RBC MORPHOLOGY AND PHYSIOLOGY Flashcards
(194 cards)
1
Q
aka Red Blood Cells (RBC)
A
ERYTHROCYTES
2
Q
Average Life Span of erythrocytes
A
120 days
3
Q
RBC Reference values for males
A
4.0 – 5.2 x 10^12/L
4
Q
RBC Reference values for females
A
3.6 – 5.6 x 10^12/L
5
Q
RBC Reference values for newborns
A
5.0 – 6.5 x 10^12/L
6
Q
Functions of erythrocytes
A
- Oxygen transport
- Removal of metabolic wastes
7
Q
Size of RBC
A
6-8 um
8
Q
T/F: RBC is nucleated
A
F (anucleated)
9
Q
Thickness of RBC
A
1.5-2.5 um
10
Q
Shape of RBC
A
Biconcave disc
11
Q
Describe the cytoplasm of RBC
A
Salmon pink with central pallor area
12
Q
Average volume of RBC
A
80-100 fL (90 fL)
13
Q
Surface area of RBC
A
140 um^2
14
Q
Ratio of RBC
A
Increased surface-to-volume ratio
15
Q
During their intravascular lifespan, erythrocytes require _____ to maintain a number of _________
A
energy, vital cell functions
16
Q
State the 7 energy-dependent RBC metabolism
A
(1) maintenance of glycolysis
(2) maintenance of the electrolyte gradient between plasma and red cell cytoplasm through the activity of adenosine triphosphate (ATP)-driven membrane pumps
(3) synthesis of glutathione and other metabolites
(4) purine and pyrimidine metabolism
(5) maintenance of hemoglobin’s iron in its functional, reduced, ferrous state
(6) protection of metabolic enzymes, hemoglobin, and membrane proteins from oxidative denaturation
(7) preservation of membrane phospholipid asymmetry.
17
Q
What are the 4 pathways in RBC metabolism
A
- Embden-Meyerhof Pathway
- Hexose Monophosphate Shunt
- Methemoglobin Reductase Pathway
- Rapoport-Luebering Pathway
18
Q
Anaerobic pathway of glucose metabolism
A
Embden-Meyerhof Pathway
19
Q
- Source of 90-95% of RBC requirement
A
Embden-Meyerhof Pathway
20
Q
Embden-Meyerhof Pathway requires _____________ to produce ATP
A
glucose
21
Q
Product of Embden-Meyerhof Pathway
A
o Lactate
o Pyruvate
o ATP
22
Q
Hexose-Monophosphate Shunt is aka as what?
A
aka Pentose Phosphate Pathway, phosphogluconate pathway
23
Q
- Aerobic and oxidative pathway
A
Hexose-Monophosphate Shunt
24
Q
- Functionally dependent on Glucose-6-phosphate dehydrogenase pathway (G-6-PD)
A
Hexose-Monophosphate Shunt
25
* Detoxifies accumulated peroxides
Hexose-Monophosphate Shunt
26
Hexose-Monophosphate Shunt produces _______________
reduced glutathione
27
reduced glutathione prevents ______
Prevents oxidative denaturation of hemoglobin
28
Maintains iron in the hemoglobin molecule in the Ferrous (Fe2+) state by the action of Methemoglobin reductase (cytob5r).
Methemoglobin-Reductase Pathway
29
what is (cytob5r)
Methemoglobin reductase
30
Action involved in Methemoglobin-Reductase Pathway
Methemoglobin reductase (cytob5r)
31
* Third metabolic shunt
Rapoport-Luebering Pathway
32
* Generates 2,3-bishosphoglycerate (2,3-BPG,2,3-DPG)
Rapoport-Luebering Pathway
33
* Regulates affinity of hemoglobin to oxygen
Rapoport-Luebering Pathway
34
Rapoport-Luebering Pathway regulates ___________________________
affinity of hemoglobin to oxygen
35
* A curve produced when pO2 and hemoglobin affinity to oxygen are plotted on a graph
OXYGEN DISSOCIATION CURVE
36
increased hemoglobin affinity to oxygen
* Shift to the left
37
decreased hemoglobin affinity to oxygen
Shift to the right
38
4 FUNCTIONS OF RBC MEMBRANE
1. It gives the RBC its shape
2. It provides skeletal system for RBC
3. It maintains Osmotic balance
4. It facilitates transportation of gases
39
* The increased surface-to-volume ratio allows RBC to stretch undamaged 2.5 times their resting diameter.
RBC MEMBRANE DEFORMABILITY
40
* Increased cytoplasmic viscosity compromised its _______________
deformability
41
* RBC membrane lipid component maintains its _______
strength and deformability
42
RBC Membrane consist of:
lipids, proteins, carbohydrates
43
percent of lipids in RBC membrane
40%
44
percent of proteins in RBC membrane
52%
45
percent of carbohydrates in RBC membrane
8%
46
Transmembrane
Integral Proteins
47
Cytoskeletal/skeletal
Peripheral Proteins
48
* Responsible for the semi- permeability of the cell
RBC Membrane Lipids
49
2 Lipid Bilayer:
o Hydrophilic polar head group
o Hydrophobic nonpolar tail
50
o Hydrophilic polar head group includes what
Phosphatidylcholine
Sphingomyelin
51
o Hydrophobic nonpolar tail includes what
Phosphatidylserine
Phosphatidylethanolamine
Phosphatidylinositol
52
confers tensile strength to the lipid bilayer.
* Cholesterol
53
forms the glycocalyx with the integral proteins
Glycolipids
54
* Penetrates the lipid bilayer
Integral Proteins
55
* Has high sialic acid residue (zeta potential)
Integral Proteins
56
sialic acid residue (___________)
zeta potential
57
Functions of Integral Proteins
o Transport site
o Adhesion site
o Signaling receptors
58
* Supports carbohydrate-defined blood group antigen
Integral Proteins
59
* Located adjacent to the cytoplasmic membrane lipid layer
Peripheral Proteins
60
* Provides lateral or horizontal membrane stability
Peripheral Proteins
61
Peripheral Proteins provides _____________ or ________ membrane stability
lateral or horizontal
62
principal proteins (25-30%)
* Spectrin (α, ß)
63
o Responsible for the elasticity of the cell (with actin and protein 4.1)
* Spectrin (α, ß)
64
percent of actin in peripheral proteins
(4.5%)
65
5 RBC anomalies
1. Variation in size
2. Variation in shape
3. Color variation
4. RBC inclusions
5. Alteration in the RBC distribution on a peripheral blood smear
66
* Variation in size
ANISOCYTOSIS
67
Anisocytosis with
>8 um
MCV: >100 fL
Seen in: Pernicious anemia, Liver cirrhosis, Aplastic anemia
* Macrocyte
68
Anisocytosis with
MCV of >120 fL
Seen in: Pernicious anemia, Vitamin B12 and folic acid deficiency
* Megalocyte
69
Anisocytosis with
<6 um
MCV: <60 fL
Seen in: IDA, Thalassemia, Hemolytic anemia, Sideroblastic anemia
* Microcyte:
70
Mean Cell Volume (MCV):
80-100 fL
71
Ways to detect anisocytosis
1. Using the nucleus of small lymphocyte in a peripheral blood
2. Mean Cell Volume (MCV) value
3. Red Cell Distribution Width (RDW) value
72
Red Cell Distribution Width (RDW) value:
o Index of anisocytosis
o Coefficient of variation of RBC volume
o Reference value (CV): 11.5-14.5%
73
* Variation in color
ANISOCHROMIA
74
* Reflects the hemoglobin content of RBC
ANISOCHROMIA
75
Describe normal RBC (Normochromia)
salmon-pink with central pallor area approx. 1/3 of the diameter.
76
o Central pallor area >1/3 of RBC diameter
o Usually microcytic
* Hypochromia
77
* Hyperchromia aka __
Spherocytes
78
aka Spherocytes
Lacks central pallor area
* Hyperchromia
79
GRADING OF HYPOCHROMIA
What is the central pallor area of +1
1/2 of RBC diameter
80
GRADING OF HYPOCHROMIA
What is the central pallor area of +2
2/3 of RBC diameter
81
GRADING OF HYPOCHROMIA
What is the central pallor area of +3
3/4 of RBC diameter
82
GRADING OF HYPOCHROMIA
What is the central pallor area of +4
Thin rim of hemoglobin
83
Three parameters of Anisochromia
* Central Pallor Area
* Mean Cell Hemoglobin (MCH)
* Mean Cell Hemoglobin Concentration (MCHC)
84
o Average weight of hemoglobin in an individual RBC
* Mean Cell Hemoglobin (MCH)
85
o Reference range (Normochromia) in Mean Cell Hemoglobin (MCH)
26-32 pg
86
MCH
<26 pg
Hypochromia
87
MCH
>32 pg
Hyperchromia
88
o Average concentration of hemoglobin in each individual RBC
* Mean Cell Hemoglobin Concentration (MCHC)
89
o Reference range (Normochromia) in * Mean Cell Hemoglobin Concentration (MCHC)
32-36 g/dL or %
90
MCHC
<32 g/dL
Hypochromia:
91
MCHC
>36 g/dL
Hyperchromia
92
RBC with different degrees of staining affinity
POLYCHROMASIA
93
* Slightly larger RBC with bluish tinge (Wright stain)
POLYCHROMASIA
94
POLYCHROMASIA indicates:
reticulocytosis
95
GRADING OF POLYCHROMASIA
Grading: Slight
Percentage of Polychromatophilic RBCs: ?
1%
96
GRADING OF POLYCHROMASIA
Grading: 1+
Percentage of Polychromatophilic RBCs: ?
3%
97
GRADING OF POLYCHROMASIA
Grading: 2+
Percentage of Polychromatophilic RBCs: ?
5%
98
GRADING OF POLYCHROMASIA
Grading: 3+
Percentage of Polychromatophilic RBCs: ?
10%
99
GRADING OF POLYCHROMASIA
Grading: 4+
Percentage of Polychromatophilic RBCs: ?
>11%
100
* Variation is shape
POIKILOCYTOSIS
101
* Normal (Discocyte)
round biconcave shape
102
What are the 17 examples of Poikilocytes
o Spherocytes
o Stomatocytes
o Acanthocytes
o Echinocytes
o Burr cells
o Ovalocytes
o Dacryocytes
o Knizocytes
o Keratocytes
o Schistocytes
o Blister cells
o Drepanocytes
o Degmacyte
o Leptocytes
o Biscuit cells
o Bronze elliptocytes
o Semilunar bodies
103
* Spherical RBC
* No central pallor area
* Decreased surface-to-volume ratio
Spherocytes
104
* Seen in:
o Hereditary spherocytosis
o Hemolytic anemia
o Burns (microspherocytes)
Spherocytes
105
* aka Mouth cells
Stomatocytes
106
* Elongated RBCs with a slit-lit central pallor
Stomatocytes
107
Stomatocytes is seen in:
o Rh null Syndrome
o Alcoholism
o Hereditary Stomatocytosis
o Electrolyte imbalance
o Severe liver disease
o Thalassemia minor
o Glutathione deficiency
o Infectious mononucleosis
108
* aka Thorn cells, Spur cells
Acanthocytes
109
* RBC with irregular spiculated surface (spike-like)
Acanthocytes
110
* Seen in:
o Abetalipoproteinemia
o Spur cell anemia
o McLeod Syndrome
o Liver cirrhosis
o Hemangioma
o Post-heparin administration
o Neonatal hepatitis
o Post-splenectomy
Acanthocytes
111
* RBCs with regularly spiculated surface
Echinocytes
112
* Seen in:
o Artifactual drying of blood smear
o Effects of salicylates or barbiturates
o Bile acid abnormalities
o Osmotic imbalance
Echinocytes
113
* aka Sea-Urchin Cells
Burr Cells
114
* RBC with regularly spiculated surface
Burr Cells
115
Burr cells is seen in
o Uremia
o Acute Blood Loss
o Pyruvate Kinase deficiency
o Stomach Cancer
116
* Seen in:
o Uremia
o Acute Blood Loss
o Pyruvate Kinase deficiency
o Stomach Cancer
Burr Cells
117
* Oval-shaped RBC
Ovalocytes
118
rod-, sausage-, cigar-shaped RBC; More elongated than ovalocytes
* Elliptocytes
119
* Seen in Hereditary Elliptocytosis
Ovalocytes
120
Hereditary Elliptocytosis examples
o Hemoglobin C disease
o Hemolytic anemia
o IDA
o Pernicious anemia
o Sickle cell trait
o Thalassemia
121
* aka Teardrop cells
Dacryocytes
122
* Pear-shaped or tear-shaped RBCs
Dacryocytes
123
* Seen in:
o Primary myelofibrosis
o Pernicious anemia
o Homozygous Beta-thalassemia
o Hemolytic anemia
o Myelopthisic anemia
o Myeloid metaplasia
Dacryocytes
124
* Resembles a pinched bottle
Knizocytes
125
Knizocytes is seen in
o Hemolytic anemia
o Hereditary spherocytosis
126
* Partially deformed RBCs but not cut
Keratocytes
127
* Spiculated resembling two horns
Keratocytes
128
* Spindle-, half moon-shaped RBC
Keratocytes
129
Keratocytes is seen in
o Disseminated Intravascular Coagulation
130
* aka schizocytes, helmet cells
Schistocytes
131
* Fragmented RBCs
* Remains of ruptured blister cells
Schistocytes
132
* Seen in:
o Prosthetic implants (artificial heart valve)
o Uremia
o Infantile pyknocytosis
o Disseminated Intravascular Coagulation
o Severe burns
o Microangiopathic hemolytic anemia
o Renal transplant rejection
Schistocytes
133
* Erythrocyte containing one or more vacuoles that resemble skin blisters
Blister Cells
134
___ and ____ are produced in blister cells
Keratocytes and schistocytes
135
blister cells are seen in:
o Pulmonary embolism in sickle cell anemia
o Microangiopathic hemolytic anemia
136
* aka Meniscocyte, Sickle cell
Drepanocytes
137
* Sickle-cell or crescent-shaped RBCs
Drepanocytes
138
* Results from gelation of polymerized deoxygenated Hemoglobin S.
Drepanocytes
139
Two forms of Drepanocytes
o Oat-shape cells
o Irreversible Sickle Cell (ISC)
140
Crescent-shaped RBC with less pronounced projection
o Oat-shape cells
141
Crescent-shaped RBC with long projection
o Irreversible Sickle Cell (ISC)
142
* Seen in:
o Sickle cell anemia
o Hemoglobin SC disease
Drepanocytes
143
* aka Bite cells
Degmacyte
144
* RBC with one or more semicircular portions removed from the margin
Degmacyte
145
Degmacyte is seen in:
oxidative-related hemolysis in G6PD deficiency
146
* aka Target cells, Mexican Hat Cells, Codocytes
Leptocytes
147
* RBC with centrally stained area with a thin outer rim of hemoglobin
Leptocytes
148
* Seen in:
o Thalassemia
o Lecithin-Cholesterol Acyltransferase deficiency
o Hepatic disorder
o Iron deficiency anemia
o Hemoglobin C disease
o Post-splenectomy
Leptocytes
149
* Folded RBC
Biscuit Cells
150
* Bipolar or central distribution of hemoglobin
* Seen in Sickle cell anemia
Bronze Elliptocytes
151
WHAT ARE THE 9 RBC INCLUSION
* Basophilic stippling
* Pappenheimer bodies
* Howell-Jolly Bodies
* Cabot Rings
* Heinz Bodies
* Hemoglobin H
* Malarial stipplings
* Babesia spp.
* Bartonella spp.
152
* Punctuate stippling/punctuate basophilia
Basophilic Stippling
153
* Aggregated RNA
o Blueberry Bagel Appearance
Basophilic Stippling
154
* Seen in:
o Lead poisoning (Plumbism)
o Arsenic poisoning
o Pyrimidine-5’-nucleotidase deficiency
o Anemia with impaired hemoglobin synthesis
o Refractory anemias
o Alcoholism
o Megaloblastic anemia
Basophilic Stippling
155
* aka Siderotic granules (Supravital stain)
Pappenheimer Bodies
156
* Intraerythrocytic collections of iron
Pappenheimer Bodies
157
* Visualization in Pappenheimer Bodies
o Supravital stain
o Wright stain:
158
Visualization
Siderotic granules
e.g., Iron stain, Perl’s reagent, Prussian Blue, New methylene blue
Supravital stain
159
Visualization:
Pappenheimer bodies
Wright stain
160
* Seen in:
o Sideroblastic anemia
o Hemochromatosis
o Hemosiderosis
Pappenheimer Bodies
161
* Remnants of nuclear chromatin (DNA)
Howell-Jolly Bodies
162
* Round, solid-staining, dark-blue to purple inclusion (1-2 um)
Howell-Jolly Bodies
163
* Visualization in Howell-Jolly Bodies
o Wright stain (reddish-blue or purple)
o Supravital stain
o Feulgen
164
* Seen in:
o Megaloblastic anemia
o Post-splenectomy
Howell-Jolly Bodies
165
* Remnants of microtubules from mitotic spindle
Cabot Rings
166
* Ring-, figure-eight-, loop-shaped inclusion
Cabot Rings
167
* Visualized using Wright stain (reddish-violet)
Cabot Rings
168
cabot rings color in wright stain
reddish-violet
169
* Seen in:
o Abnormal erythropoiesis
o Pernicious anemia
o Lead poisoning
Cabot Rings
170
* Ehrlich bodies
Heinz Bodies
171
* Denatures and precipitated hemoglobin
Heinz Bodies
172
heinz bodies inclusions
0.2 to 2.0 um in size
173
Heinz bodies is visualized in ___ or ___
crystal violet or brilliant cresyl blue
174
* Seen in:
o Congenital hemolytic anemia
o G6PD Deficiency
o Drug-induced hemolytic anemia (phenacetin)
o Hemoglobinopathies
o Favism
Heinz Bodies
175
* Abnormal hemoglobin composed of 4 ß-globin chains
Hemoglobin H
176
Precipitated hemoglobin H appearance
o Pitted-golf ball/raspberry appearance
177
Hemoglobin H is visualized using
Supravital stain
178
* Seen in Hemoglobin H disease
Hemoglobin H
179
* Fine granular appearance in erythrocytes that harbor malarial parasites
Malarial Stippling
180
* Inclusion bodies resembling maltese cross
Babesia spp.
181
* Comma-shaped inclusion bodies
Bartonella spp.
182
RBC MORPHOLOGY GRADING CHART
MORPHOLOGY:
* Polychromatophilia
* Helmet cells
* Dacryocytes
* Acanthocytes
* Schistocytes
* Spherocytes
GRADING: ?
1+ = 1-5 per field
2+ = 6-10 per field
3+ = >10 per field
183
RBC MORPHOLOGY GRADING CHART
MORPHOLOGY:
* Poikolocytosis
* Ovalocytes
* Elliptocytes
* Burr cells
* Bizarre-shaped RBC
* Target cells
* Stomatocytes
GRADING: ?
1+ = 3-10 per field
2+ = 11-20 per field
3+ = >20 per field
184
RBC MORPHOLOGY GRADING CHART
MORPHOLOGY:
* Sickle cells
* Basophilic stipplings
* Pappenheimer bodies
* Howell-Jolly bodies
GRADING: ?
If present = “POSITIVE”
185
* Stacking or coining pattern of erythrocytes due to abnormal or increased plasma proteins
ROULEAUX
186
* Seen in: hyperproteinemia, multiple myeloma, Waldenstrom macroglobulinemia, increased fibrinogen
ROULEAUX
187
thicker area of blood smear
Artifactual (rouleaux)
188
seen in thinner area of blood smear
True (rouleaux)
189
GRADING
ROULEAUX
+1?
- aggregates of 3-4 RBC
190
GRADING
ROULEAUX
+2?
- aggregates of 5-10 RBC
191
GRADING
ROULEAUX
+3?
- many aggregates with only few free RBCs
192
Clumping of RBC with no pattern
AGGLUTINATION
193
* Occurs when RBC are coated with IgM antibodies and complement
AGGLUTINATION
194
AGGLUTINATION IS SEEN IN:
cold autoimmune hemolytic anemia (cold agglutinin disease)
