Hema Cell Abnornalities Ajfb

Front 1

Erythrocyte Membrane Composistion:

Back 1

1. Proteins (50%)

2. Lipids (40%)

3. Carbohydrates (10%)

Front 2

Protein Components of

RBC Membrane:

Back 2

Integral Protein:

Glycophorin A & Component A

Peripheral Protein:

Spectrin & Actin

Hint 2

Glycophorin A

- Sialic Acid, (-) charge zeta potential, RBCs repel each other

Actin

- Maintain Biconcave Shape of RBC membrane deformability

Front 3

External Surface Components:

Back 3

1. Phospholipids

2. Phosphatidylcholine

3. Glycolipid

4. Sphingomyelin

Front 4

Internal Surface Components:

Back 4

1. Phosphatidylethanolamine

2. Phosphatidylinositol

3. Phosphatidylserine

Front 5

Cholesterol content of the membrane depends upon the

Back 5

1. Conc of Plasma Chole & Bile Acids

2. Activity of LCAT

Hint 5

LCAT - Lecithin:Cholesterol Acyltransferase

Ovalocyte - Dec Chole

Front 6

Metabolic Pathways on Erythrocyte:

Back 6

1. Embden - Meyerhof Pathway

2. Hexose Monophosphate Shunt (Oxidative Pathway)

3. Rapaport - Luebering Pathway

4. Methemoglobin Reductase

Front 7

Pathway of Anaerobic Glycolysis (90%)

Maintains cellular energy by generating ATP

Back 7

Embden - Meyerhof Pathway

Hint 7

Glycolysis - Breakdown of Glucose from erythrocytes

*For every glucose broken down to lactic acid yields Two ATPs

Controls flow of Na & K

Front 8

Pathway that prevents denaturation of globin of the hgb molecule by oxidation

Energy system couples oxidative catabolism of glucose with reduction of NADP to NADPH which is required to reduce glutathione

Aerobic Pathway

10% Glycolysis

Back 8

Hexose Monophosphate Shunt (Oxidative Pathway)

Front 9

Needed to neutralize oxidants to prevent denaturation of globin

Back 9

Reduced Glutathione

Hint 9

Defective Hexose Monophosphate shunt yields insufficient reduced glutathione, therefore globin is denatured and then precipitates as aggregates referred to

Heinz Bodies

*G6PD Def

Front 10

Pathway that generates 2,3 DPG (2,3 BPG Biphosphoglycerate) which regulate hemoglobin affinity to oxygen

Back 10

Rapaport - Luebering Pathway

Hint 10

Dec 2,3 DPG - Inc Hemoglobin Affinity to Oxygen

(SHIFT TO THE LEFT)

Inc 2,3 DPG - Dec Hemoglobin Affinity to Oxygen

(SHIFT TO THE RIGHT)

Front 11

Pathway that functions in the maintenance of heme iron in a functional state (Ferrous, Fe2+) requires the reducing action of NADH and enzyme methemoglobin reductase

Back 11

Methemoglobin Reductase Pathway

Front 12

A condition in which there is an Inc concentration of Hemiglobin which is a derivative of hemoglobin in which iron is oxidized to the ferric state

Back 12

Methemoglobinemia

Front 13

As RBC Ages, there is a

Back 13

1. Dec in its Size, Emzymes, ATP

2. Inc in Density

Front 14

Approximately ___% of the RBCs leave the circulation each day and are broken down by the _________

Back 14

1%

Mononuclear Phagocyte System (MPS)

Front 15

Destruction of RBCs outside of blood vessel

Splenic or Macrophage Phagocytosis

Also called macrophage-mediated hemolysis

90% Aged RBC Destruction

Back 15

Extravascular

Hint 15

*When complement is not activated or incompletely activated

Inc

1. Unconjugated Bilirubin

2. Urine & Fecal Urobilinogen

Front 16

Occurs when hgb breaks down in the blood and free Hgb is realeased into plasma

Free Hgb binds to Haptoglobin, Hemopexin, & Albumin and is phagocytized by liver macrophages

10% Aged RBC destruction

Back 16

Intravascular

Hint 16

*When complement is completely activated

HAPTOGLOBIN - major free hemoglobin transport protein

Front 17

Variation in Cell Size

Back 17

Anisocytosis

Front 18

An index of variation of cell volume in a RBC population

Correlates w/ degree of anisocytosis

Calculated by dividing SD by the mean of the red cell distribution

Back 18

Red Cell Distribution Width (RDW)

Front 19

Normal sized RBC

6-8 um in dm

MCV 80-100 fL

Back 19

Normocytic

Front 20

Normocytic RBC:

Back 20

1. Acute Blood Loss

2. Hemolytic Anemia

3. Aplastic Anemia

Hint 20

AHA

Front 21

Small RBC

<6 um in dm

MCV <80 fL

Back 21

Microcytic

Front 22

Microcytic RBC:

Back 22

1. Anemia of Chronic Inflammation

2. Thalassemia

3. IDA

4. Sideroblastic Anemia

Hint 22

ATIS

Front 23

Large RBC

>8 um in dm

MCV >100 fL

Back 23

Macrocytic

Front 24

Macrocytic RBC:

Back 24

1. Bone Marrow Failure

2. Chronic Liver Dse

3. Megaloblastic Anemia

4. Myelodysplastic Syndrome

5. Reticulocytosis

Hint 24

BCMMR

Front 25

Variation of color of erythrocytes caused by unequal hemoglobin Concentration

Back 25

Anisochromia

Front 26

Central pallor does not exceed 1/3 RBC dm

MCHC 31-36%

Back 26

Normochromic

Hint 26

AHA

Front 27

Central Pallor

> 1/3 RBC dm

MCHC <31%

Back 27

Hypochromic RBC

Hint 27

ATIS

Front 28

No Central pallor

MCHC >36%

Back 28

Hyperchromic

New Term: Spherocyte

Hint 28

Hereditary Spherocytosis

- Inc OFT Test (d/t Na Chloride)

Front 29

Blue-gray tint to RBC

Pink Cytoplasm

Young RBC contain residual RNA

Stained w/ Brilliant Cresyl Blue, show up as Reticulocytes

Back 29

Polychromatophilic RBC

Hint 29

1. Hemolysis

2. Hemorrhage

Front 30

Presence of hypochromic cells and normochromic cells in the same film

Back 30

Dimorphic Anemia

Hint 30

1. Sideroblastic Anemia

2. Weeks after iron therapy for IDA

3. Hypochromic Anemia after blood transfusion w/ normal cells

Front 31

Alterations or variations in the shape of erythrocytes

Back 31

Poikilocytosis

Hint 31

Dec ESR

Front 32

Oval or Egg-like

Seen in:

1. Vit B12 & Folate Def

2. RBC in Retic Stage

Back 32

Oval Macrocytes (Megalocytes)

Front 33

Nuclear maturation lags behind cytoplasmic maturation

Impaired ability of cells to synthesize DNA

Back 33

Asynchronous Development

Hint 33

Megaloblastic Anemia

Front 34

Small, dense RBC, w/ few irregularly spaced projections of varying length

Inc Spingomyelin over Lecithin

(Abn L:S Ratio)

Back 34

Acanthocyte

Spur, Thorn Cell

Hint 34

MANS

1. McLeod Syndrome

2. Abetalipoproteinemia

3. Neuroacanthocytosis

4. Severe Liver Dse

Front 35

RBC w/ blunt or pointed, short projections, evenly spaced

Crenation d/t Osmotic Imbalance (loss of intracorpuscular water)

Back 35

Echinocyte (Artifactual)

Crenated, Sea Urchin

Burr Cell (Pathologic)

Hint 35

1. Uremia

2. Liver Dse

3. Heparin Therapy

4. Pyruvate Kinase Def

5. Renal Insufficiency

6. Artifact (Hypertonic, Drying)

Front 36

RBC w/ hemoglobin conc in the center & around the periphery resembling a target

Inc surface:volume ratio

Excessive cholesterol in the membrane or Hgb distribution Imbalance

Back 36

Codocyte

Mexican Hat,

Target Cell,

Bell

Hint 36

1. Hemoglobinopathies

2. Thalassemia

3. Liver Dse

Front 37

Thinner variant of codocyte

Central portion not completely datached from the outer membrane

Back 37

Leptocyte

Hint 37

1. Hepatic Disorders

2. IDA

3. Thalassemia

Front 38

Small, round, dense RBC with no central pallor

Dec Surface:Volume Ratio

Spectrin Def

Back 38

Spherocyte

Hint 38

1. Hereditary Spherocytosis

2. Immune Hemolytic Anemia

3. Extensive Burns (W/ Schistocytes)

Front 39

RBC w/ slit-like area of central pallor

Caused by Osmotic changes d/t Cation Imbalance (Na/K)

Back 39

Stomatocyte

Hint 39

1. RH NULL SYNDROME

2. Hereditary Stomatocytosis

3. Acquired (Liver Dse, Alcoholism)

4. Artifact

Front 40

Cigar shaped

Defect in the cytoskeleton, Dec Membrane protein band 4.1 defect

Back 40

Elliptocyte

Hint 40

1. Hereditary Elliptocytosis

2. Anemias assoc w/ malignancy

3. Hb C dse

4. Hemolytic Anemias (Occasionaly)

5. IDA

6. Sickle Cell Trait

7. Thalassemia

8. Pernicious Anemia

Front 41

Thinner variant of Ovalocyte

Back 41

Pencil or Oat Cell

Hint 41

IDA

Front 42

1. Fragmented RBC due to rupture in peripheral circulation

2. RBC fragment in shape of helmet, Horn-like projections

3. Resemble Pinched Bottle, Triangular RBC w/ 2 Pallor Areas

Back 42

1. Schistocytes

Schizocytes, Fragmentocytes

Greek: Cloven, schizo:split

2. Helmet Cell (Keratocyte)

3. Knizocytes

(Pinch Cell)

Hint 42

MET

1. Microangiopathic Hemolytic Anemia

2. Extensive Burns

3. Traumatic Cardiac Hemolysis

Front 43

RBC w/ a single pointed extension resembling a teardrop or pear

Squeezing and fragmentation d/t splenic passage

Back 43

Dacryocyte (Teardrop)

Hint 43

1. Primary Myelofibrosis

2. Myelophthisic Anemia

3. Thalassemia

4. Megaloblastic Anemia

Front 44

Abnormality in membrane protein

Heat Sensitive

Inc when blood cells are heated in vitro at 45C

Back 44

Microspherocyte, Pyropoikilocyte

Hint 44

Normal RBC fragment @ 49C

Front 45

Large, pale-pink staining ghost of the red cell

Back 45

Semilunar Bodies, Half-moon,

Crescent Cell

Hint 45

1. Malaria

2. Conditions causing overt hemolysis

Front 46

Result from gelation of polymerized deoxygenated

Hgb S

Polymerization of Hgb S is influenced by both lowered oxygen levels & dec blood pH

Back 46

Depranocyte

(Sickle Cells)

Holly-leaf shape

Hint 46

Sickle Cell Anemia

Front 47

RBC Inclusion that is round, purple staining nuclear fragments of DNA

Feulgen Reaction (+)

Back 47

Howell-Jolly Bodies

Hint 47

Appear Singly in:

1. Hemolytic Anemia

2. Splenectomy

3. Splenic Atrophy in Sickle Cell Anemia

Appear Multiple in:

1. Megaloblastic Anemia

2. Other forms of nuclear maturation defect

Front 48

RBC Inclusion that is coarse or fine, deep blue to purple granules

Result from aggregation of Ribosomes

Back 48

Basophilic Stippling

(Punctuate Basophilia)

Hint 48

Fine stippling:

1. Increased Polychromatophilia (Inc pxn of RBC)

Coarse Stippling:

1. Lead Poisoning

2. Other dses w/ impaired Hgb synthesis

3. Megaloblastic Anemia

4. Other forms of severe anemia

5. Abnormal instability of the RNA in the young cell

Pyrimidine-5-Nucleotidase Deficiency

PICA (Children: Lead Poisoning, Adult: IDA)

Acoholism

Front 49

Thin ring-like structure

May represent a part of the Mitotic Spindle, remnants of microtubules, or a fragment of the nuclear membrane

Figure of 8

Back 49

Cabot Rings

Hint 49

1. Megaloblastic Anemia or in severe anemias

2. Lead Poisoning

3. Dyserythropoiesis (Erythrocytes are destroyed before being released from bone marrow)

Front 50

Round, refractile inclusions not visible on wright stain, best ID by supravital staining

Consist of denatured globin

Back 50

Heinz Bodies

Hint 50

1. G6PD Deficiency

2. Unstable Hgb (Hb Zurich, Hb Koln)

3. Oxidant Drugs, Chemicals

4. Exposure to sulfonamides or similar drugs

5. Splenectomized Patients

Pitted Golf Ball

- Multiple Heinz Bodies

Bite & Blister Cells

- Splenic pitting of Heinz Bodies

Front 51

Seen with Brilliant Cresyl Blue stain and appear as blue globules

Precipitate of Hgb B Chains

Back 51

Hgb H Bodies

Hint 51

1. Hgb H Disease

Front 52

Reddish Hexagonal Cytoplasmic Crystal

Gold-Bar

Washington Monument (RODAK)

Back 52

Hgb C Crystals

Hint 52

Homozygous Hgb C Disease

the crystals form as deoxyhgb C polymerizes

Front 53

Irregular Reddish cytoplasmic crytals

Glove or Pistol

Washington Monument (Steininger)

Back 53

Hgb SC Crystals

Hint 53

Heterozygous Hemoglobin SC Disease,

the crystals form as deoxyhgb S & C Polymerizes

Front 54

Nucleated RBC that contains nonheme iron particles arranged in ring form

Excessive Iron overload in mitochondria of normoblasts; d/t defective heme synthesis

Back 54

Ringed Sideroblast

Hint 54

Sideroblastic Anemia

*RBCs w/ Iron granules, Hemosiderin (+) Prussian Blue

Front 55

Non-nucleated cell containing Iron granules

Mature RBCs

Back 55

Siderocyte

Hint 55

Sideroblastic Anemia

Front 56

Inclusions composed of

Ferric Iron

Prussian Blue stain preparations appear as multiple dark blue irregular granules at the periphery

On Wright's Stain, appear as Pale Blue clusters

Back 56

Pappenheimer Bodies (Siderotic)

Hint 56

1. Sideroblastic Anemia

2. Hgbinopathies

3. Hyposplenism

4. Megaloblastic Anemia

Front 57

Condition associated w/ mitochondrial iron loading in marrow erythroid precursors (ringed sideroblast) and ineffective erythropoiesis

Back 57

Sideroblastic Anemia

Hint 57

Diagnosis:

1. RBC Indices

2. Microcytic, Hypochromic

3. Inc serum iron & serum ferritin

4. Ringed sideroblasts on Iron stain of BM aspirate

Front 58

Plasmodium spp. Inclusions

Back 58

1. P. vivax - Schuffner's Dots

2. P. malariae - Ziemann Stippling

3. P. falciparum - Maurer Dot's

4. P. ovale - James Dots, Schuffner's

Hint 58

Maturation Stage: Rings, Troph, Schizonts, Gametocytes

Transmitted by: Bite of Female Anopheles mosquito

Preferred Stain: Giemsa

Enlarged RBC Size:

P. ovale, P. vivax

Normal RBC Size:

P. falciparum, P. malariae

Front 59

Plasmodium spp. Infected RBC Population:

Back 59

1. YOUNG RBCs:

P. ovale, P. vivax

2. MATURE:

P. malariae

3. ALL AGES:

P. falciparum

Hint 59

Resistant to Malaria:

1. Fy (a-b-) - P. vivax, P. knowlesi

2. M-N- - P. falciparum merozoites

Front 60

Gives tiny rings or occasionally as tetrads inside RBCs

Tetrads may also appear in a Maltese Cross Formation

Back 60

Babesia spp. (Babesiosis)

Hint 60

Resemble P. falciparum Rings but:

1. No Malarial Pigment

2. No growing troph

3. Vector: Ticks

B. microti

- The most common cause of Babesiosis in US

- Nantucket Fever

- First cluster of cases found in

Nantucket Island, Massachussets

Front 61

Cells aggregate into random clusters or masses when exposed to various RBC abs

Clumping of RBCs

Back 61

Agglutination

Hint 61

1. Cold Agglutinin Dse (CAD)

2. Primary Atypical Pneumonia (Mycoplasma pneumoniae infec)

3. Cold Hemeagglutinin Dse (CHD)

4. Cold Agglutination Dse/Syndrome (CAS)

Front 62

Occurs when an individuals RBCs agglutinate in his own plasma or serum tha contains no specific known agglutinins

Back 62

Autoagglutination

Front 63

Represents RBCs arranged in rolls or stacks

Stack of Coin

Prsence of Inc concentrations of globulins & fibrinogen

Back 63

Rouleaux Formation

Hint 63

1. Multiple Myeloma

2. Macroglobulinemia

*May also be d/t an Artifact as a result of delay in smearing the bld once it has been dropped on the slide

Drop of NSS:

Disperse: Rouleaux

Intact: True Agglutination

Front 64

Granulocytes & Polymorphonuclears

Back 64

1. Basophils

2. Eosinophils

3. Neutrophils

Hint 64

BEN

Phagocytes: BEN+M

Monocytes

Front 65

Non-granulocytes & Mononuclear

Back 65

1. Monocytes

2. Lymphocytes

Hint 65

Immunocytes:

Lymphocytes

Front 66

Genetically acquired, autosomal dominant disorder produces hyposegmentation of many of the mature neutrophils

Nuclear shape may resemble dumbbell or a pair of eyeglasses

Pince Nez, Spectacle, Peanut Shaped, Hourglass

Back 66

Pelger-Huet Anomaly

Hint 66

Pelger-Huet

- Single or Bilobed nucleus

Assoc w/:

1. Pelger-Huet

2. Pseudo-Pelger-Huet

3. CML

4. MDS

Front 67

Most frequently seen in segmented neutrophils with more than five lobes or nuclear segments

Vit B12 & Folic Acid Def

Enlarged, Oval shaped Erythrocytes

Back 67

Hypersegmentation

Hint 67

Pseudohypersegmentation may be seen in old segmented neutrophils

Hypersegmented Neutrophil

- Abnormal DNA Synthesis

- Right Shift

Assoc w/ Megaloblastic Anemia

Front 68

Precipitated mucopolysaccharides that appear as purple red (purple-black) particles seen in leukocytes

Can resemble very coarse toxic granulation

Back 68

Alder-Reilly Inclusions

Hint 68

1. Hurler (Gargoylism)

2. Hunter

2. Maroteaux-Lamy types of genetic mucopolysaccharidoses

Front 69

Gigantic, peroxidase-positive deposits represent abnormal lysosomal dev't in neutrophils & other leukocytes such as mono & Lympho

Neutrophils display impaired chemotaxis & delayed bacterial killing of ingested bacteria

Back 69

Chediak-Higashi Syndrome

Hint 69

Autosomal Recessive Trait

Chediak-Higashi Granules

- Giant red, blue, grayish round inclusions in cytoplasm

- Def in enzymes for phagocytosis

- Peroxidase & Sudan Black (+)

1. Assoc w/ Albinism

2. Recurrent Infections

Front 70

Genetic condition characterized by presence of Dohle body-like inclusions in neutrophils, eosinophils, & monocytes

Abnormally large and poorly granulated platelets

Thrombocytopenia

Back 70

May-Hegglin Anomaly

Hint 70

May-Hegglin Inclusions resemble Dohle-bodies

Front 71

Seen in single or multiple, light-blue staining on Wright-stained blood smear

Predominantly seen in neutrophils, may also be seen in monocytes & lymphocytes

Aggregates of Free Ribosomes of RER (RNA)

Back 71

Dohle-Bodies

Hint 71

Assoc w/:

1. Viral Infections (Severe)

2. Burns

3. Certain Drugs (Toxic States)

Front 72

Prominent dark (purple-black) granulation, either fine or heavy, can be observed in band & segmented neutrophils & monocytes

Azurophilic (Primary) granules,

Peroxidase (+)

Precipitation of Ribosomal Protein (RNA) caused by metabolic toxicity to cells

Back 72

Toxic Granulation

Hint 72

Resmble Alder Reily

Assoc w/:

1. Infections

2. Toxic States

3. Burns

4. Malignancy

5. Chemical Poisoning

Front 73

Similar to normal lympho exc. that the nucleus is notched, lobulated, & cloverleaf-like

Occur in CLL

May be artificially produced thru blood smear prep

Back 73

Reider Cells

Front 74

Natural artifact produced during blood smear prep

Bare nuclei of lympho & neutro

Inc Fragility, Inc %

Inc in lymphocytosis, particularly CLL

Back 74

Smudge Cells/Basket Cell

Hint 74

Degenerated nucleus or ruptured cell

Fragile lymphocytes & break upon smearing

Front 75

Cytoplasm stains a bright-red color and contains inc quantities of glycogen & intracellular deposits of amorphous matter

Back 75

Flame Cells

Hint 75

Red-pink Cytoplasm

Inc Cytoplasmic Ig (IgA)

Multiple Myeloma

Front 76

Plasma cell that contains

small colorless vacuoles

Large protein globules

Cytoplasm completely filled w/ Russell Bodies

Back 76

Grape or Mott Cells

Hint 76

1. Multiple Myeloma

2. Reactive States

*Russell Bodies - individual globules of IgA

Front 77

Most common of the lysosomal lipid storage dses

Def of B-glucocerebrosidase (B-glucosidase) which results in the accumulation of cerebroside in (macrophages) histiocytes

Back 77

Gaucher's Dse

Hint 77

B-glucocerebrosidase (B-glucosidase)

- Enzyme that normally splits glucose from its parent sphingolipid, glucosylceramide

Front 78

Large cell, with one to three eccentric nuclei and a characteristically wrinkled cytoplasm

"Chicken Scratch"

Strongly Periodic Acid Schiff (PAS) Positive

Back 78

Gaucher Cell

Front 79

Disorder represents a def of the enzyme that normally cleaves phosphoryl choline from its parent sphingolipid, sphingomyelin

Sphingomyelin accumulates in the tissue macrophages

Back 79

Niemann-Pick Disease

Hint 79

Pick Cell

- Similar to Gaucher, but the cytoplasm is FOAMY in appearance

Front 80

Accumulation of glycolipids & gangliosides

Def of Hexosaminidase A

Vacuolated Cytoplasm

Back 80

Tay-Sachs

Hint 80

Sandhoff's

- Accumulation of glycolipids & gangliosides

- Def of Hexosaminidase A & B

- Vacuolated Cytoplasm

Front 81

Blue-Green cytoplasm

Unknown Enzyme Deficient

Back 81

Sea Blue Histiocytes

Front 82

Pink or Red, Rod-shaped cytoplasmic structures

Fused primary granules

Found in myeloid & monocytic series only

Peroxidase (+)

Back 82

Auer Rods

Hint 82

1. AML

2. AMML

Front 83

Large empty white areas w/in cytoplasm

Represent end stage phagocytosis

Back 83

Toxic Vacuoles

Hint 83

1. Septicemia

2. Severe Infections

3. Toxic States

Front 84

Neutrophil w/ large purple homogenous round inclusion w/ nucleus wrapped around

3 Factors needed to produce Cell: ANA, Cell Nuclei, Phagocytes w/ Ingested Material

Back 84

LE CELL

Hint 84

Lupus Erythematosus