etiology for Anemia of chronic disorders?
- -multifactorial in origin
- -associated w/ infections, autoimmune disorders
- -anemia present 1-3 months following onset of chronic disease state
Anemia of chronic disorders laboratory features are what ?
- -normocytic RBCs (normal MCV), may be hypochromic or normalchromic
- -anisopoikilocytosis- mild to absent
- -polychromasia -mild to absent
- decrease in RBC life expentancy
- -decrease in erythropoisis
- -impaired of iron metabolism
- -suppression of erythopoisis by cytokines
- -starts as normal/normal
- increases in RDW, serum iron
What is the Etiology of anemia of chronic renal problems?
- -failure of kidneys to produce erythropoetin
- -renal diesease leads to chemical imbalance or uremia
Macrocytic normochromic are due to what?
- -Vit B12 and folic acid deficiency
- -result in large RBC 2 granulocytes
- B12 not absorbed
What are the laboratory features for macrocytic/normochromic?
- large hypersegmented neutrophils
- -5 or more lobes
- -seen in more than 98% of the cases
What is the etiology of aplastic anemia?
- failure of bone marrow to produce blood cells
- -cellular depletion of BM
- -fatty replacement of BM
Aplastic anemia laboratory findings are what?
- Pancytopenia(decrease RBC, WBC, Platelets)
- normocytic, normochromic RBCs
list the types of hemolytic anemias?
- :due to intrinsic defect in RBC membrane
- -hereditary spherocytosis
- -hereditary elliptocytosis
- -hereditary stomatocytosis
What is the most common RBC enzyme disorder?
What is the Etiology of G6PD?
- absence of G6PD is harmless unless exposed oxidative stress
- -antimalarial drug
- -fava beans
This anemia involves antibodies w/ optimal serological activity at 37 degree C and is rare
WAIHA(warm agglutinin auto-immune hemolytic anemia)
PCH(paroxysmal cold hemoglobinuria) involves what?
- -biphasic autoantibody Anti-P
- -anti-P attaches to RBC at low temperature
what is called when the mother sensitized during pregnancy or delivery called fetal-maternal hemorrhage?
HDN (hemolytic disease of Neworn)
in Poximal Nocturnal hematuria the membrane is what?
- -susceptible to hemolytic action of component
- fairly rare
What the types of Hemoglobin and ranges?
- Hgb A:95-97%
- Hbg A2: 2-3%
- Hgb F: 1-2%
this the anemias characterized by a structural defect in the hemoglobin?
What happens in homozygous condition of Hgb S?
- -leads to chronic hemolytic anemia
- -ischemic tissue injury due to vaso-occlusion
- -decreased oxygen causes RBC to sickle and become very rigid
- -sickled cells plugs small vessels in joints and abdomen
What are the laboratory feature of sickle cell anemia?
- -moderate anisocytosis and poikilocytosis
- -decreased ESR
- -sickle cell test:positive
- -Hgb electrophoresis shows:
- no hgb A
- 80% or more Hgb S
- 1-20% Hgb F
what is the etiology of Hbg C?
substitution of lysine for glutamic acid on 6th position of beta chain
Hgb C may be seen in what?
Hgb C crystals
this decreases erythropoisis?
erythrocytes are increased in number?
this is hypoxic situation like cynosis, COPD, CHF, High altitudes
this is an increase red cell mass and due to decrease in plasma
Relative polycythemia is seen in where?
- acute & subacute dehydration
- -middle aged men w/ history of smoking, hypertension, obesity
this test is use to diagnose heolytic anemia, specifically hereditary sperocytosis
Osmotic fragility test
% of cells that differe in size or shape for normal RBCs