Module 2 - RBC Morphology, Metabolism, H&H, plus ESR

What is the percentage of HGB A for adults

95-100%

What is the percentage of HGB A2 for adults

0-3.5%

What is the percentage of HGB F for adults

0-2.0%

What is the percentage of HGB A for newborns

10-40%

What is the percentage of HGB A2 for newborns

0%

What is the percentage of HGB F for newborns

60-90%

What HGB have two alpha and two gamma globins chains

F

What HGB have two alpha and 2 eplision globin’s chains

A2

What HGB has 2 alpha and 2 beta globins cahins

A

What enzyme do Emden Meyerhof Pathway utilized

Pyruvate Kinase

What enzyme do Hexose Monophosphate Pathway utilized

Glucose-6 Phosphate Dehydrogenase

What enzyme do Methemoglobin Reductase Pathway utilized

Methemoglobin Reductase

What enzyme do Rapoport-Leubering Pathway utilized

Biphosphoglycerate mutase and Biphosphoglycerate phosphatase

What is the main function of Emden Meyerhof Pathway

Major glycolytic Pathway, Generator of ATP

What is the main function of Hexose Monophosphate Pathway

Main line of injury against oxidative injury

What is the main function of Methemoglobin Reductase Pathway

Regeneration of reduced form of hemoglobin

What is the main function of Rapoport-Luebering Pathway

Increases 2,3 BPG

What is the defect of Embden Meyerhof Pathway

formation of echinocytes

What is the defect of Hexose Monophosphate Pathway

formation of Heinz Bodies

What is the defect of Methemoglobin Reductase Pathway

increases the amount of methemoglobin

What is the defect of Rapoport Luebering Pathway

inadequate oxygen delivery

What is the composition for Basophilic Stippling

RNA

What is the composition for Howell Jolly Body

DNA

What is the composition for Reticulocyte

RNA

What is the composition for Heinz Body

Denatured Hemoglobin

What is the composition for Pappenheimer Body

Iron

What is the composition for Cabot Ring

Remnant Mitotic Spindle 

What is stomatocytes observed in

Electrolyte imbalance
◦ Increased sodium; decreased potassium
◦ Alcoholism
◦ Lipid alteration of membrane

What are codocytes observed in

Increased cell membrane and surface area
◦ Due to lipid alteration
◦ Cells expand with increased surface area

Decreased hemoglobin
◦ Hemoglobin synthesis is altered
◦ Thalassemia
◦ Severe cases of iron deficiency anemia

Disorders causing an increase in membrane lipids
◦ Liver Disease (acquired)

Hemoglobinopathies
◦ Sickle cell anemia
◦ Hemoglobin C disease
◦ Thalassemia

What cause Howell-Jolly Bodies

Accelerated or abnormal erythropoiesis
◦ Spleen not removing (pitting) piece of nucleus
◦ Non-functioning spleen

Where can you observe Howell Jolly Bodies

Megaloblastic anemia
◦ B12 and Folic acid deficiency
◦ Faulty maturation of RBC
precursors
◦ Splenomegaly or
splenectomy
◦ Thalassemia
◦ Sickle Cell Anemia
◦ Hemolytic Anemia

Where can you observe Pappenheimer Bodies

Sideroblastic anemia
◦ Iron overload
◦ Over abundance of iron metabolism causing iron to be stored in other places besides liver and
BM
◦ Thalassemia (altered hemoglobin production)
◦ Splenectomy

What can cause the blood to Rouleaux

Due to elevated antibodies (globulins) or improper balance of proteins
◦ IgG, IgA, fibrinogen

What cause Agglutination of RBC

Usually due to a cold antibody
◦ IgG antibodies will stop agglutinating at 37oC
◦ IgM antibodies agglutinating at 25oC (Room temperature)
◦ Warm the specimen to 37oC to disperse the agglutination
◦ Causes problems for instrument counting
◦ MCV increases; RBC count decreases; MCHC > 38%

Anisocytosis

variation in size

Poikilocytosis

variation in shape

Polychromasia

pale blue-gray RBCs

Where can Ovalocytes (Elliptocytes) be observed in

Hereditary ovalocytosis - if majority are oval
• Sickle cell anemia
• Iron deficiency anemia
• RBC enzyme deficiencies
• Pernicious anemia as macro-ovalocytes
• Miscellaneous anemia – non-specific

What can cause Ovalocytes (Elliptocytes)

Defect in Spectrin
(protein in RBC
membrane) affecting
the horizontal linkage
of cell cytoskeleton

Where can Acanthocytes be observed in

Liver disease
• Congenital Abetalipoproteinemia - rare
• Alcoholic liver disease
• Post splenectomy

What can cause Acanthocytes

increased cholesterol

Where can you observed Echinocytes (Burr/Crenated Cells)

Liver disease
• Uremia (increase in blood urea due to kidney disease)
• Dehydration
• Peptic ulcers
• Pyruvate Kinase Deficiency

What can cause Echinocytes (Burr/Crenated Cells)

Due to change in tonicity of cell
• Cation imbalance
• (+charges – sodium and potassium)

What can cause Spherocytosis

Defect in membrane protein
• Vertical disruption between
transmembrane proteins and underlying
cytoskeleton

What are the normal values for ESR

Male: 0-15mm/hr (0 – 50 y)
 Male: 0 – 20 mm/hr ( >50 y)
 Female: 0-20 mm/hr (0 – 50 y)
 Female: 0 – 30 mm/hr (> 50 y

Partial Pressure (PO2)

proportion of oxygen that is
released to tissues or loaded
onto cell at a given time

What can cause the Oxygen Dissociation Curve to go left

Increased pH
• Decreased Temperature
• Decreased 2,3 DPG

What can cause the Oxygen Dissociation Curve to go right

Decreased pH
• Increased Temperature
• Increased 2,3 DPG “Tense state”

Hemoglobin

determines presence of anemia

Hematocrit

determines presence of anemia

What is the significance of Zeta Potential

Zeta is a cloud of negative charges found on cell
membrane
• Certain proteins, such as fibrinogen weaken the zeta
potential by attracting positive ions close to the cell
• Fibrinogen is an acute phase reactant
• A weakened zeta potential allows RBCs to come close
together, rouleaux, and fall

What are the 2 common methods that the ESR use

Wintrobe/ Westergren

What are some technical factors that can increase ESR

Vertical slant

Higher than Room Temp

Improper anticoagulants

Concentration of anticoagulant

What is the Reference Range for HGB in women

Female 12-16 g/dL

What is the Reference Range for HGB in male

13.5-18 g/dL

What is the Reference Range for HGB in newborns

16.5-21.5 g/dL

What is the math formula for MCV

HCT x 10

RBC

What is the math formula for MCH

hgb X10

RBC

What are the eight globin chains

Zeta (ς)
 Epsilon (ε)
 Gamma-A (γA)
 Gamma-G (γG)
 Delta (δ)
 Beta (β)
 Alpha (α)

Do Deoxyhemoglobin
has a lower affinity
for oxygen

yes

Do Oxyhemoglobin has
higher affinity for
oxygen

yes

Carboxyhemoglobin

Occurs when hemoglobin is exposed to
carbon monoxide

Hemoglobin’s affinity for carbon monoxide is
>200 times greater than affinity for oxygen
 Smokers can have up to 12%

Methemoglobin

Hemoglobin with iron in the ferric (Fe+3) state

Incapable of combining with oxygen

Increased levels are formed when exposed to
certain oxidizing chemicals or drugs
 Infants are more susceptible to
methemoglobin production
◦ HbF more readily converts

Sulfhemoglobin

An irreversible change in the hemoglobin
molecule
 Sulfur atom combines with each of the four
heme groups
◦ Binds to the oxygen
 Hemoglobin molecule has an affinity for oxygen only
1/100 that of normal hemoglobin

Where is the main portion of getting iron from

by recycling

Where is the location of Chromosome 16

◦ Zeta (embryonic)
◦ Alpha

Where is the location of Chromosome 11

◦ Epsilon (embryonic)
◦ Gamma
◦ Delta
◦ Beta

Is 90% of aged erythrocyte destruction is
extravascular

yes

Is 10% of erythrocyte destruction is
intravascular

yes

What can cause RBC to be Macrocytes

Impaired DNA synthesis
 Reticulocytes
 Lipid Metabolism
 Liver disease
 Megaloblastic Anemia

What can cause RBC to be Microcytes

impaired hemoglobin
synthesis
 Missing any essential
hemoglobin element
 Heme
 Globin

What are wright stains use for

blood smears; bone marrow