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A normal red blood cell can be described as:
a. biconcave disk, 8 μm d, 2 μm thick, 150 fL
b. Round, 9 μm circumference, 3 μm thick, 90 fL
c. Round, 7 μm diameter, 5 μm thick, 100 fL
d. biconcave circle, 6 μm diameter, 3 μm thick, 90 fL
- D = 6–8 μm thickness = 2 μm
- vl = 90 fL w/ surface of about 136 μm2
- - can swell up 150 fL, w/o distention.
- - size as a lymphocyte nucleus.
is the process by which red blood cells are produced
How long does it take erythrocytes to Develop from stem cells?
A. 4 days
B. 2 days
C. 1 week
D. 7 weeks
B. 7 days
(this multiple choice question has been scrambled)
What stimulates the production of RBC's? What is/are the organ/s in involved?
Stimulated by decreased O2 in circulation detected by the kidneys.
What happens in response to low circulation of O2 in the blood?
kidneys secrete a hormone erythropoietin. This activates increased erythropoiesis in the bone marrow. Producing more RBC's.
Where is Erythropoietin produced?
A. b & c
B. a, b, c
D. a & c
D. The liver and kidneys produce erythropoietin but it is only secreted by the kidney.
(this multiple choice question has been scrambled)
What helps to regulate erythropoietin to prevent the bone marrow from making too many RBC's
Feed back loop involving erythropoietin.
How does circulating erytropoietin work to stimulate the production of new RBC's
After being released from the kidneys it binds to circulating RBC's. A low number of RBC's to bind with creates a high level of unbound erythropoietin which stimulates the bone marrow to make more RBC's.
As a result of not containing mitochondria, erythrocytes use none of the oxygen they transport. What do erythrocytes produce instead and how?
ATP by lactic acid fermentation of glucose.
What makes Erythrocytes incapable of cellular division?
The lack of DNA.
Mature RBC’s do not contain DNA and cannot synthesize any RNA, and consequently cannot divide and have limited repair capabilities.
How long do RBC's live in blood circulation?
List some possible Etiologies of False Readings of RBC?
- Supine phlebotomy - Decreased RBC count by 5%
- Dehydration - hemoconcentration - increase [RBC]
- Pregnancy - dilutional anemia (RBC’s appear low)
- Stress - raises RBC count
- Altitude - Decreased O2 causes RBC to rise
Which of the following conditions does not cause Erythrocytosis
a. Polycythemia Vera
b. Addison’s Disease
c. Cardiopulmonary Disease
d. Renal Disease
Bonus: name one more condition of Erythrocytosis.
- b. Addison's dz is an anemia
- Another cause would be High Altitude
The following are causes of anemic with the Exception of which one.
c. Hodgkins disease Leukemia
e. Liver Disease
Bonus: name more conditions that may cause anemia.
- f. none
- Bonus: Hemorrhage, Renal Disease, Addison’s Disease
the proportion of blood volume that is occupied by red blood cells?
1. Hgb is the main component of Erythrocytes made of__
2. Hgb is composed of amino acids that form__
3. Heme is a compound which contains __
4. Each Hgb has 4 globin chains __
a. Globin and Heme
b. protein called globin
c. iron and porphyrin ring.
d. alpha and beta
a b c d
What part(s) of Hgb has a heme / iron binding site.
The 2 alpha and 2 beata chains of globin.
Combines readily with O2 and gives blood its red color.
It is the iron that,
How many binding sites are on 3 RBC's total?
How much of the total cell volume is taken up by Hgb?
Hemoglobin comprises about a third of the total cell volume.
This protein is responsible for the transport of more than 98% of the oxygen? What is carries the other 2%?
- it is dissolved in blood plasma.
How much Iron is stored in each RBC? How much of the total Iron stored in the human body is done by RBC's?
Each RBC stores 2.5 grams of iron, representing about 65% of the total iron contained in the body
Hgb also serves as an important buffer in blood? T/F
At a ___ pH, more O2 dissociates from Hgb. What happens as a result?
- The deoxygenated Hgb binds to hydrogen ion, thereby raising the pH.
Which of the follow increase Hgb and which ones decrease Hgb?
- Decreased levels of Hgb
- Fe deficiency
- Liver Disease
- Renal Disease
- Increased levels
What is the best method to classify anemia?
What do you call the vl occupied by a single erythrocyte.
Range and Formula?
- Mean Corpuscular volume (80-100)
- MCV = HCT x 10 / RBC
The most prevalent worldwide cause of anemia.
What are the major causes of Iron Deficiency?
- dietary inadequacy (more so kids)
- infections (#1 worldwide, Hookworm)
- iron/ blood loss (#1 cause in USA, menses)
- GI blood loss, non menses ptn (colon CA until proven otherwise)
- increased iron requirements
Confirm Iron deficiency –
Decreased serum iron and ferritin but Increased TIBC (total iron binding capacity)
Ineffective erythropoiesis due to disorder of the porphyrin pathway.
Atypical, abnormal nucleated erythroblasts with granules of iron accumulated in perinuclear mitochondria.
_____is a disease in which the bone marrow produces Ringed sideroblasts rather than healthy red blood cells (erythrocytes).
Sideroblastic anemia / Sideroachrestic anemia
Causes of Sideroblastic anemia / Sideroachrestic anemia
- Genetic disorder
- Indirectly as part of myelodysplastic syndrome
- chronic alcoholism
- drugs (inh)
- lead and zinc poisoning.
What would the labs reveal in comparison to Iron deficiency.
labs reveal: Increased Iron and Ferritin, Normal or Increased TIBC.
Lead poisoning SSx include:
- wrist/ foot drops
- renal tubular acidosis
- BURTON’s lines (blue gray discoloration of gums)
- BASOPHILIC STIPPLING OF RED CELLS (blue dots in RBC’s) - Peripheral smear
is an inherited autosomal recessive blood disease. results in reduced rate of synthesis or no synthesis of one of the globin chains that make up hemoglobin.
What are Microcytic Anemias and give examples?
- MCV is low:
- Iron Deficiency
- Sideroblastic anemia
- Lead poisoning
What are Normocytic Anemias and give examples?
- Anemia with good bone marrow response.
- - Hemolytic anemia
- - Hemorrhagic anemia
- Anemia with impaired bone marrow response.
- - Kidney and liver disease
- - Malnutrition
- - Anemia of chronic disease
What is Macrocytic/Megaloblastic Anemia and give some examples.
- Results from decreased DNA synthesis with normal RNA/protein synthesis.
- Pathognomonic blood smear reveals hypersegmented neutrophils.
Types of Normocytic Hemolytic anemias
(Ex. Sickle Cell, AIHA, G6PD deficiency)
What labs would confirm Hemolytic anemia?
- labs for HA- Increased reticulocytosis, increased indirect bilirubin, decreased haptoglobin.
- Smear may show schistocyte
Give examples of causes for Macrocytic anemia.
- - (B12) Cobalamin DeficiencyCompetitive
- - Parasites – Tapeworm
- - Folate deficiency
- - Increased requirements – Pancreatic disease, pregnancy, CA, Hyperthyroidism
Cause of HYPOchromic anemia.
Fe deficiencyChronic blood lossThalassemias (some)
Cause of Hyperchromic anemia
Spherocytosis (hereditary) and in newborns
MCH (Mean Corpuscular Hgb)
MCH is a measure of the average weight of Hgb per RBC.
MCHC (mean corpuscular hemoglobin concentration)
Measures average concentration of Hgb in RBCs.
increase of the MCH is associated with
Macrocytic anemias and newborns
decrease of the MCH is associated with
Degree of anisocytosis.
Normal RBCs have a slight degree of variation
RDW (Red cell Distribution Width)
How do Reticulocytes mature into erythrocytes?
Reticulocytes develop in the red bone marrow circulate in the blood for about a day and mature in to erythrocytes.
What is the normal percentage of reticulocytes found in blood circulation? What is suggestive of a Corrected count of >2% and <2%?
- 1% in normally found in everyday circulation.
- >2% is suggestive of hemolysis or acute blood loss.
- <2% is suggestive of hypoproliferative process.
What types of patients are found with schistocytes on blood smear?
Often found in Hemolytic anemia.
What ptns would you find Spherocytes?
- Hereditary Spherocytosis
- Autoimmune Hemolytic anemia
What is commonly found it ptn with asplenia and why?
- Howell Jolly Bodies
- - The spleen normally removes these cell but cannot do so if dysfunctional (sickle cell anemia) or has been removed following trauma.
Codocytes are often found in what types of patients?
- Aka Target cells
- Asplenia, Sickle Cell, Hemoglobin C (HbC) disease.
- severe Iron deficiency anemia
- Excess membrane relative to amount of Hgb
Inclusions found within RBC's formed from denatured Hgb. What is the name of the cell type and what is the cause?
- Heinz Bodies
- G6PD deficiency hemolytic anemia.
What types of cells are found in ptn with lead poisoning?
Erythrocytes with Basophilic stippling.
What type of cells imply Uremia?
Burr cells or Echinocytes
RBC's found with exaggerated spicules are commonly called? What dz state is it usually found?
Pencil/ Cigar cells are found in what type of patients.
- Hereditary elliptocytosis
- Also found in Iron deficiency anemia and other pathological states that decrease red blood cell turnover and or production.
Ptn with cigar shaped cells are found on blood smear. What are your DDx and how would you R/O suspected dz states?
- Hereditary elliptocytosis, Iron def, other dz that reduce RBC trun over and production.
- Microcytosis and hypochromia would be found in the latter.
Tear Drop Cell (Dacroyte) is found in what dz state?
Sever anemia (MC w/ macrocytic and hemolytic)