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Unit 2 - Erythropoiesis Flashcards

(105 cards)

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1
Q

Erythropoiesis Sequence

A

HSC –> MPP –> CMP –> CFU-GEMM –> BFU-E

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2
Q

Where is EPO produced in adults

A

Kidneys in the peri tubular interstitial cell

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3
Q

What happens to EPO in kidney disease?

A

Levels decrease

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4
Q

Where is EPO produced in embryos?

A

Liver

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5
Q

Where is the backup production for EPO in adults? How much is produced?

A

Liver
Not much

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6
Q

What is the first cell recognized as a young erythrocyte by light microscopy?

A

Pronormoblast
Rubiblast

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7
Q

How long is the maturation time from blast to erythrocyte?

A

5-7 days

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8
Q

What are nucleated RBC precursors called in the bone marrow, collectively?

A

Erythroblast

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9
Q

Cytoplasm trend in RBC as it matures

A

Deep blue to red

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10
Q

How does the nucleus size of an RBC move as it matures?

A

Large to small to gone

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11
Q

Chromatin trend in RBC as it matures

A

fine to coarse

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12
Q

Cell stages (normoblast version)

A

Pronormoblast
Basophilic normoblast
Polychromatophilic normoblast
Orthochromic normoblast
Reticulocyte/Polychromatophilic RBC
Mature Erythrocyte

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13
Q

Cell stages (other version)

A

Rubriblast
Prorubricyte
Rubricyte
Metarubricyte
Diffusely basophilic RBC
Discocyte

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14
Q

Pronormoblast/Rubriblast size

A

20 micrometers

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15
Q

Color of pronormoblast/rubriblast cytoplasm

A

Very blue/purplish
Darker at edge

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16
Q

Appearance of nucleus in Pronormoblast/Rubriblast

A

Large nucleus
Fine parachromatin/euchromatin

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17
Q

Basophillic Normoblast/Prorubricyte size

A

16-18 micrometers

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18
Q

Extra features inside Pronormoblast/Rubriblast

A

Prominent nucleoli
Unstained golgi body

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19
Q

Appearance of nucleus in Basophilic Normoblast/Prorubricyte

A

Some coarseness

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20
Q

Appearance of cytoplasm in Basophilic Normoblast/Prorubricyte

A

Still very blue, but hgb starts to give a pinkish tinge

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21
Q

Extra features of a Basophilic Normoblast/Prorubricyte

A

Nucleoli less visible
Almost can’t see Golgi body

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22
Q

Polychromatophilic normoblast/Rubricyte size

A

15 micrometers

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23
Q

Appearance of nucleus in polychromatophilic normoblast/Rubricyte

A

Clumped areas of chromatin
Some patches of parachromatin

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24
Q

Appearance of cytoplasm in polychromatophilic normoblast/rubricyte?

A

Blue RNA
Pink Hb
Dirty gray-ish pink

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25
What is the last stage of an erythroblast that has a nucleoli and Golgi body?
Basophilic Normoblast Prorubricyte
26
Orthochromic Normoblast/Metarubricyte size
12 micrometers
27
Appearance of Orthochromic Normoblast/Metarubricyte nucleus
More clumped PYKNOTIC!
28
What is the name of the appearance of the nucleus of an orhochromic normoblast/metarubricyte?
Pyknotic
29
Appearance of orthochromic normoblast/metarubricyte cytoplasm
Mostly pink Slight blue tinge mRNA still synthesizing Hgb
30
What can't an orthochromic normoblast/metarubricyte do?
Mitose
31
Which is the first erythroblast that can't mitose?
Orthochromic Normoblast Metarubricyte
32
Which is the last erythroblast that can mitose?
Polychromatophilic Normoblast Rubricyte
33
What does an orthochromic normoblast/metarubricyte do with its nucleus?
Pushes it to the side as it gets ready to push it out
34
Reticulocyte size
9-11 micrometers
35
Appearance of cytoplasm of a reticulocyte/Diffusely basophilic RBC?
Blue tinge mRNA still synthesizing Hgb
36
Appearance of nucleus of a reticulocyte/diffusely basophilic RBC?
None
37
How long do reticulocytes remain in the bone marrow?
1-2 days
38
How long does it take for reticulocytes to mature in the peripheral blood?
~1 day
39
mRNA still present gives off what color? Retics
Purple
40
What is a reticulocyte called on a blood smear?
Polychromatophilic
41
How does the RNA stain in a relic?
The ACIDIC RNA stains BLUE Basic (blue) component of stain loves the acidic (basophilic) part of the cell
42
Can supravital stains penetrate dead cells?
No
43
What is the supra vital stain used to observe the RNA in retics?
New Methylene Blue
44
What does new methylene blue do to the reticulocyte appearance?
mRNA in endoplasmic reticulum looks like coarse granules
45
How many inclusions are required to call a reticulocyte?
At least TWO
46
Mature erythrocyte size
7-9 micrometers
47
What removes old RBCs?
Reticuloendothelial/phagocytic system
48
Where are old RBCs removed?
Spleen Liver Marrow
49
What RBCs are found in adult peripheral blood normally?
Retics RBCs
50
What RBCs are found in newborn peripheral blood normally?
Polychromatophilic normoblast/Rubricyte Orthochromic normoblast/Metarubricyte Reticulocytes Erythrocytes
51
What could be possible if nucleated RBCs are in periphera blood
Patient is a newborn Patient has a disease or anemia
52
What tests are ordered to evaluate Erythropoiesis?
CBC Peripheral blood smear Reticulocyte count
53
What does CBC tell you?
WBC count RBC count PLT count Hct Hgb Indices (MCV/MCH/MCHC)
54
What is one of the most valuable lab tests for evaluating erythropoiesis?
Peripheral blood smear
55
Normal portion of RBCs that are retics?
1% 0.5%-2.0%
56
When would retics be elevated?
Blood Loss RBC destruction (hemolysis)
57
When would retics be decreased?
Bone Marrow Production issue Transfusion
58
Why does transfusion cause a decrease in retics?
RBCs in blood bag are still alive and continue to mature
59
How long is blood for retics stable at RT in EDTA?
6 hours
60
How many RBCs are counted to get retic count?
1000
61
Retic supra vital stains
New Methylene Blue Brilliant Cresyl Blue
62
How is the classic manual reticulocyte counting done?
Mix with supra vital stain Incubate to allow staining Count number of retics/1000 RBCs for %
63
What is a miller disc?
A device in the ocular that places squares over the field
64
How big is the small square of a miller disc?
1/10 the size of the large square
65
Miller Disc Retic count procedure
B square - count total red cells (mature & retic) A square - count only retics (+B square) Count 111 RBCs in B square Divide # of retics counted by 10 for retic % (#retics/10) = %
66
How do you know what cells to count and not count on the miller disc procedure?
Count a cell if it falls on LEFT or UPPER LINE Don't count a cell if it falls on RIGHT or BOTTOM LINE
67
What cells do you NOT count on a miller disc?
BOTTOM and RIGHT line
68
What cells DO you count on a miller disc?
LEFT and UPPER line
69
Sources of error in reticulocyte evaluation
Poor mixing of blood and stain Moisture in air/poor slide drying RBC inclusions
70
What does poor mixing of blood and stain do to reticulocyte observation?
Retics sit on top of stain giving inaccurate count
71
What does moisture in air or poor slide drying do to reticulocytes on smear?
Refractile appearance of cells on slide
72
What other RBC inclusions can affect Retic counts
Heinz bodies Howell Jolly bodies Pappenheimer bodies
73
What RBC inclusions appear very similar to reticulocytes?
Pappenheimer bodies
74
What are stress or shift reticulocytes?
Cells younger than "normal" reticulocytes so they are larger and more blue
75
What is the appearance of stress or shift reticulocytes
Larger More blue
76
What is a "normal" hematocrit?
45%
77
What is the formula for corrected reticulocytes?
(PT Hct /45%) * (Raw Retic %)
78
What is the corrected retic count used for?
Interpreting reticulocyte release in response to anemia
79
What is Reticulocyte Production Index (RPI)?
Correction that takes into account reticulocytes leaving marrow on a daily basis
80
What is the normal number of maturation days in blood?
One day
81
How long does it normally take a reticulocyte to mature in the blood?
One day
82
Normal range Hct
35-45%
83
For every two percentage point drop in the Hct, the reticulocyte maturation time is increased by how many days?
0.1 days
84
How does percentage drop in hct affect the reticulocyte maturation time?
For every 2% HCT decrease, the maturation time increases by 0.1 days
85
RPI Formula
(PT HCT/45%) * (Raw Retic %/#Days to mature)
86
Number of days to mature calculation
(PT HCT - 45%) = x / 2 = y * 0.1 = z + 1
87
Percentage of reticulocytes
(# Reticulocytes / 1000 RBCs) * 100 = % or (# Retics/10) = %
88
Adult Reticulocyte reference range
0.5-2.0%
89
Newborn Reticulocyte reference range
2.5-6.0% (up to age two weeks)
90
Up to what age is a newborns reticulocyte reference range going to be different from an adults?
Up to two weeks of age
91
What is the formula for absolute reticulocyte count
(% Retics) * (# RBCs)
92
What is the absolute reticulocyte count
#retics per microliter
93
Absolute reticulocyte reference range
25,000 - 175,000 reticulocytes/mcL or 25-175 x 10^9 reticulocytes/L
94
Does this RPI indicate an appropriate response? >3 RPI
Yes, this indicates there is an RBC destruction problem and the bone marrow is responding adequately
95
Does this RPI indicate an appropriate response? <2 RPI
No, this indicates an inadequate response Bone marrow production problem
96
How should the absolute retic count look if a person is anemic?
Elevated
97
What is the better way to express a patient's reticulocyte count?
Absolute reticulocyte count
98
What is the IRF?
Immature reticulocyte fraction
99
How do younger retics stain and why?
More densely have more m-RNA
100
When does IRF increase?
BEFORE RPI, Hgb, or Hct when an intervention has worked (EPO therapy, bone marrow transplant)
101
Which is preferred RPI or IRF?
IRF
102
Hemoglobin nomenclature on instrument
CHr RET-He
103
What does the hgb content look like in a patient with an iron deficiency?
Low hgb content of RBC
104
When a patient is responding to iron therapy, where is this first detected?
Hgb levels in retics
105
If 30 retics were counted using. miller disk, what is the % Reticulocytes?
3%

Hematology (12 decks)

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