RBC Abnormalities

What ars nutritional requirements of RBCs

1. CHON (carbohydrates)

2. Amino acids

3. Vitamin B12

4. Folic acid

5. Vitamin B6

6. Fe ++

7. Riboflavin

8. Panthotenic acid

9. Nicotinic acid

What are the nutritional requirements for nuclear maturation

1. Folic acid

2. Vitamin B12

3. Vitamin B6

This refers to changes in the size of RBCs

Anisocyte

What do we call anisocytes in the blood

Anisocytosis

We measure the size of RBCs using

Mean cell volume (MCV)

What is the normal MCV of a red cell

80 to 100 fL

If red cells are normal in size, it means that it has enough (blank) inside

Hemoglobin

If an RBC has a MCV of 80 to 100 fL, we call it what

Normocyte

These three diseases are associated whe all RBCs appear normal (normal size normal MCV) but prioritizes quality over quantity

1. Aplastic anemia

2. Hemolytic anemia

3. Acute bleeding

• This is one of the three diseases are associated whe all RBCs appear normal (normal size normal MCV) but prioritizes quality over quantity

• Few hematopoietic cells in the bone marrow

• Results to no cells in the blood at all

Aplastic anemia

• This is one of the three diseases are associated whe all RBCs appear normal (normal size normal MCV) but prioritizes quality over quantity

• Red cells are lysed

• But if we were to measure, the MCV would still be normal

Hemolytic anemia

• This is one of the three diseases are associated whe all RBCs appear normal (normal size normal MCV) but prioritizes quality over quantity

• Losing large amounts of blood means losing red cells

• MCV remains normal

Acute bleeding

• This is when the MCV is <80fL

• Commonly seen in patients with thalassemia

• Since there is decrease in globin, there will be less Hgb, smaller RBCs, which leads to decrease in the delivery of O2 in the tissues

Microcytic

In microcytic patients, their RBCs are small meaning they have (blank) amount of hemoglobin

Small

What are TICS?

1. Thalassemia

2. Iron deficiency anemia (IDA)

3. Chronic diseases

4. Sideroblasfic anemia

• This is when you have no iron production

• Since we have less iron, it cannot bind to protoporhyprin IX and cannot form heme

• Since there is no heme, there will be less Hgb meaning the RBCs are gonna be small

Iron deficiency anemia (IDA)

• This is when iron is not being delivered in the cells because the disease blocks it

• Without iron, there is no heme, meaning small RBCs

Chronic disease

• This is when the iron enters the cell but it cannot proceed since there is no protoporphyrin IX

• No heme so small RBCs

• Usually there is no D-ALA inside

Sideroblastic anemia

In sideroblastic anemia, usually when there is no D-ALA, you usually have a (blank) and if D-ALA synthesis is inhibited, there will be low delivery of O2 since we cannot produce heme, which causes a (blank) in children

Lead poisoning; delayed cognitive ability

What are the three types of anisocytic cells or anisocytes

1. Normocyte

2. Microcyte

3. Macrocyte

• This is when the RBCs are larger than the usual size

• >100 fL

• They are large since they failed to develop (remember diba na as cells mature, they get smaller pero since hindi sya nag mature, malaki lang sya)

• Hindi nag mature ng maayos kasi kukang sa nutrients (VB12 and folic acid)

Macrocyte

Macrocytic cells are associated with diseases like (blank) and (blank)

Megaloblastic state and liver diseases

• This is when the maturation and development of hematopoietic cells in the bone marrow is affected which then results to anemia

• Since hematopoietic cells are affected, all other cell production is affected too

Megaloblastic state

Any variations in RBC size is termed as (blank) or (blank) in blood

Anisocyte or anisocytosis

This measures the average weight of hemoglobin

Mean cell hemoglobin (MCH)

This measures ths actual concentration of Hgb

Mean cell hemoglobin concentration

What is the normal MCHC valuen

30 to 32 g/dL

If the MCHC is normal/normochromic, that means its also (blank) because the MCHC is normal meaning normal Hgb

Normocytic

• This MCHC is when it is low

• <30 g/dL

• More than 1/3 pallor area

• If it is this, means it doesn't have enough hemoglobin so its also (blank)

Hypochromic; microcytic

• This has excess hemoglobin

• >32g/dL

• There is a very small pallor area

• There is too much Hgb kasi

• Easily lysed

Hyperchromic

• This is a variation in hemoglobin content which shows a slight blue tinge due to a stain

• Is colored gray-blue and is larger than normal because of residual RNA

Polychromatic red cell

What is another term for polychromatic red cell

Reticulocyte

Polychromatic red cells appears to have a slight blue tinge because of (blank) stain

Wright's stain

Too much reticulocyte in the blood means that there is an (blank) activity in the bone marrow and is referred to as (blank) and it does this as it tries to respond to anemia specifically (blank)

Increase; hyperactive bone marrow, hemolytic anemia

What are the 5 grades when rating reticulocytes or polychromatic red cells

1. Slight

2. 1+

3. 2+

4. 3+

5. 4+

What should you grade polychromatic red cells if they are 1%

Slight

What should you grade polychromatic red cells if they are 3%

1+

What should you grade polychromatic red cells if they are 5%

2+

What should you grade polychromatic red cells if they are 10%

3+

What should you grade polychromatic red cells if they are >11%

4+

What does poikilocyte mean

Abnormally shaped RBCs

• This is an example of poikilocyte secondary to developmental macrocytosis

• Increased MCV

• The cholesterol goes down so no one could maintain the structural integrity of the cell kaya nagiging elongated shape

• Seen in megaloblastic state, megaloblastic anemia, megaloblastic erythropoiesis

• Seen in folic acid deficiency, VB12 deficiency, and perricious anemia

Oval macrocyte

• This is a macrocyte

• Seen in alcoholism

• Liver disease

• Hypothyroidism

Round hypochromic macrocyte

• This is a macrocyte

• Seen in neonate response to anemic stress

• Response to anemic stress

Blue-tinged macrocyte

What poikilocyte is this? They are abnormak membrane components on a red cell, particularly proteins and lipids

Poikilocytes secondary to membrane abnormalities

• This is a poikilocyte secondary to membrane abnormalities

• Is a spheroid with 3-12- irregular spikes with no pallor area

• We form this when there is an abnormal ratio of lipids (lecithin and sphingomyelin)

Acanthocyte

Acanthocyte is also known as

Thorn-cell or spur cells

Acanthocyte is also known as

1. Abetaliproteinuria

2. Alcoholic cirrhosis with hemolytic anemia

3. Malabsorption states

4. Post splenoctomy

5. Hepatatis of newborn

6. Pyruvate-kinase deficiency

• Since acanthocytes are associated with abetalipoproteinuria, this means that there is an absence of (blank) which means that there is no enough chlolesterol delivered in the tissues which is why lecithin and sphingomyelin is abnormally distributed causing those spikes

• Without (blank), cholesterol can’t be delivered to the tissues which forms spikes

B-lipoprotein or LDL

• This is a poikilocyte secondary to membrane abnormalities

• Similar to acanthocytes due to spikes but the spikes here are scalloped 10-30 shorter and evenly distributed all throughout the red cell

• Happens due to osmotic changes in cell

• Depletion of ATP

• Happens whenever RBCs are exposed in hypertonic solution

Echinocytes

Echinocyte is also known as

Sea-urchin cell or crenated cell

If echinocytes are seen in cases of people with kidney diseases, then it will be called as

Burr cells

• This is a poikilocyte secondary to membrane abnormalities

• Has a peripheral rim of hemoglobin followed by a “moat” ring of pallor area and then a central hemoglobinized area

• Is because of high cholesterol levels which causes imbalance distribution of Hgb

Codocytes

Codocytes are also called as (blank)

Target cell or mexican hat cell

What are diseases where we can see codocytes

1. Liver diseases

2. Obstructive liver diseases

3. Hemoglobinopathies

4. Iron deficiency

What is the #1 case of disease where we can see codocytes

Thalassemia

• This is a poikilocyte secondary to membrane abnormalities

• Can form due to genes

• Can form when red cells are exposed to increased temperature (45 degrees)

• Can form due to autoimmune hemolytic anemia where our antibodies destroys our own antigens

• Can be seen in old blood bags as the nutrients get less for the cells and theg become fragile

Spherocytes

If spherocytes are formed in genes, it is due to a deficiency in the special protein (blank) whoch is a cytoskeletal protein that makes up the shape of the RBCs

Spectrin

If we form spehrocytes because of our genes, itmeans we have what illness

Hereditary sperocytosis

• This is a poikilocyte secondary to membrane abnormalities

• Caused by osmotic changes due to cation imbalance due to the increased permeability of red cell membrane with sodium

• This results to imbalance with the distribution of hemoglobin

• Seen if a patient is classified as Rh null

Stomatocyte

Stonatocyte is also known as

Mouth cell or bowl shaped cell

What are diseases where we can observe spherocytes

1. Hereditary spherocytosis

2. Isoimmune and autoimmune hemolytic anemia

3. Sever burns

4. Old blood bags

5. Membrane defects

What are diseases where we can see stomatocytes

1. Hereditary stomatocytosis

2. Rh null

3. Alcoholism

4. Cirrhosis

5. Obstructive liver disease

What does it mean when a patient is classified as Rb null

They do not express any antigen

• This is a poikilocyte secondary to membrane abnormalities

• Rod or cigar shaped

• Formed when there is a deficiency in protein bag 4.1

• Different from ovalocytes kasi those are wide rods or parang eggs kasi oval pero this naman ay narrow

Elliptocyte

In which diseases do you see elliptocyte

1. IDA

2. Hereditary elliptocytosis

3. Thalassemia

What kind of poikilocyte is this?: Exposure to injuries causing damage to red cells and their shape is altered

Poikilocytes secondary to trauma

• This is a poikilocyte secondary to trauma

• Split RBCs

• Due to the pressure as the heart pumps so red cells flow into the vessels with pressure

• And if there are diseases that causes clots in the vessels, and the red cells are speeding in the vessels due to pressure, they will crash and be lysed

Shistocyte

Formation of clots in the vessel means more RBCs will be lysed which leads to the formation of (blank)

Shistocytes

You can form shistocytes when there is a presence of an anemia called (blank)

Microangipathic hemolytic anemia

If shistocytes have thorn-like projections, we call them as what

Keratocytes

Keratocytes or Schistocytes sre also referred to as

1. Helmet cells

2. Horn cells

• This is a poikilocyte secondary to trauma

• Red cells pass through the spleen, young and healthy ones survive

• If old and broken red cells pass through the spleen, of course the spleen will remove them

• But, if you have many abnormal or broken red cells passing through the spleen, our spleen cannot accommodate all of them

• And if the red cell is big and damaged and it is still able to escape the spleen, the pressure inside the spleen squeezes it so when it comes out, it is its known shape

Dacrocyte

These are what we call the clots formed in the vessels that the red cells in fast pressure will pass through

Dessiminated intravascular coagulation

Dacrocytes are seen in diseases like

1. Myeloid displasia

2. Thalassemia

3. Enlarged spleen

• This is a poikilocyte secondary to abnormal HB content

• Due to the polymerization of the oxygenated HbS because of AA replacement

• Instead of glutamic acid in the 6th position, there is valine instead

• If we have HbS, it will make our red cekls sickling

Drepanocyte

Depanocytes have an appearance that resemble

Holly leap

Depanocytes are also called as

1. Menisocyte

2. Sickle cells

• This is a member of other poikilocytes

• In shistocytes, remember that they are already split cells, before they become split, they will look like this

• These are considered as precursors of helmet cells

• Red cell with single or multiple vacuoles or marked thinned areas sa mga gilid

• Result of trauma to red cells due to fast passage on obstructed or clotted blood vessels

Blister cells

Blister cells are precursors of

Shistocytes

• This is a member of other poikilocytes

• Happens shen red cells have heinz bodies

• Again, heinz bodies are formed because of oxidative stress resulting to denaturation of hemoglobin

• Because these blood cells have hemoglobin, when they go through the spleen, the spleen will pit the cell to remove the heinz bodies

Degmacyte

Degmacytes are also called as

Bite cells

Degmacytes are seen in people with what

1. G6PD deficiency

2. Thalassemia

3. Drug induced anemia

4. Unstable hemoglobinopathies