Rbcs

Front 1

Nutrients required for RBC production

Back 1

Fe, Co, Mn.

B12, B6, C, E, folate, riboflavin, pantothenic acid, thiamine.

Amino Acids

Front 2

Erythropoiesis regulated mainly by

Back 2

Erythropoietin

Thryroid hormone

Androgens

Front 3

Hemoglobin molecule

Back 3

Synthesized at the polychromatic normoblast stage of red cell development.

Hemoglobin = Heme + Globin.

Hemoglobin = 4 Heme structures with Fe in the center and 2 pairs of Globin chains.

Front 4

Reticulocyte

Back 4

Cell just one stage prior to the mature erythrocyte.

Front 5

Normal Reticulocyte count

Back 5

0.5 - 1.5%

Front 6

Stains for reticulocyte count

Back 6

Methylene Blue

Brilliant Cresyl Blue

Front 7

Increased Retic Count

Back 7

Hemolytic Anemia

Response to treatment of Iron / B12 / Folic acid.

Recent Hemorrhage.

Thalassemia.

Pregnancy.

Erythroblastosis fetalis.

HbC disease.

Leukemias.

Hypoxia.

Front 8

Decreased Retic Count

Back 8

Decreased adrenocortical and anterior pituitary activity.

Aplastic anemia.

Cirrhosis.

Megaloblastic anemia.

Exposure to radiation.

Anemia of chronic diseases.

MDS

Front 9

Oversimplification of Retic count

Back 9

If cause of anemia is inside marrow - decreased Retic count.

If cause of anemia is outside marrow - increased Retic count.

Front 10

Reticulocyte index

Back 10

= Reticulocyte count x Patient's HCT/Normal HCT

Front 11

Reticulocyte Proliferation Index

Back 11

= Corrected Reticulocyte Count/Shift Correction Factor

PCV 45% = 1

PCV 35% = 1.5

PCV 25% = 2

PCV 15% = 2.5

Front 12

Hematocrit (HCT) aka...

Back 12

Packed Cell Volume (PCV)

Erythrocyte volume fraction (EVF)

Front 13

Formula for HCT

Back 13

Red cell number x Red cell volume

Front 14

High HCT/PCV

Back 14

Dehydration.

Kidney disease with high EPo.

Low O2 level in blood.

Congenital heart disease.

Cor Pumonale.

Pulmonary fibrosis.

High altitude.

Polycythemia vera

Smoking

Front 15

Low HCT/PCV

Back 15

Blood loss.

Bone marrow failure.

EPo deficiency.

Hemolysis.

Leukemia.

Malnutrition.

Multiple myeloma.

Autoimmune/Collagen vascular disease like SLE or RA

Front 16

Note about PCV value:

Back 16

An elevated PCV may be due to spleen hyperfunction and a low PCV may indicate low thymus function.

Front 17

Rule of Three....

Back 17

Hb x 3 = HCT +/- 3

RBC x 3 = Hb

Exception to this rule is in patients with hypochromic red cells. These patients will have hematocrits that are more than 3 times the hemoglobin.

Front 18

MCV, MCH, MCHC were first introduced by....

Back 18

Wintrobe

Front 19

MCV

Back 19

MCV = (HCT/Red Cell Count) x 100

Front 20

MCV<72fl with normal RDW

Back 20

Usually Thalassemia

Front 21

Anemia with normal MCV - Normocytic Anemia

Back 21

Acute Hemorrhage.

Dimorphic Anemia.

Hemoglobinopathies.

Anemia due to inadequate blood cell production.

Endocrinopathies (hypopituitarism, hypothyroidism, hypoadrenalism, hypogonadism)

Anemia of chronic diseases.

Front 22

Anemia with increased MCV - Macrocytic anemia

Back 22

Megaloblastic Anemia.

Pernicious Anemia.

Sprue.

Macrocytic anemia of pregnancy.

Di Guglielmo disease.

Myelodysplastic syndromes.

Myelophthisic Anemia

Post - splenectomy.

Alcoholism.

Liver disease.

Anemia of hypothyroidism.

Drugs.

Front 23

Anemia with decreased MCV - Microcytic Anemia

Back 23

Hypochromic

Iron deficiency

Thalassemia

Lead poisoning

Disorders of Porphyrin synthesis

Normochromic

Anemia of chronic disease (< 1/3rd of the patients)

Heterozygous thalassemia and hemoglobinopathies

Front 24

Interferences with MCV

Back 24

Cold agglutinins (increased values)

Warm autoantibodies.

Marked hyperglycemia (increased MCV)

Marked leukocytosis (increased values)

In vitro hemolysis or fragmentation of RBCs (decreased values)

Methanol poisoning (increased values)

Marked reticulocytosis (>50% from any cause) (increases MCV)

Front 25

MCH

Back 25

MCH = (Hb/red cell count) x 100

Front 26

Increased MCH

Back 26

Macrocytic Anemia

Newborns and Infants

Front 27

Decreased MCH

Back 27

Microcytic and Normocytic Anemias

Front 28

Interferences in MCH

Back 28

Lipemia

Marked Leucocytosis (>50,000/microL)

Cold agglutinins

In Vivo hemolysis

Monoclonal proteins in blood

High heparin concentration

Front 29

MCHC

Back 29

= Hb/HCT x 10

Front 30

MCHC decreased in

Back 30

Microcytic hypochromic anemia (Normal value does not rule it out)

Front 31

MCHC increased in

Back 31

Hereditary spherocytosis

Infants and Newborns

Autoagglutination

Artifactual

Front 32

Interferences to MCHC

Back 32

Decrease

Marked Leucocytosis

Increase

Hemolysis

Cold agglutinins

Severe Lipemia of serums

Rouleaux / RBC agglutinates

High Heparin conc.

Front 33

RDW

Back 33

Front 34

RDW - what is it?

Back 34

Quantitative measurement or numerical expression of anisopoikilocytosis.

Front 35

RDW-CV

Back 35

= (SD of RBC Volume/mean MCV) x 100

Reference values: 11.5-14.5%

Front 36

RDW-SD

Back 36

Actual measurement of the width of erythrocyte distribution curve. This measurement is performed at the relative height of 20% above the baseline.

The wider the curve is spread by RBCs of different sizes, the higher the RDW-SD value will be.

Reference values: 35-45 fL.

Front 37

RDW - Exclusion of two extreme ends of RBC histogram

Back 37

Excluding extreme left side : Platelets, platelet clumps, and electrical interference.

Excluding extreme right side : Clumped RBCs, overly large RBCs.

Front 38

Anemia - Normal MCV, Normal RDW

Back 38

Anemia of chronic disease

Acute blood loss

Acute hemolysis

CLL

CML

Hemoglobinopathy

Front 39

Anemia - Normal MCV, Increased RDW

Back 39

Early IDA

Early Vit.B12

Early Folate

Sickle Cell Anemia

Front 40

Anemia - Low MCV, Normal RDW

Back 40

Anemia of chronic disease

Thalassemia (heterozygous)

Front 41

Anemia - Low MCV, Increased RDW

Back 41

IDA

RBC Fragmentation

HbH

Thalassemia intermedia

G6PD deficiency

Front 42

Anemia - High MCV, Normal RDW

Back 42

Aplastic Anemia

Preleukemia

Myelodysplsatic Syndrome

Front 43

Anemia - High MCV, Increased RDW

Back 43

Vit B12 deficiency

Folate deficiency

Immune hemolytic anemia

Liver disease

Cold agglutinins

Alcoholism

Front 44

Gross summary of above combinations

Back 44

Nutritional disorders - Independent of MCV have increased RDW

Hemolytic disorders - Independent of MCV have increased RDW that is directly proportional to the degree of anemia caused by the disorder.

Hypoproliferative disorders - Independent of MCV have normal RDW

Front 45

Microcytic, hypochromic RBCs

Back 45

RBCs are smaller than the nucleus of the small lymphocyte.

Have markedly increased pallor, more than 1/3rd of diameter of RBC.

Causes:

IDA

Thalassemia Minor

Sideroblastic Anemia

Lead Poisoning

Pyridoxine defiency

Front 46

Macrocytic RBCs

Back 46

Most of the RBCs are larger than the nucleus of small lymphocyte. (Size >8.5 microns)

Causes:

Vit B12 or folate deficiency.

Alcoholism

Liver Disease

MDS

Hypothyroidism

Drugs impairing DNA synthesis

Front 47

Oval Macrocyte

Back 47

Causes:

Folate deficiency

Vit B12 deficiency

Pernicious anemia

MDS

Post Chemotherapy

Front 48

Hypochromic macrocyte

Back 48

Causes:

Alcholism

Hypothyroidism

Liver Disease

Post Splenectomy

Front 49

Blue Tinged Macrocytes

Back 49

Causes:

Neonates

Response to Anemic Stress

Front 50

Target cells aka Bell cells aka Mexican hat cells aka Cododcytes

Back 50

Characteristic ringed appearance - due to increased surface area to volume ratio - excess membrane pools in the middle of the cells.

Causes:

Thalassemia

Hemoglobinopathies (HbAC/CC/SS/SC)

Liver disease

Post splenectomy

Severe IDA

HbE

Abetalipoproteinemia

Front 51

Note about Target cells

Back 51

In patients with obstructive liver disease, lecithin cholesterol acetyltransferase activity is depressed, which increases the cholesterol-to-phospholipid ratio and produces an absolute increase in the surface area of the red cell membrane. In contrast, membrane excess is only relative in patients with iron-deficiency anemia and thalassemia because of the reduced quantity of intracellular hemoglobin.

Front 52

Schistocytes aka Schizocytes

Back 52

Physical damage to RBCs within bloodstream create these cells - include helmet cells, triangles, crescents and microspherocytes.

Front 53

Causes of Schistocytes

Back 53

Causes:

DIC

Severe hemolytic anemia

Microangiopathic hemolytic anemia

Hemolytic Uremic Syndrome

Prosthetic/Abnormal Cardiac Valve

Coarctation of Aorta

Connective tissue disorders

Burns (spheroschistocytes as a result of heat)

TTP

Uremia, ATN, Glomerulonephritis

Malignant HTN

Systemic amyloidosis

Liver Cirrhosis

Disseminated Carcinomatosis

Chronic Relapsing Schistocytic hemolytic anemia

Front 54

Tear drop cells aka Dacrocytes

Back 54

Pear shaped cells usually microcytic, hypochromic.

Causes:

Newborn

Thalassemia major

Leukoerythroblastic reaction

Myeloproliferative syndrome

Front 55

Spherocytes

Back 55

Ball shaped RBCs, decreased surface/volume ratio, hyperdense (>MCHC).

Causes:

Hereditary spherocytosis

ABO incompatibility

Autoimmune hemolytic anemia,

Microangiopathic hemolytic anemia,

SS disease,

Hypersplenism,

Burns,

Post Transfusion,

Pyruvate Kinase deficiency,

Water-dilution hemolysis

Front 56

Elliptocyte

Back 56

Normally seen in less than 1% of RBC

Causes:

Hereditary Elliptocytosis

IDA
SS disease and SA Trait

Thalassemia Major

Leukoerythroblastic reaction

Malaria

Megaloblastic Anemia

Any anemia may present with 5-10% elliptocytes