HEMA 1-8

2 disorders in RBC production

Anemia

Erythrocytosis

Greek word of anemia meaning without blood

Anaimia

Clinical manifestation of anemia*****

Palpitation & dyspnea upon physical exertion

Tachycardia

Skin conjunctival pallor

Headache & dizziness

Fatigue & leg cramp

Insomnia

Enlargement of spleen, lymph, liver

Coma

Death

Jaundice - severe intravascular hemolysis

Physiologic response to anemia

Increase oxygenated blood flow

A true decrease/increase in red cell mass (RCM)

Absolute anemia

Caused by a fluid shift from extravascular to intravascular or vice versa

causing the red cell mass to appear increased or decreased (but remains normal)

relative anemia

Associated with increased red cell number, hemoglobin content & hematocrit

erythrocytosis/polycythemia

classification of erythrocytosis that involve Stress syndrome/Gaisbock's syndrome/spurious erythrocytosis

relative

an absolute primary erythrocytosis that is a pluripotent stem cell disorder

polycythemia vera

Increased cardiac rate, cardiac output & circulation rate leading to shortness of breath can be due to:

increase oxygenated blood

decrease oxygenated blood

increase oxygenated blood

Increase in oxygen utilization by tissue causes:

shift to the left

shift to the right

shift to the right

blood component best used to identify anemia

Hb

ref range of Hct in male & female

male: 40-54%

female: 35-49%

formula of MCV

(Hct (L/L)/RBC #) x 10

ref range of MCV

80-100 fL

formula of MCH

(Hb (g/dL)/RBC #) x 10

ref range MCH

26-34 pg

ref range MCHC

31-37 g/dL

calculated index provided by hematology analyzers to help identify

anisocytosis

Red cell distribution width

RBCs that appear like a “stack of coins" usually due to increased

proteins like fibrinogen or acute phase proteins in the plasma

Rouleaux

RBC appear clumped wherein the outline of each individual cannot be distinguished

agglutination

an abnormal degree of variation in the shape of erythrocytes in the

blood

Poikilocytosis

No central pallor

Increased Hb

MCV >125 fL

oval macrocyte

Round without central pallor

6.2-7 um

spherocyte

oval/elliptical shape

egg-shaped,rod,pencil forms

elliptocyte & ovalocyte

RBC with evenly distributed, uniform size blunt spicules protruding from cell surface

echinocyte

RBC with irregular size spicules protruding from cell surface

reversible

burr cell

thorn like projections of various lengths & widths over the surface

No longer disc shaped

acanthocyte

Bowl-shaped RBC with elongated slit-like pallor

retained in spleen

stomacyte

bulls-eye, bell, tall hat shaped

codocyte

Fragmented red cells due to membrane damage

schistocyte

horn like projections creating a vacuole that ruptures

keratocyte

pear/tear-shaped

dacrocyte

Small, round cells in severe burns

microspherocyte/pyropoikilocyte

Large, pale pink staining ghost of red cell membrane

semi lunar bodies/half moon

semicircular area removed by the spleen

degmacyte

triconcave shape having 2 central pallors

pinch cell

knizocyte

blister cell

pyknocyte

mushroom shaped

goldfish like

pincer cell

Shrunken, dehydrated, speculated cell

dessicocyte (puddle RBC)

Membrane of cell folded over

pocketbook/folded

elongated red cells with pointed ends (SVL configuration)

drepanocyte (sickle cell)

Dark staining hexagonal crystals

Hb CC crystal

dark hued crystal

washington’s monument

Hb SC crystal

small round fragments of nucleus

reddish brown in Wright stain

Howell-Jolly bodies

Fine or coarse, deep blue to purple inclusion on dry Wright stained film

basophilic stippling

appear near the periphery of young rbc

• with perl’s Prussian blue

pappenheimer bodies

Young red cells that no longer have a nucleus but still contain RNA

polychromatophilic red cell

Thin, ringlike structure that stains red-violet in Wright stain

circular figure 8

Cabot ring

Observed when using supravital stains

"pitted golfball”

bite cells

heinz bodies

appear after 4 drops of blood is incubated with 0.5 mL of 1% BCB for 20 min at 37C

Hb H inclusion

Needle-like, bluish rods

porphyrin crystals

Indicates the degree of effective bone marrow activity

reticulocyte #

the actual number of reticulocytes in 1L of whole blood

Absolute reticulocyte #

means to adjust the reticulocyte count in proportion to the severity of

anemia as reflected by the patient's hematocrit

Corrected reticulocyte count (CRC)

CRC formula

(px Hct/0.45 L/L) x reticulocyte #

RPI formula

CRC/maturation in days

how much px Hct is in the following days

1 - 1.5 - 2 - 2.5 - 3

1 - 40-45

1.5 - 35-39

2 - 25-34

2.5 - 15-24

3 - <15

Provides supplemental diagnostic information in namic patients when other lab tests are not conclusive

BM exam

reticulocyte # formula

(# reticulocyte/1000 RBC) x 100

what day in maturation is considered adequate BM response

>= 3

an MCV of <80

microcytic

an MCV of >100

macrocytic

an MCHC <31

hypochromic

an MCHC >37

hyperchromic

ineffective erythropoiesis is indicated by an RPI of _____

<2

px has RBC # of 2.3x10^12/L, Hb of 7.3 g/dL, Hct of 24%, & retic # of 9%.

identify the MCV, MCHC, RPI, morphology, & physiology

morph & phys = macrocytic hypochromic

MCV of 104 = >100 = macro

MCH of 32

MCHC of 30 = <31 = hypo

RPI of 1.92 = ineffective erythropoiesis

Immature cells that would give rise to megakaryocyte & could not be differentiated from other progenitor cells

committed progenitor cell

which of the following is capable of endomitosis:

BFU-Meg

CFU-Meg

LD-CFU-Meg

AOTA

LD-CFU-Meg

division of chromosomes not followed by nuclear division that results in an increased number of chromosomes in the cell

endomitosis

form of mitosis that lack ttelophase & cytokinesis

endomitosis

growth factor produced primarily in the liver followed by the BM in response to platelet demand in circulation

thrombopoietin

growth factor produced in the BM by macrophages, fibroblasts, T lymphocytes & stimulated endothelial cells in response to the mass of megakaryocytes in the BM

Meg-CSF

cell derived growth factors with stimulator effects on myeloid &

lymphoid progenitor cells

IL-3, -6, -11

earliest recognizable form in EM capable of undergoing endomitosis

megakaryoblast

stage capable of protein synthesis & development of demarcating membrane system (DMS)

promegakaryocyte

T/F

megakaryocyte has no specific organelles

true

process where cells pass through cytoplasm of megakaryocyte without being destroyed

emperipoiesis

stage capable of releasing PLT:

megakaryocyte

metamegakaryocyte

promegakaryocyte

megakaryoblast

metamegakaryocyte

how much PLT are shed by metamegakaryocyte

1k-4k

stage where PLT are adhering to cell membrane

metamegakaryocyte

produced in the extravascular sinus which breaks off into smaller PLT

proplatelets

process of PLT shedding from a mature megakaryocyte

thrombopoiesis

shape of PLT at rest:

biconcave

discoid

asterisk like

pseudopods

discoid

what organ is 20-30% of PLT sequestered

spleen

ref range of PLT

140-440x10^9/L

shape of active PLT:

biconcave

discoid

asterisk like

pseudopods

pseudopods

PLT that is 4-6 um

macrothrombocyte

PLT that is >6.5 um

megathrombocyte

PLT that is <2 um commonly mistaken as dirt

microthrombocyte

PLT structure that is adhesive & responds readily to hemostatic requirements

negatively charged to to repel other PLT away

glycocalyx

PLT structure that anchors glycoproteins & proteoglycans that support surface glycosaminoglycan, oligosaccharides, & glycolipids

plasma membrane

PLT zone which is a stable gel component to regulate the rangement of internal organelles

Responsible for the PLT shape

structural zone

composed of multiple subunit which makes up the cytoskeleton support system of the PLT

maintains PLT shape at rest

contracts on activation to encourage alpha granule release

circumferential microtubules

causes the change in PLT shape upon PLT activation

actomyosin

PLT component for contraction & pseudopod formation

microfilament

makes up 20-30% of PLT protein

microfilament

15-20% total protein content

actin filament

how many dense bodies are in each PLT

2-7

Migrates to the plasma membrane & release their contents directly into

the plasma upon PLT activation

dense bodies (beta granules)