Lecture 6: RBC Assessment in Anemia Flashcards by Katlyn Heneghan

Which lab assessment can assess RBC’s?
A. CMP
B. PKA
C. BMP

A. CMP

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Which of these are not features of RBC’s?
A. Contains Hb
B. 120 day lifespan
C. Biconcave
D. Central pallor
E. Nuclear
F. Stores 70% of body’s iron

E. Nuclear
(does not have a nucleus)

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____: Abnormally low Hb, HCT, and RBC’s

Anemia

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What happens to healthy people when hypoxia is sensed?

Erythropoiesis is stimulated

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Where does hematopoiesis occur in adults? Kids?

Adults: bone marrow of flat bones
Kids: ALL bones

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HSC’s can become ___stem cells, which can become BFU, CFU, then: ____ (committed cell), ____, ____, and RBC’s!!

pro-erythroblast, erythroblasts, reticulocyte

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Under hypoxic conditions, what cells will display accelerated maturation?

Reticulocytes

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At the end of their life, what molecules digested RBC’s in the spleen, liver, and bone marrow?

Macrophages

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Where is erythropoietin made?

Kidney
- It then travels to bone marrow to signal proliferation, maturation, and released of RBC

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True or False: A pluripotent stem cell can become a myeloid stem cell

True

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What allows for Burst-forming unit-erythroid (BFU-E) to be converted to CFU-E?

Erythropoietin

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What allows for CFU-E to become a committed cell (proerythroblast)?

Erythropoietin + Fe

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What molecule signals proliferation, maturation, and release of RBC precursors that mature into RBC’s?

Erythropoietin

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True or False: A single CFU-E produces a colony of > 1000 proerythroblasts

False - a single BFU-E produces a colony of > 1000 proerythorblasts

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True or False: Reticulocytes are smaller than mature RBC’s

False - Reticulocytes are larger than mature RBC’s

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Does reticulocyte production increase or decrease in response to blood loss or premature RBC destruction (hemolytic anemias)?

Increases

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How much time do reticulocytes spend in the bone marrow and blood before maturing into RBC’s?

3 days in bone marrow
1 day in circulating blood

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What three requirements must be met to have a normal response to hypoxia?

1) Responsive bone marrow (stem cells)
2) At least one healthy kidney
3) Adequate nutrition to support Hb synthesis and cell division of erythroid cells

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Intake of what two substances can support adequate Hb synthesis?

1) Iron
2) Protein

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Intake of what three substances support adequate DNA synthesis and cell division of RBC precursors?

1) Vit B12
2) Folate
3) Protein

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What causes pallor of skin, as visible in anemia?

1) Decreased RBC’s
2) Decreased O2 delivery to peripheral tissues

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Why do anemic patients feel dizzy?

1) Decreased RBC’s
2) Decreased oxygen transport to brain

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Why are anemic patients easily fatigued?

1) Decreased RBC's and O2 supply to tissues (muscles)

True or False: Anemia is a disease itself.

False - anemia is a sign of underlying disease

What are the three causes of anemia?

1) Pre-mature RBC destruction (or blood loss) 2) Insufficient stimulation of Erythropoiesis 3) Insufficient RBC production (iron, folate, vit B12 deficient)

True or False: Peripheral blood smears and stains, along with RBC indices, form the initial lab assessment of erythropoiesis

True

Which of the following is defined as the number of erythrocytes/RBC's in a given volume of whole blood? A. Hb Concentration (HGB) B. RBC (RBC concentration) C. Hematocrit (HCT)

B. RBC (RBC concentration)

Which of the following is defined as the concentration of Hb in a given volume of whole blood? A. Hb Concentration (HGB) B. RBC (RBC concentration) C. Hematocrit (HCT)

A. Hb Concentration (HGB)

Which of the following is defined as the % of volume of blood that is composed of RBC's? A. Hb Concentration (HGB) B. RBC (RBC concentration) C. Hematocrit (HCT)

C. Hematocrit (HCT)

What is the average Hb concentration (HGB)? A. 45% B. 15 g/dL C. 25 g/dL D. 25%

B. 15 g/dL

What is the average hematocrit (HCT)? A. 45% B. 15 g/dL C. 25 g/dL D. 25%

A. 45%

What value is calculated to assess RBC morphology and Hb content in classification of anemias? A. CBC B. Corpuscular Indices C. HgT

B. Corpuscular Indices

What are the three types of anemia?

1) Fewer RBC's, but normal size and normal HGB (Hg) 2) Fewer RBC's, are smaller, less HGB 3) Fewer RBC's, are larger, more HGB

_____: The average volume of circulating RBC's

Mean Corpuscular Volume

How is Mean Corpuscular Volume (MCV) calculated? How is Mean Corpuscular Hemoglobin (MCH) calculated? How is Mean Corpuscular Hb Concentration (MCHC) calculated?

MCV = HCT / RBC * 10 MCH = HGB/RBC * 10 MCHC = HGB/HCT * 100 MCHC = MCH / MCV * 100

MCV < 80 = _____ MCV of 80-100 = _____ MCV > 80 = ______

microcytic normocytic macrocytic

____ is defined as the quantity of Hb in an average circulating RBC A. Mean Corpuscular Volume B. Hb Concentration (HGB) C. RBC (RBC concentration) D. Hematocrit (HCT) E. Mean Corpuscular Hemoglobin (MCH)

E. Mean Corpuscular Hemoglobin (MCH)

_____ is the concentration of Hb in the average circulating RBC A. Mean Corpuscular Volume B. Hb Concentration (HGB) C. RBC (RBC concentration) D. Hematocrit (HCT) E. Mean Corpuscular Hemoglobin (MCH) F. Mean Corpuscular Hb Concentration

F. Mean Corpuscular Hb Concentration

MCHC < 33.4 = _____ MCHC 33.4 - 35.5 = ____

MCHC < 33.4 = Hypochromic MCHC 33.4 - 35.5 = Normochromic

Why is there no macrochromic or hyperchromic in MCHC?

HGB is not completely soluble at higher concentrations, so cannot be measured accurately

True or False: According to the Rule of 3, MCHC usually = 33

True

True or False: MCH and MCHC generally parallel MCV values because protein content can impact cell size

True

True or False: Routinely low MCHC is diagnostic for pernicious anemia

False - dx for iron deficiency anemia

If one is deficient in B12/folate, DNA synthesis will be impaired. How will this affect RBC's?

1) RBC's become larger because HGB production continues (macrocytic - high MCV) 2) MCH will be elevated 3) MCHC is in ref range because cell volume increases proportionally (there are fewer RBC's but they are larger)

What is the average Observed Reticular Count (OR)?

0.5 to 2%

___: The % of RBC's that are in reticulocytes

Observed Reticular Count (OR)?

True or False: Observed Reticular Count indicates the level of bone marrow reticulocyte production taking place to repopulate RBC's and maintain equilibrium

True

When anemia is present due to ___ or ____, the % of RBC that are reticulocytes will INCREASE as body tries to recover healthy # of mature RBC's

acute blood loss; premature destruction

Why are reticulocytes larger than mature RBC's?

They contains ribosomes, mitochondria, and RNA

True or False: In anemias, RBC count and HCT are so low that even normal reticulocyte production may appear as an elevated OR

True

What does Corrected Reticulocyte Count (CR) correct for?

The fact that, in anemias, RBC count and HCT are so low that even normal reticulocyte production may appear as an elevated OR

True or False: In anemic patients, reticulocyte: RBC may be artificially high

True

True or False: Corrected Reticulocyte Count (CR) considers patient's Hb compared to normal Hb

False - it considers patient's HCT compared to normal HCT

True or False: Elevated Corrected Reticulocyte>0.5-2% represents increased reticulocyte production

True

What is a normal response to RBC loss?

Release of reticulocytes from bone marrow, stimulated by EPO (elevated CR)

In anemia, premature RBC destruction/loss (hemolysis) result in elevated ___

Deficient production of RBC (e.g insufficient bone marrow response to anemia) results in __ within or BELOW reference range

Four causes of deficient production of RBC?

1) Kidney damage, less EPO made 2) Decreased bone marrow mass 3) Decreased HGB synthesis 4) Decreased RBC precursor cell division

If one has FEWER RBC's, which are normal and size, and has normal HGB content, what is the likely dx? A. Microcytic, hypochromic B. Normocytic, normochromic C. Macryocytic, normochromic

B. Normocytic, normochromic

If one has FEWER RBC's that are SMALLER and contain LESS HGB, what is the likely dx? A. Microcytic, hypochromic B. Normocytic, normochromic C. Macryocytic, normochromic

A. Microcytic, hypochromic

If one has FEWER RBC's that are LARGER and contain MORE HGB, what is the likely dx? A. Microcytic, hypochromic B. Normocytic, normochromic C. Macryocytic, normochromic

Macryocytic, normochromic

Macryocytic, normochromic anemia is associated with A. Blood loss, kidney deficits B. Vit B12/folate deficiencies C. Iron deficiency

B. Vit B12/folate deficiencies

Microcytic, hypochromic anemia is associated with A. Blood loss, kidney deficits B. Vit B12/folate deficiencies C. Iron deficiency

C. Iron deficiency

True or False: Normocytic, normochromic anemia is associated with Vit B12 deficiencies

False - it is associated with premature destruction, blood loss, kidney/bone marrow deficits

Pernicious anemia is related to lack of extrinsic factor

False - lack of intrinsic factor

Iron is required for synthesis of Hb and cell division of erythroid precursors. Sources of iron?

1) Diet 2) Recycled from HGB from old or damaged RBC's

True or False: Chronic iron deficiency can lead to decreased RBC production and decreased HGB synthesis, which can lead to fewer RBC's that are smaller and less pigmented than normal RBC's

True

True or False: Iron is required in ____ and for ribosome synthesis and ___ production

proerythroblasts; HGB

True or False: Iron deficiency can lead to production of small, microcytic RBC's (low MCV) that contain more HGB

False - Iron deficiency can lead to production of small, microcytic RBC's (low MCV) that contain LESS HGB

What is required for DNA synthesis in all cells?

Vit B 12 and Folate

How are erythropoietic progenitors in bone marrow affected by impaired DNA synthesis?

They have larger nuclei and continue to make HGB

Why are mature RBC's in blood larger in macrocytic anemia?

High HGB / protein content

What causes macrocytic anemia?

Decreased RBC division

True or False: In macrocytic anemia, RBC's are small, HGB is low, RBC's are normochromic, and cell volume increases proportionally with HGB, so there are fewer RBC's that are larger