Heme Quiz 3 Red cell variations

purple dots

hint-color

look at red cells

they are very condensed

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Megaloblastic anemia due to Vitamin B₁₂ or Folate deficiency

disease that causes

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a route to change any methgb (3+) back to functional hgb (2+)

Methgb reductase pathway

where 2,3 BPG can be made. Increased 2,3 BPG helps speed up oxygen unloading from hgb molecule

Luebering-Rapaport pathwway

yields ATP for an energy source for the renewal of membrane lipids and operation of cationic pump

anaerobic glycolysis (Embden-Meyerhof) pathway

What four chains are made during globin synthesis?

α, β, γ, ∆

How is the hemoglobin molecule assembled?

- Each globin links with a heme
- Four subunits together form a molecule
- Two alpha chains with heme +
- Two non-alpha chains with heme (can be beta, gamma or delta)

What is the order that O2 binds hemoglobin? What is the order it unloads?

1) First alpha chain binds an O2

2) Salt bridges broken and molecule rearranged

3) The two beta subunits bind O2

4) Last O2 bound to last alpha subunit

When hgb unloads, the reverse order occurs

What happens when there is a shift to the right on the oxygen dissociation curve?

Hgb has a decreased oxygen affinity but increased in O2 delivery to tissues

What happens when there is a shift to the left on the oxygen dissociation curve?

Hgb has increased oxygen affinity
- hgb holds on to O2 longer and tissue may be more deprived to get any O2

At a pO2 of 40, hgb is usually about _______ saturated

75%

Conditions of hypoxia (right shifted curve)

• low pO2

• higher 2,3 DPG

• acidic pH

anemic patients can force rbc to unload _______ and somewhat compensate for anemia

faster

At the end of their days, RBC are removed by:

macrophages of spleen, liver and marrow

as RBCs age

• ag/ab complexes accumulate on surface

• cells become rigid

• spherocyte occur as membrane gradually picked away and inclusions form

Hemoglobin is broken down into:

• amino acids recycled

• heme separated into porphyrin ring and iron

Steps of Extravascular Hemolysis

- Porphyrin ring opened up and changed into biliverdin

- Biliverdin changes into bilirubin (unconjugated) and is bound to albumin

- As blood passes through liver, bilirubin is removed and gets conjugated

- Conj. Bili is secreted via bile into intestines

- Bacteria convert into urobilinogen and it exits

- Some urobilinogen reabsorbed, filtered by kidneys and excreted in the urine

During intravascular hemolysis, hgb separates into alpha-beta pairs and is picked up by a salvage protein called ______

haptoglobin

Any hgb not bound to haptoglobin or reabsorbed gets oxidized to _______________ which breaks down into methme and globin

methemoglobin

What is the maturation process for erythrocytes?

- Pronormoblast

- Basophilic normoblast

- Polychromatophilic normoblast

- Orthochromic normoblast

- Polychromatophilic red cell

- Mature RBC

What happens when erythropoietin is made by the kidneys?

More RBC are released, the oxygen capacity is increased and production of erythropoietin is eventually turned off

By age 18 or so, only active marrow is contained within the _________, _________, ________, and _________

Pelvis, vertebrae, ribs, and sternum

At about ______ years of age, the available bone space exceeds the amount of marrow so bones begin to fill with fat

5

What regulates erythropoiesis?

regulated by how much oxygen is in the blood

Burst forming unit erythrocyte (BFU)

cells have low concentration of erythropoietin receptors

- CD34 pos

colony forming unit erythrocyte (CFU)

have more receptors and respond to better EPO

- CD34 neg

- Very few, even in bone marrow ( <3% of nrbc in marrow)

- Usually seg size or a little bigger

Pronormoblast

Bottom arrow

- nucleus more condensed

- deep blue cytoplasm

- Nucleolus is lost

- 1-10% of nrbc bone marrow

Basophilic normoblast

- more bluish (confederate blue than leukocyte)
- 10-30% of bone marrow
- "Hamburger Nucleus"

Polychromaticphilic normoblasts

- 5-10% of nrbc in marrow

Orthochromic normoblast

- triangle of RBC = 1 neutrophil
- central pallor 1/3 of cell size and gradual shading from hgb to central area

Mature red blood cell

~ 1% in blood
- slightly blue tinge

polychromatophilic red cell

When hemopexin capacity is exceeded, metheme combines with albumin to form ________ and circulates until hemopexin becomes available to take it to the liver

methemalbumin

Metheme binds to another transport protein called ____________ and gets carried to the liver and is processed as usual

hemopexin

The layers of a RBC membrane is

lipid bilayer supported by a protein mesh like framework

Deficiency is globin

Thalassemia

Left curve is caused by

• abnormal hgb

• alkalosis

• decreased 2,3 DPG

• CO poisioning

• fetal hgb

the process by which any RBC that breaks apart in circulation and results in free hgb complexing with haptoglobin to be recycled.

intravascular hemolysis

The kidneys filter out, reabsorb hgb by renal to a point. After this, free hgb in the urine occurs what is this called?

Hemoglobinuria

free hgb in the urine at a chronic level and over a long period of time

hemosiderinuria

what Parameter on a CBC report is an indication of Microcytosis

MCV

What Parameter on the automated instruments will reflect the amount of anisocytosis in a specimen

RDW

Poikilocytosis

An abnormal variation in the shape of red cells

Why are polychromatophilid RBC so blue

RNA is still present

What are pappenheimer bodies composed of

Iron

What is a howel jolly body made of

DNA or part of the chromosome