Hematology Test II

80-100 fL

How much hemaglobin is contained in each red cell (in picograms)

Hgb/Hct *100 = % of volume that is hemaglobin

The average volume of a red blood cell (in fL)

MCV = (Hct x 10) / # of RBC

Gross mass of hemaglobin in each RBC

Hgb * 10 / # of RBC

12 g/dL or 37% respectively

When the Hgb becomes deoxyHgb, the O2 dissociation curve is shifted to the right.

Vasoconstriction, blood is shunted away from cutaneous tissue

It is less viscous, allowing it to move more freely through vasculature

Babies are given too much commercial milk, which is low in iron. This produces anemia.

Multiple pregnancies increase the prevalance of anemia.

Any condition where RBC lifespan is significantly decreased

alpha and gamma

alpha and beta

erythrocyte production is insufficient to deal with increased RBC destruction

Hgb, MethHgb, methemalbumin, bilirubin, urobilinogen and binding proteins

mechanical destruction of RBC's in the vasculature. Produces helmet shaped "schizocytes"

produces spherocytes

IgG autoimmune anemia occurs at any temperature, while IgM usually occurs only in the wintertime.

Insufficient iron causes small and pale (hypochromic and microcytic) cells. Low MCHC and MCV.

Ferrous sulfate (FeSO4) or parental iron in GI malabsorption

Anemia of chronic disease - dec. RBC life span, impaired iron metabolism

Failure to synthesize adequate amounts of normal DNA (AKA ineffective erythropoiesis)

folate, B12

terminal ileum, because B12 can only be carried by a special transport protein

Intrinsic factor is not produced or neutralized (cannot absorb B12)

Gastrectomy

autoimmune destruction of gastric mucosa (atrophic gastritis) and antibodies vs intrinsic factor

Genetic; abnormal globin chain

Low production of a hemaglobin chain or chains

Hgb S

Hgb C

Destabalized hemoglobin causes red cell inclusions

microcytic cells but no anemia

Hgb:
Male = 14 - 17 g/dL
Female = 12 - 15 g/dL

Hct:
Male = 42 - 52 %
Female = 36 - 46%

RBC
Male = 4.3 - 5.7 x 10^12 / L
Female = 3.8 - 5.1 x 10^12 / L

Leukopenia = decreased WBC count
Leukocytosis = increased WBC count
Pancytopenia = decrease all formed elements

Unequal cell size indicated by a higher RDW

Presence of unusually shaped red blood cells in blood

Normal range 0.5 - 2.5 and is used to judge the activity of the bone marrow.

(basophilic stained) nuclear remnants inside circulating RBC's

nucleated red blood cells containing percipitated iron and associated with myelodysplasia

Inclusions containing percipitated iron granules

Inclusions consisting of percipitated hemoglobin

Accumulated rRNA inclusions in erythrocytes

Thalassemia

1. Increased erythropoietin secretion by the kidneys in response to hypoxia

2. Increased 2,3-DPG

3. Redistribution of blood flow via vasoconstriction to increase oxygenated blood supply to vital organs.

4. Increased cardiac output

Pallor, fatigue, sharp or labored breathing, low BP, heart attack

Because the beta chain does not become a predominant part of the hemaglobin molecule until about 6 weeks after birth. Alpha chain abnormalities will usually cause fetal death.

Microcytes = smaller than normal RBC (<7 um) and large central pallor

Macrocytes = >10um, very little pallor visible (more spherical)

Anisocytosis = variations in size
Poikilocytosis = variations in shape

About 2/3

Note: MCH is NOT a measure of how much volume hemoglobin occupies, but the average mass of hemoglobin per erythrocyte.

Teardrop shaped erythro's

MCHC will usually be normal. Associated with extramedullary hematopoiesis: myelofibrosis, severe anemia, myeloproliferative disorders, pernicious anemia

AKA Echinocytes

Distortion of the outer plasma membrane layer.

Very similar to artifactual crenated RBC's, so proper smear preparation is vital.

Can be associated with uremia

AKA drepanocytes

Caused by substitution of glutamate for valine at pos 6 of beta chain

Seen in abetalipoprotanemia, severe liver disease, vitamin E deficiency (rare), alocohol poisoning, post-splenectomy

AKA codocytes

Seen in liver disease and other hemaglobinopathies. Associated with thalassemia (in thalassemia will see a homogenously small erythrocyte size)

RBC fragments, associated with increaed RBC destruction: DIC (disseminated intravascular coagulation) Hemolytic processes, thrombotic thrombocytopenia purura (TTP)

Normal: in newborns
Abnormal: spherocytosis (genetic disorder)

Spherocytes are much more fragile than the normal biconcave shape.

AKA "Mouth cells)

Seen in liver disease (due to lipid disruption in inner cell membrane) and hereditary stomatocytosis

Seen with:
Hereditary elliptocytosis
IDA (Iron deficiency anemia)
Thalassemias

Caused by percipitated stain, can be confused for bacteria and should be examined.

A slightly basophilic color seen commonly with basophilic stippling

0.5 - 2.5%

small (microcytic)

Small spherical dark purple granules that represent chromosomal remnants. Located eccentrically within the RBC (not in the middle)

The process by which the spleen removes Howell Jolly bodies

Prussian blue stain

Seen in sideroblastic anemia, looks like a ring of siderosome surrounding a normoblast (in bone marrow)

Caused by hemoglobin denaturation due to glycolysis enzyme (G6PD and pyruvate kinase) abnormalities.

Associated with exposure to oxidizing drugs, thalassemia and post-splenectomy

Do NOT react with wright stain

fetal/neonatal;

Remnants of mitotic spindle; occur in severe anemias and dyserythropoiesis. Stains dark red to purple

Inclusions caused by aggregations of HgC, often seen with target cells

Seen in sideroblastic anemia, looks like a ring of siderosome surrounding a normoblast (in bone marrow)

Caused by hemoglobin denaturation due to glycolysis enzyme (G6PD and pyruvate kinase) abnormalities.

Associated with exposure to oxidizing drugs, thalassemia and post-splenectomy

Do NOT react with wright stain

fetal/neonatal;

Remnants of mitotic spindle; occur in severe anemias and dyserythropoiesis. Stains dark red to purple

Inclusions caused by aggregations of HgC, often seen with target cells

Caused by the genus Plasmodium and shows as ring-shaped inclusions within the erythrocyte. When mature, cause cell to change shape to a banana-shaped form.

"Stack of coins" seen with protein abnormalities (ie. multiple myeloma)

Caused by cold agglutanins (non coagulation induced aggregation of RBC's) Solution: warm up the sample to induce separation.

1+ = 1-9 per high power field
2+ = 10-25 per high power field
3+ = >25 per high power field

Spherocytes

Seen most commonly with acute blood loss. Also with aplastic anemia, most leukemias, and bone marrow infiltration
- normal MCV and MCHC

Most common: IDA
- decreased MCV and MCHC
- also seen with lead poisoning, ACD and thalassemia (thalassemic pt's will have high RBC count)