Structure and Function of RBC's Flashcards Preview

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Flashcards in Structure and Function of RBC's Deck (93):
1

3 cell types in blood

RBCs
platelets
Leukocytes

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normal RBC count for Male/Female

>4.7-6.1 x 10^6/microliter
>4.2-5.4

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Normal Hgb for male/female

>14-18
>12-16

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Normal Hct for male/female

>42-52 male
>37-47 female

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MCV < 80

microcytic

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MCV >100

macrocytic

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MCV 80-100

normocytic

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MCV<70

thalassemia

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definition of anemia

reduction in the mass of RBC's

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Hematocrit=

Total RBC count x MCV

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Normal hematocrit shortcut

3 x Hgb

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differnces in shape

anisocytosis

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differences in size

poikilocytosis

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normal RDW range

11.5-14.5%

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How to keep blood sample from clotting

EDTA (lavender top)

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Stain used in periph. smear

"wright-giemsa"

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EOSIN CHARACTERISTICS

**STAINS HEMOGLOBIN**
>ACIDIC/AROMATIC
>STAINS HYDROPHOBIC BASIC MACROMOLECULES
>soluble in ethanol
>insoluble in water

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CELL with clearly defined pink cytoplasmic granules
>segmented nucleus

EOSIN-ophil

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Characters of Methylene Blue stains

>BINDS NUCLEIC ACIDS (HYDROPHOBIC ACIDS)
>aromatic/basic
>positively charged
>SOLUBLE IN WATER OR METHANOL

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RELATED TO TISSUE MAST CELLS

basophils

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list cells in order of their prevalence

neutrophils (40-70%), lymphocytes(20-30%), monocytes (3-8%), eosinophils (5%), basophils (1%)

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cells that bind little eosin of methylene blue

neutrophils

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describe neutrophil appearance

neutral cells with salmon pink cytoplasmic granules
SEGMENTED NUCLEI

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LIFESPAN OF NEUTROPHILS

1 DAY

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NEUTROPHILS INCREASE IN RESPONSE TO

BACTERIAL INFECTIONS
*10 FOLD

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Weapons employed by neutrophils during bacterial infections

1. phagocytosis
2. degranulation-->so will have granules
3. Extracellular NETS

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secondary neutrophil granules

salmon pink

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How to separate monocytes from lymphocytes

indented "ameboid" nucleus in a mono

>lymphocyte will have a rounded nucleus

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how to separate monocytes from BANDS or granulocytes

-->absence of granules in mono (but nuclei will look similar)

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2 conditions under which lymphocytes increase in number

1. viral syndromes
2. neoplastic events (leukemia)

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life span of a lymphocyte

months-years

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distribution of lymphocytes

T cells-->B cells-->NK cells

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reactive lymphocytes

increase in viral syndromes
(more cytoplasm, prominent nucleoli)

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"large granular lymphocytes"

NK and CTL's with basophillic cytoplasmic granules

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SMall fragments that lack nuclei

plastelets
(100 x more prevalent than white cell population)
*400 Billion/person

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4 functions of platelets

1. primary hemostatic plug
2. stimulate coagulation cascade-->fibrin clot formation
3.recruit fibroblasts and promote wound repair
4. secrete platelet factor 4 to inactivate pathogens
5. antigen presentation

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platelet response in IDA

platelets increase

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lifespan of platelets

9-10 days

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90% of the time: reactive Left Shift indicates

bacterial infection

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cells seen in a left shift

bands, metamyelocytes, myelocytes

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What is toxic granulation

Increase in PRIMARY (basophillic) cytoplasmic granules in neutrophils seen in bacterial infection

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primary granules/toxic granulation is only present in

early myeloid precursors in the bone marrow

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eosinophils increase...

in response to allergic reactions and infection with parasites

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Anion exchanger

band 3

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Methemoglobin

hemoglobin with oxidized iron Fe+++ that cannot carry O2

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describe the RBC antioxidant system

02 spontaneously converted to H2O2 (toxic free radical)--> converted to the inert molecule water by GSH-->to replanich GSH...NADPH is required!!!!

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Mutations in anti-oxidant system results in...

bit cells-->tissue macrophages take chunks out of RBC to remove the ROS's

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enzyme required to reduce methemoglobin
(hemoglobin with iron in the ferric /fe+++ state)

Cytochrome B5 reductase

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Cytochrome B5 reductase requires

NADH

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How does free radicals affect Hgb in a RBS

oxidized Hgb molecules (oxidizes SH groups) crosslink and cause hemoglobin to denature and/or precipitate

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do mature RBC's have nucleus or mitochondria

NO

to make room for HGb and they only rely on glycolysis

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Glycolysis within the RBC provides

ATP (though inneficiently) and NADH (for Cytochrome b5 reducatase)

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Pentose phosphate shunt within the RBC is used for

repletion of NADPH so that the cell can replentish GSH for H2O2-H2o reaction

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first enzyme in pentose phophate shunt pathway

g6pd

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G6pd deficiency will show what on blood smear

bite cells and blister cells
(SH groups are cross linked and precipitate out-->tissue based macrophages remove the membrane+ cytoplasmic arease affected by the ROS

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slow the process of compliment fixation on a normal RBC-->

Decay Accelerating Factor

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DAF counteracts which compliment fixation process

alternative

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definition of hypochromia

greater than one third of the cytoplasm on Peripheral Blood Smear is taken up by area of central pallor

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Define polychromasia and when it is usually seen

Bluish tinge caused by methylene blue binding to residual RNA in a newly formed RBC
>usually seen when RAPID production of RBC's is required-->due to rapid blood loss

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Rapidly produced RBC's are usually

biger than more mature counterparts and hypochromatic

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genetic defect in hemoglobin structure

hemoglobinopathy

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Heinz bodies

small clumps within the cytoplasm of an RBC that indicated oxidized and denatured hemoglobin--> LEADS TO BITE CELLS

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conditions which would give you heinz bodies

1. G6pd deficiency
2. NADPH deficiency
3. Chronic liver disease
4. alpha thalassemia

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Cleaved RBC's

schistocytes

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Schistocytes tell you what?

microangiopathic hemolytic anemia
*there are many things that can cause/lead to this finding

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supernatant of clotted blood

serum

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supernatant of unclotted blood

plasma

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manual hematocrit=

RBC volume/ Total blood volume

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hematology analyzer hematocrit

= MCV x TOTAl RBC count

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estimate of hematocrit=

normally should be Hgb x 3

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how to correct for reticulocyte count

total retic x (hct/45)
*should be less than 1.7

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What methods does a hematology analyzer measure

3. Spectophotometry (assesses number)
2. CONDUCTIVITY-Coulter Chamber- (assesses number, COMPLEXITY and volume/size
3. FLOW CYTOMETRY

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Hgb concentration is measured via

spectophotometry
*add cyanide and measure % absoprtion

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most reliable measure of anemia

Hgb because it is measured directly and is not dependent on two measured variables as Hct is

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How are reticulocytes counted

SPECTOPHOTOMETRY
>add methylene blue-->analyzer will measure recently made (larger than usual) RBC's containing residual RNA)

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reticulocytes seen on a peripheral smear should elicit

a "polychromasia" comment
*RNA is a fine network staining blue-->reticular network

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Routine CBC WILL measure...

>Hgb concentration
>RBC count
>MCV
>RDW-->indicates anisocytosis
>platelet count
>MOV

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Caculated value that the CBC also spits out but doesnt measure directly

hematocrit
mch (hgb/RBC)
mchc (hgb/hct)

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In pt.s with anemia which value do you being with for DX

MCV

*will tell you micro vs macrocytic

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A patient who for any reason is making red cells rapidly will have

increased MCV

*Macrocytic, polychromatic, reticulocytes

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Coulter chamber can also count leukocytes how?

separate set of electrodes measures complexity as they pass thru aperture-->more lobulated nuclei will diff. poly's vs. mono's etc

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flow cytometry in a CBC is used for

--> separating out leukocyte cell populations even further than the conduction study
-->Immature Platelet Fraction (platelets with excess RNA)

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What the hematology analyzer will NOT count

>bands
>blasts-->wil not catch acute leukemias
>Red Cell fragments
>platelet clumps
*therefore these measurements require a manual differntial!!!!

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bands usually charcterized as

neutrophils by most analyzers

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blasts usually counted as

lymphocytes or monocytes

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red cell frags usually counted as

pletelets

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platelet clumps usualy counted as

not always counted and can result in artifactual thrompocytopenia

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what causes hypochromia in RBC's

lack of hemoglobin

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oxidized HGhg will lead to what to peripheal smear findings

1. heinz bodies
2. bit cells-->tissue macrophages take out chunks of a cell that has been damaged by ROS

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polychromasia is usally seen with?

accelerated prodcution

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main function of monocyte

antigen presentation to lymphocytes

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eosinophils increase with

parasite infections, drugs and allergic reactions

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starting point for Dx of ay increase in any cell type

reactive vs. neoplastic