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RBC Morphology Flashcards

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1
Q

what does a CBC provide info about?

A 
RBCs
WBCs
platelets
nutritional status
inflammation
specific disease states
hydration
occult blood loss
many more...
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2
Q

RBCs compose what %age? how many made a second? shape? size? nucleus?

A

99%
2-3 million/sec
7 micrometers in diameter but can pass through capillaries small as 3 micrometers wide
no nucleus (room for hemoglobin)

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3
Q

what molecule contributes to buffering capacity of blood?

A

hemoglobin & oxygen (& CO2)

hgb acts as buffer by picking up H+

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4
Q

what hormone signs the bone marrow stem cells to increase production of RBCs? what is it regulated by?

A

erythropoietin

regulated by O2 levels detected by kidneys

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5
Q

what can lead to an increase in EPO?

A 
decreased O2 states:
-high altitude
-COPD
-heart disease
-smoking
-hypoxic events
improper excretion:
-renal carcinoma or tumors
-hepatic carcinoma or tumors
-adrenal gland tumors
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6
Q

what can lead to depressed EPO?

A
  • renal failure
  • increased prod of IL-1 or TNF
  • severe malnutrition
  • hypothryroidism
  • malignancy
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7
Q

where does erythropoiesis occur in adults?

A

bone marrow of long or flat bones

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8
Q

what is the cell maturation path for RBCs? how long do they live for?

A

undifferentiated stem cell acted on by colony stimulating factor–> rubriblast–> prorubicyte–> rubricyte–> metarubricyte–> looses nuc–> reticulocyte–> released into cir & matures in about 24 hrs–> ERYTHROCYTE (mature RBC, lives 120 d)

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9
Q

where do metarubricytes lose their nuclei?

A

on erythroblastic islands; nurse MO

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10
Q

how long do reticulocytes live in the blood?

A

24 hrs until becomes mature RBC

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11
Q

are reticulocytes smaller or larger than mature RBCs? color? how does anemia affect them?

A

larger than mature RBCs
bluish appearance due to residual RNA
non-anemic= mature in peripheral circ in 24 hrs
anemic= maturation time increased in proportion to severity of anemia

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12
Q

when should you see an increase in reticulocytes?

A

when body is responding to anemia or hemorrhage

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13
Q

what does anemia w/low reticulocytes indicate?

A

failure of bone marrow (aplastic anemia)
EPO deficiency (renal failure)
bone marrow malignancy (leukemia)
anemia of chronic dz

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14
Q

what are 2 interfering factors with reticulocyte counts?

A

pregnancy: may see increased count secondary to increased fluid vol, hypoxia
howell-holly bodies (nuclear remnants): may be miscounted by techs or machines

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15
Q

reticulocyte index in pts with good marrow responses to anemia should be what? what does an RI<2% indicate?

A

2-3% indicating increased RBC production

<2% indicates, even w/elevated ritic counts, that the response is inadequate (hypoproliferative)

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16
Q

when do you see increased levels of reticulocytosis?

A

hemolytic anemia
hemorrhage
hemolytic disease of the newborn
treated deficiency anemias

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17
Q

when do you see decreased levesl of reticulocytopenia?

A 
pernicious anemia
nutrient deficiencies
aplastic anemia
radiation therapy
marrow failure
chronic diseases
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18
Q

RBC counting by machine is independent of what? what do automated RBC counts allow for?

A

cell shape, color & density

allow for hematocrit calculation

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19
Q

primary polycythemia has what EPO level?

A

low EPO

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20
Q

bone marrow proliferative disorder and dehydration has what EPO level?

A

normal EPO

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21
Q

renal proliferative disorder and secondary polycythemia leads to what EPO level?

A

elevated EPO

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22
Q

what is a decrease in RBCs called? what is it due to?

A

ANEMIA= erythrocytopenia

due to malnutrition, malabsorption, inflam, hemorrhage, hemolytic, BM failure, renal dz, etc.

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23
Q

what are interfering factors with RBC counts?

Study These Flashcards
A

pregnancy (decreased counts)
high altitude (increased count)
hydration (increase or decrease
drugs that increase: gentamycin, methyldopa
drugs that decrease: chloramphenicol, quinidine

24
Q

what is hematocrit?

Study These Flashcards
A

portion of blood composed of erythrocytes
% of total blood vol
indirect measure of # of RBCs and their total blood volume

25
what is anisocytosis? causes? result of?
any significant variation in size of RBC found in anemias & leukemias results from abnormal cell development often due to deficiency in raw material
26
what is RDW?
Red blood cell distribution width statistical measure of variation in RBC size calculated from MVC & RBC indicator of degree of anisocytosis
27
what do increases in RDW signify? are decreases significantly significant?
``` iron deficiency anemia B12 or folaic acid deficiency anemia hemoglobinopathies hemolytic anemias posthermorrhagic anemia decreases in RDW not clinically significant ```
28
what are macrocytes?
increased size greater than 8 micrometers well hemoglobinized (lacks central pallor)
29
what are the two types of macrocytes and what does each signify?
``` round= liver dz oval= B12/folic acid deficiency, pernicious anemia ```
30
what are microcytes?
decreased size smaller than 6 micrometers increased central pallor due to decreased hgb concentrations
31
what causes microcytes?
iron deficiency blood loss sideroblastic anemia
32
what is good about peripheral smear evaluation? why is it good to use/
inexpensive & diagnostic determine is cells appear normal in size, shape & count not required in all pts
33
what is poikilocytosis?
RBC variation in shape | excessive variation in normal RBC shape
34
what are target cells? what causes it?
dark center & periphery separated by pale area | caused by: thalassemia, splenectomy, liver disease, iron deficiency, hemoglobinopathies, decreased osmotic fragility
35
what are spheroctyes?
sphere or globe w/dense appearance (no central pallor), increased hgb content, increased thickness of cell & decrease in diameter
36
when do you see spherocytes?
autoimmune hemolytic anemia | hereditary spherocytosis
37
what is the problem with spherocytes? what do pts present w/?
problem is they burst more readily when exposed to osmotic pressure due to increased osmotic fragility pts present w/anemia, splenomegaly & jaundice
38
what are schistocytes? what dz states cause?
``` fragmented cells from trauma to membrane artificial heart valve hemolytic uremic syndrome disseminated intravascular coagulation thrombotic thrombocytopenia purpura ```
39
what are echinocytes?
multiple tiny spicules even distributed over cell surface | from exposure of certain substances to cell surface
40
what are acanthocytes?
also known as spur cells spheroid RBCs w/few lg thorny projections 5-10 spicules per cell hard to differentiate from echinocytes
41
what causes acanthocytes?
post splenectomy alcoholics cirrhois various hemolytic anemias
42
what are dacrocytes? when do you see them?
teardrop shaped cells seen meylofibrosis w/myeloid metaplasia usu indicate significant bone marrow failure seen in megaloblastic anemia, renal failure, severe iron deficiency & thalassemia major
43
what are elliptocytes? when do you see an increase up to 10%? acquired or congenital?
known as ovalocytes normally <1% of RBCs, can increase up to 10% in cases of thalassemia of deficiencies of iron or folate, can also get w/hereditary elliptocytosis?
44
what happens to hgb in sickle cell? RBCs? blood flow?
abnormal hbg prone to crystallization when O2 tension low | RBCs change shape into sickles that get stuck in capillaries and further decrease blood low & O2 tension
45
in sickle cell what do pts start out with and progress to?
start w/splenic enlargement but eventually spleen size has tremendously reduced in size due to continual stasis & infarctions
46
what are howell-jolly bodies? when do pts present usu?
small 1 mm inclusions of nuclear chromatin remnants or fragments most present post splenectomy b/c spleen would normally remove these RBCs from circulation also see in hemolytic anemia
47
when are heinz bodies formed?
formed by damage to hbg through oxidative stress= irreversible hemichrome oxidation & precipitation
48
when do you see heinz bodies?
alpha thalassemia congenital hemolytic anemia G5PD deficiency
49
what does basophilic stippling indicate?
toxic injury to bone marrow severe anemia: megaloblastic lead poisoning myelofibrosis
50
what is erythrocyte sedimentation rate used to detect? diagnostic?
simple & inexpensive lab to test overall inflammation track progress of a dz or to monitor tx (sickness index) not diagnostic
51
why would ESR increase? what is it called when RBCs stack up on one another?
``` inflam proteins (acute phase reactants, mainly fibrinogen) neutralize negative charge usu on cellular surface (zeta potential) which normally repels RBCs RBCs overcome zeta potential & stack up on one another= rouleaux formation= settles faster ```
52
why is ESR useful?
in general as dz worsens ESR increases & as dz resolves ESR decreases can be used to monitor therapy esp for inflam autoimmune dz
53
what are the limitations to ESR?
nonspecific, nonsensitive may NOT be elevated in active dz many factors can alter test results
54
what are specific interfering factors for ESR?
``` low results if test not set up w/in 3 hrs of sample pregnancy menstruation may elevate sedimentation tube must be vertical some anemia's falsely increase polycythemia & sickle cell decreases protein-producing malignancies falsely increases ESR any bubble in column invalidates test ```
55
what dzs can increase ESR?
``` chronic renal failure malignant dzs bacterial infxn inflam/autoimmune dzs necrotic diseases, MI dzs associated w/increased plasma proteins ```
56
what 2 dzs does ESR assist in the diagnosis of?
polymyalgia rheumatica and temporal arteritis
57
what can cause falsely decreased levels in ESR?
sickle cell dz hereditary spherocytosis hypofibrinogenemia polycythemia vera

Lab Diagnosis (5 decks)

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