Red Blood Cells

Front 1

Describe where in the body blood cells are made during:

- After Embryogenesis

- Fetal Development post-3&4 months

- Children

- Adults

Back 1

After Embryogenesis: Yolk sac

Fetal 3rd month until birth: Liver

Fetal 4th month until birth: marrow

Children: entire skeleton

Adults: axial skeleton

Front 2

What happens to marrow as people age?

Back 2

Blood cells are replaced with fat

Front 3

What are 3 important nutrients for RBC maturation?

Back 3

- Vitamin B12

- Folate

- Iron

Front 4

What molecule transports iron ions through circulation?

What molecule stores it intracellularly?

Back 4

Transferrin - in circulation

Ferritin - inside the cell

Front 5

What are sideroblasts?

Back 5

Abnormal nucleated erythroblasts with peripheral granules of iron that has accumulated in mitochondria

Front 6

What does each essential nutrient help RBCs produce?

Back 6

Vitamin B12 and Folate: DNA synthesis

Iron: Hemoglobin

Front 7

What are the subunits in hemoglobin for adults and fetuses?

(Give both Adult types.)

Back 7

Adult - 2 alpha and 2 beta chains or

2 alpha and 2 delta chains (minor)

Fetal - 2 alpha and 2 gamma chains

Front 8

Why does fetal hemoglobin have a different set of components than adult hemoglobin?

Back 8

It needs a higher oxygen affinity to abstract oxygen from placental blood in utero

Front 9

What is polycythemia?

Back 9

Increased number of red blood cells

Front 10

What are causes of primary polycythemia?

Secondary?

Back 10

Primary: myeloproliferative disorder

Secondary: increased EPO

Front 11

How is hemoglobin measured in blood?

Back 11

Spectrophotometry

Front 12

What is Red Cell Distribution Width?

Back 12

RDW = measure of one standard deviation above and below the average cell size

Front 13

How are RBCs counted?

Back 13

Electrical impedance flow cytometry

Front 14

How is hematocrit calculated from RBC count and mean cell volume?

Back 14

The average of RBC count and MCV is ten times the hematocrit

Front 15

What is the most useful measure of hemoglobin?

Back 15

Mean Cell Hemoglobin Concentration (MCHC), because it accounts for different sizes of RBCs

Front 16

Why do women have less hemoglobin than men in adulthood?

Back 16

Menses

Front 17

What are reticulocytes?

Back 17

Immature RBCs with residual RNA

Front 18

What is a normal adult reticulocyte count?

Back 18

~50,000/uL

Front 19

How is corrected reticulocyte percentage calculated?

Back 19

Pt retic% x Pt Hct

----------- -----------

.01 45

Front 20

What happens to the normal reticulocyte percentage in an anemic patient?

Back 20

It goes up to compensate loss of RBCs in healthy marrow

Front 21

What does corrected reticulocyte percentage mean?

Back 21

It adjusts reticulocytes for the degree of anemia

Front 22

What is the reticulocyte production index in a severely anemic patient?

Back 22

2

Front 23

What effect does hypoproliferative anemia have on bone marrow production of blood cells and reticulocyte index?

Back 23

Both marrow production and reticulocyte index are low

Front 24

What effect does hemolytic anemia have on bone marrow production of RBCs and reticulocyte index?

Back 24

It causes and increase in both bone marrow cell production and reticulocyte index.

Front 25

What effect does ineffective erythropoiesis have on bone marrow production of RBCs and reticulocyte index

Back 25

Marrow production may be high, but reticulocyte index is lower than expected

Front 26

What does anisocytosis mean?

Back 26

RBCs vary in size

Front 27

How do neonatal RBCs differ in morphology than adult RBCs?

Back 27

Their center is not as translucent.

Front 28

What shape do some RBCs take in macrocytic anemia?

What is this RBC called?

Back 28

Oval

macroovalocyte

Front 29

How does megaloblastic anemia affect RBC morphology?

Back 29

Induces anisocytosis

(RBCs are all different sizes)

Front 30

What effect does iron deficiency have on RBC morphology?

Back 30

Makes them hypochromic and microcytic

Front 31

What effect does hemolytic anemia have on RBC morphology? (3)

Back 31

Induces polychromasia, spherocytes, and schistocytes (RBC fragments)

Front 32

What is poikilocytosis?

Back 32

Variation in shape of RBC.

Front 33

What are acanthocytes and what cause them?

Back 33

RBCs with spiked plasma membrane

Caused by abetalipoproteinemia

Front 34

In what type of anemia do RBCs take up a targetoid appearance?

Back 34

Thalassemia (abnormal hemoglobin)

Front 35

Describe echinocytes?

Back 35

Star-like appearance but the tips are more rounded than in acanthocytes

Front 36

What are RBCs called if they have a tear-drop shape?

Back 36

Dacrocytes

Front 37

What are Howell-Jolly bodies?

Back 37

Nuclear chromatin remnants in RBCs

Front 38

What are Heinz bodies?

Back 38

Denatured hemoglobin in RBCs

Front 39

What are Pappenheimer bodies?

Back 39

excess ferric iron in RBCs

Front 40

How do Howell-Jolly bodies appear under histology?

Back 40

Black dots in the periphery

Front 41

After what procedure do Howell-Jolly bodies begin to appear on RBCs?

Back 41

Splenectomy

Front 42

What is Rouleaux formation?

Back 42

Stacking of RBCs due to high serum protein levels

Front 43

Does a mature red blood cell have a nucleus?

Organelles?

Back 43

No and no

Front 44

What organs can make blood cells when marrow cannot keep up with demand?

Back 44

Liver and spleen

Front 45

What cell is the common origin for all blood-derived cells?

Back 45

Hematopoietic stem cell

Front 46

What are two growth factor types involved in hematopoiesis?

Back 46

- Stem cell factor

- Interleukins

Front 47

In normal adults, what is the ratio of fat to cells in bone marrow?

Back 47

1:1

Front 48

What type of anemia is marked with low cellularity of bone marrow?

Back 48

Aplastic anemia

Front 49

What anemias are marked with high cellularity of bone marrow?

Back 49

- megaloblastic

- hemolytic

Front 50

What is the normal ratio for myeloid to erythroid in marrow?

Back 50

3:1

Front 51

What is the normal reticulocyte to RBC percentage range in adults?

Back 51

0.5% - 2.5%

Front 52

What effect does anemia have on reticulocyte percentage?

Back 52

Artificially raises it due to fewer RBCs

Front 53

How is reticulocyte percentage corrected for an anemic patient?

Back 53

Multiply Reticulocyte percentage by (Hematocrit/45)

Front 54

What two terms refer to a normal color and normal cell-shape for an RBC?

Back 54

normochromic and normocytic

Front 55

What effect does anisocytosis have on RDW?

Back 55

increases it

Front 56

What affect does hypothyroidism have on RBC size?

Alcoholism?

Back 56

Both increase it

Front 57

What is the normal size range in microns for an RBC?

Back 57

6um - 8um

Front 58

What term refers to biconcave disc shape?

Back 58

discocyte

Front 59

How does a spherocyte's MCHC compare to that of a normocyte?

Back 59

Higher

Front 60

What organ is severely diseased if blood stain shows acanthocytes?

Back 60

liver

Front 61

What disease will show blood stain with Heinz bodies?

Back 61

G6PD Deficiency

Front 62

What diseases will show basophilic stippling under blood stain? (2)

Back 62

lead poisoning and thalassemia

Front 63

At what age are nucleated RBCs normal?

Back 63

In a fetus or neonate