Unit 2 Exam Heme Lecture

If any of these are seen, they need to reported in rbc morphology

sickle cells, rbc fragments, parasites (malaria), and Nucleated RBCS

What is the RBC size reported by?

MCV which is measured by microns

What is aniszocytosis?

variation in rbc size (RDW)

What type of variations are because of macrocytes?

Impaired DNA synthesis, reticulocytes, lipid metabolism, liver disease, and megaloblastic anemia

What type of infarctions are due to microcytes?

impaired hemoglobin synthesis, missing any essential hemoglobin content like heme or globin

What is poikilocytosis

Variation in the shape of teh rbcs

what causes acanthocytes?

increased cholesterol

What causes echinocytes?

cation imbalance or a change in tonicity

How to tell the difference between an acanthocyte and an echinocyte?

Acanthocytes are not perfectly shaped and look like a shistocyte, echnicoytes are rounded with jagged edges and look like a speech bubble

What casuses schistocytes

these are broken red cells that are fragmented by fibrin

What causes dacrocytes (tear drop cells)?

enlarged spleen

What is your hemoglobin concentration indicated by?

MCH and MCHC

What does water artifact look like on a slide?

Looks slightly like hyperchromia

What is polychromasia?

blue color on the rbc

What is the difference between polychromasia and reticulocytes?

polychromasia is seen on a wright stain, retics are not.

When does an increase in polychromasia/ retics show up?

after an increase of acute blood loss

describe what causes a target cell

increased membrane to volume ratio, increased lipids, and a decreased hemoglobin

What causes speherocytes?

alerted membraned and are actually hyperchromic

What is a stomatocyte?

coin slot cell

What causes a stomatocyte?

a lipid alteration in the membrane

What rbc morphology is mostly seen as an artifact?

stomatocyte

What are Howell-jolly bodies

a nuclear DNA remnant

What do Howell-jolly bodies indicate?

that the spleen is functioning improperly

What causes basophilic stippling?

RNA from a defective heme synthesis

What does a pappenheimer body look like

a quick dash of pepper on a red cell

What causes pappenheimer bodies?

ineffective iron metabolism

What stain is used to determine pappenheimer bodies

Prussian Blue Stain to detect the iron

What are heinz bodies?

precipitated hemoglobin from the hgb not being protected from oxidants which can denature the protein molecules

What stain are heinz bodies seen on?

a supravital stain such as New Methylene Blue

What are cabot rings?

looks like a ring in the red cell

What causes a cabot ring

remants of mitotic spindle Wh

What does agglutination look like

clumping of red cells

what does agglutination indicate

cold agglutinin

How do you fix agglutinates?

Warm the sample to 37 degrees C

What happens to MCH and MCHC in rbc aggultinates?

they both increase

What does Rouleaux indicate

fibrinogen or reduced zeta potential (cloud of ions)

What is the normal range for an ESR on a male

0-15 mm/hr

What is the normal range for an ESR on a female

0-20 mm/hr

What is an esr for

A mechanism for cells falling or settling

What factors can affect an ESR

fibrinogen, protein, cell count, anemias, PV and Polycythemia, Rouleaux, and increased inflammation, infections, and malignancies

What is the formula for the Rule of Three

Hct = 3 x Hgb, ± 3%

What is the MCV calculation

Hct x 10/ RBC

What is the reference range for MCV

80-100 fL

What is the formula for MCH?

Hgb x 10/ RBC

What is the reference range for MCH

26-34 picograms

What is the MCHC formula

Hgbx100/ Hct

What is the reference range for MCHC

32-36%

What is the difference between MCH and MCHC

MCH measures the average weight of hgb per cell while MCHC measures the average hemoglobin concentration of each cell

What are the principles of automated parameters?

to determine the Hgb Concentration and the HCT value

What does the RBC curve indicate

size and frequency of the red cell

What do red cells look like shape wise

biconcave shaped due to spectrin protein

within the destruction of rbcs what percent of this happens intravscular?

10%

within the destruction of rbcs what percent of this happens extravasculary?

90%

How is hemoglobin structure formed/

Heme and the protoporphyin IX Ring and Iron

What is the function of hgb

to deliver and release oxygen to tissues

What is the body’s main source of iron from

it is recycled from destroyed cells in the spleen

what amount of the body’s iron is present as hemoglobin iron

2/3 the other 1/3 is in tissue iron

Hemoglobin is broken down into three chains. What are those 3 chains

A, A2, F

What are the polypeptides of Hgb A

a2b2

What is the normal amount of hgb A in an adult

>95%

What is the normal amount of hgb A in a newborn?

10-40%

What is the normal amount of hgb A2 in an adult?

<3.5%

What is the normal amount of hgb A2 in a newborn?

<1%

What is the polypeptide of A2

a2d2 (delta)

What is the polypeptide for Hgb F

a2y2

What is the normal amount of hgb F in an adult

1-2%

What is the normal amount of hgb F in a newborn

60-90%

What is carboxyhemoglobin

a compound formed in the blood by the binding of carbon monoxide to hemoglobin. It is stable and therefore cannot absorb or transport oxygen

What is methemoglobin

a form of hemoglobin where the iron is oxidized (ferric, Fe³⁺) instead of its normal reduced (ferrous, Fe²⁺) state

What is sulfhemoglobin

a rare, dysfunctional green-pigmented derivative of hemoglobin formed by the irreversible binding of a sulfur atom to the heme molecule during oxidant stress

what is the main red cell metabolism pathway

Emden-myerhof pathway

what is the point of the emden-myerhof pathway

to mainitain rbc shape, flexibility, and membrane integrity

What does the Emden-myerhof pathway utilize?

pyruvate kinase

What pathway is the hexose monophosphate shunt

oxidative pathwaywhat

what is the point of the hexose monophosphate shunt

to provide cell protection against oxidative energy from toxic reducing agents

What enzyme is associated with the hexose monophosphate shunt

G6PD W

What inclusion is seen if the hexose monophosphte pathway is defective?

Heinz bodies

what is the point of the methemoglobin reductase pathway

to maintain heme in reduced ferrous state (Fe++)

What can a defiance in the methemoglobin reductase pathway cause

it can lead to crisis

What is the main function of the Leubering-Rapaport Shunt

to produce 2,3 diphosphoglycerate and regulate oxygen delivery to the tissues

What are the reasons for a left shift

increased ph, decreased temperature, and decreased 2,3 DPG

what causes a right shift

decreased pH, increased temperature, increased 2,3 DPG “tense state”

What is the normal RDW range

11.5-14.5%

What effect does impaired hemoglobin synthesis have on MCV

decreases