Hematopathology: Disorders of the Formed Blood Elements, Physiology of Blood Components, Pneumonia & Lung Tumor Pathology, Respiratory Pathology, BRS Pathology ALL QUESTIONS
What can anemia be associated with?
1. Appearance of abnormal hemoglobin 2. Reduced number of RBCs 3. Structural abnormalities of RBCs
What survivor disorders can lead to anemia?
1. Blood loss - hemorrhage (external or internal) 2. Premature RBC destruction (hemolytic anemia)
What may anemia be a consequence of?
1. Decreased hematopoiesis 2. Abnormal hematopoiesis 3. Increased loss or destruction of RBCs
What production disorders can lead to anemia?
1. Hematopoietic Cell Damage (drugs, radiation, infections, toxins) 2. Factor Deficiency (Iron - Heme synthesis, Vitamin B12 - DNA Synthesis, Folate - DNA Synthesis)
What are the anemias of insufficient red cell production?
1. Iron deficiency anemia 2. Vitamin B12 or folic acid deficiency 3. Anemia of chronic disease 4. Primary marrow failure (aplastic anemia) 5. Bone marrow destruction or replacement
What precursor cells are released from the bone marrow?
1. Reticulocytes 2. Band cells
What is the lifespan of a RBC?
120 days
What percentage of the blood volume is fluid and what percentage is packed cells?
45% is pack cells 55% is fluid
What is the protein composition of the plasma?
5% fibrinogen 15% immunoglobulins (gamma) 20% other globulins (beta) 60% albumin
What percentage of the WBCs in the blood are monocytes, lymphocytes, and granulocytes?
5% monocytes 30% lymphocytes 65% granulocytes
What is the composition of plasma?
7% proteins 92% water 1% other
What percentage of the granulocytes in the blood are neutrophils, eosinophils, and basophils?
97% neutrophils 2% eosinophils 1% basophils
Of the cellular components of blood, what percentage is RBC and what percentage is WBC?
99% is RBC while 1% is WBC
What does anemia mean in practice?
<13 g/dL in males and <11.5 g/dL in females
What is hypersplenism?
A condition that results from splenomegaly. Due to the enlarged spleen, RBCs, WBCs, and platelets become sequestered there and destroyed en masse. The spleen becomes engorged and enlarged and pancytopenia occurs.
What is the lifespan of platelets?
A day or two
What can cause bone marrow destruction?
A bone marrow transplant failing or bone marrow being destroyed by cancer
What is the definition of anemia?
A reduction of hemoglobin in the blood to below-normal levels
What is a "blue" RBC?
A reticulocyte - a precursor to a RBC The nucleus is dissolving but it has a blueish tint because it has not dissolved completely
What is the lifespan of lymphocytes and monocytes?
A week or two
What is the lifespan of granulocytes?
About 4 days
What are the normocytic anemias?
Acute bleeding Aplastic Hemolytic Low erythropoietin Malignancy
What is the role of neutrophils?
Acute inflammatory reactions, phagocytosis, digestion of foreign and inflammatory debris
What is the role of eosinophils?
Allergic and anti-parasitic reactions
What is the role of basophils?
Allergic reactions
What other compounds are found in plasma (other than water and proteins)?
Amino acids Glucose Electrolytes Lipids Hormones Vitamins Wastes
What is the target of erythropoietin?
Bone marrow
What is the pathophysiology of iron deficiency anemia?
Brittle, thin, coarsely ridged, and spoon-shaped nails (koilonychia) A red, sore and painful tongue
What is venipuncture?
Collection of blood from a vein It involves tubes with negative pressure which helps suck the blood into them Different tubes have different additives to check for different things
Why do RBCs have little white circles in them on a slide?
That means that the RBC is laying flat on the smear and the light is able to shine through the biconcave discs The ones that you cannot see through are still normal, they just aren't laying flat on the smear
Is it true that women on their period can become anemic?
That's true, women can lose too much blood and require an increase in their iron intake to avoid anemia
How is hemoglobin measured?
Direct measurement (g/dL)
How can drugs trigger hemolytic anemia?
Drugs can have some affinity for surface proteins on RBCs and attack them (toxins, toxicants, etc.)
What things can cause hematopoietic cell damage?
Drugs, radiation, infections, toxins
What are the classic anemia symptoms?
Fatigue Weakness Dyspnea Pallor
What is the iron storage molecule?
Ferritin
How does absorption of heme iron differ from absorption of non-heme iron?
Heme: ~25% absorbed Non-heme: ~1-2%
What is the active protein of RBCs?
Hemoglobin - it allows them to remain in the bloodstream and move oxygen and carbon dioxide around
What is an example of increased loss or destruction of RBCs?
Hemolytic anemia (type 2 mechanism)
What kind of anemia is caused by cyanide poisoning?
Hyperchromic anemia The RBCs are completely saturated with oxygen because the cyanide uncouples the oxygen phosphorylation which is an electron transport process to get oxygen off hemoglobin The body looks red/pink and you die in the presence of too much oxygen
How are anemias distinguished based on hemoglobin content?
Identified by terms that end in -chromic Normochromic Hypochromic Hyperchromic
How do we classify anemia based on size?
Identified by terms that end in -cytic Macrocytic Normocytic Microcytic
What is the role of lymphocytes?
Immune reactions
Where is the highest concentration of ferririn found?
In the bone marrow and the liver, but it is found in all tissues as well
What is iron primarily absorbed?
In the duodenum
What factor deficiencies can cause anemia?
Iron - Heme Synthesis Vitamin B12 - DNA Synthesis Folate - DNA Synthesis
What are the microcytic anemias?
Iron deficiency Hemoglobinopathy Chronic disease Lead poisoning
How does lead poisoning lead to microcytic anemia?
Lead inhibits an enzyme called ferrochelatase which puts iron in the middle of the heme ring. The body compensates by putting in zinc (iron and zinc both have a 2+ valence). Zinc doesn't have the red color and it is smaller. Lead poisoning is also hypochromic
What is the starting point for hematopoiesis?
Low blood oxygen which is detected by the juxtaglomerular cells of the kidney
What are the macrocytic anemias?
Low vitamin B12 Low folate
What organ is responsible for removing RBCs and WBCs from the circulation?
Lymphoid organs like the spleen
How are lymphocytes formed (steps from lymphoid stem cell to lymphocyte)?
Lymphoid stem cell -> Lymphoblast cell -> Prolymphocyte -> Lymphocyte
What is MCH?
Mean cell hemoglobin (HGB divided by RBC)
What is MCHC?
Mean cell hemoglobin concentration (HGB divided by HCT)
What is MCV?
Mean cell volume (HCT divided by RBC)
Does chronic disease tend to give us macrocytic, normocytic, or microcytic anemia?
Microcytic
What cells are derived from a myeloid stem cell? A lymphoid stem cell?
Myeloid - everything except lymphocytes (monocyte, RBC, platelets, neutrophils, eosinophils, basophils) Lymphoid - lymphocytes
How are RBCs formed (steps from myeloid stem cell to RBC)?
Myeloid stem cell -> Erythroblast -> Normoblast -> Reticulocyte -> RBC
How are platelets formed (steps from myeloid stem cell to platelet)?
Myeloid stem cell -> Megakaryoblast -> Megakaryocyte -> Platelets
How are monocytes formed (steps from myeloid stem cell to RBC)?
Myeloid stem cell -> Monoblast -> Promonocyte -> Monocyte
How are basophils formed (steps from myeloid stem cell to basophil)?
Myeloid stem cell -> Myeloblast -> Myelocyte -> Metamyelocyte -> Band cell -> Basophil
How are eosinophils formed (steps from myeloid stem cell to eosinophil)?
Myeloid stem cell -> Myeloblast -> Myelocyte -> Metamyelocyte -> Band cell -> Eosinophil
How are neutrophils formed (steps from myeloid stem cell to neutrophil)?
Myeloid stem cell -> Myeloblast -> Myelocyte -> Metamyelocyte -> Band cell -> Neutrophil
Are granulocytes active in the vascular system?
No, they are inert and not active until you have some type of inflammation. They can become active during septicemia because there are bacteria in the vasculature (maybe activated by PAMP receptors)
Are bones dry?
No, they are very well vascularized so anything in the blood can affect the RBC production
What is the most difficult anemia to distinguish?
Normocytic anemia The slide tells you nothing about what is going on because the RBCs are all completely normal
What would a blood smear look like in a patient with hypersplenism?
Normocytic, normochromic All of the RBCs are fine but they are trapped in the spleen
What are the types of iron deficiency anemia?
Nutritional iron deficiency - not eating enough iron Metabolic or functional deficiency - like lead poisoning where the ability to insert iron is inhibited, or genetic deficiencies
When do we use MCHC?
Only used in weird blood disorders Tells us the relationship between hemoglobin and hematocrit
How do you measure hematocrit (Hct)?
Packed RBC volume (PV) - manual "spun" hematocrit (%) Automated counters calculate based on RBC number and size
What is the role of monocytes?
Phagocytosis, immune reactions
What is the physiologic manifestation of anemia?
Reduced oxygen carrying capacity
What is an example of abnormal hematopoiesis?
Sickle cell anemia, thalassemia
What is koilonychia?
Spoon shaped nails often seen in iron-deficiency anemia
Why is there usually a backup or RBCs in the bone marrow?
The RBCs exist for quite some time so we don't always need to be releasing a ton from the bone marrow
Why is tachycardia a compensation mechanism of anemia?
The heart races because the heart thinks that it isn't getting the RBCs to the tissues fast enough so it speeds up to try to fix the problem.
What happens to your RBCs if you have to have your spleen removed?
The liver will take over its job of removing old RBCs and WBCs from circulation. The hepatocytes are very busy cells and they can manage if they need to do an additional task
What is a RBC count?
The number of RBCs per uL of blood
What is hematocrit?
The percentage of blood volume taken up by pack RBCs
If a person has a high WBC count, what does that mean?
The person might have a bacterial infection
What does MCV tell us?
The size of the RBC Whether they are normal, too big, or too little
Does most of hematopoiesis happen in the soft bones or the long bones?
The soft bones
Are blood samples usually venous blood or arterial blood?
They are usually venous blood. We don't really test arteriole blood anymore because we can just get oxygenation information from skin tests now
Why are most things absorbed in the first 2-3 meters of the intestines?
This is where the highest concentration gradient is located because everything has just left the stomach
What is the iron transport protein?
Transferrin
What is the role of albumin?
Transport, plasma osmotic pressure
What is the role of beta globulins?
Transport, reactant proteins
What does the top of venipuncture tubes tell you?
What additives are inside of the tube Ex. Lavender - EDTA Green - heparin
Which is bigger: WBCs or RBCs?
WBCs are always bigger than RBCs
What are you looking for with a healthy bone marrow sample?
We want to see lots of cells growing in the sample. They should be purple/blue because there is a lot of basophilia - nuclei in the precursor cells. Pink fragments are just bone pieces - that is normal
What is an internal hemorrhage?
When you are bleeding inside your body. You can't see the blood but blood is still escaping your vasculature and getting to where it shouldn't be
Do immature RBCs have nuclei?
Yes, the precursor cells (erythroblasts, normoblasts) DO Have a nuclei so that can be affected by pathophysiology that impacts the ability of cells to divide
Why is tachypnea a compensation mechanism of anemia?
You aren't getting enough oxygen to the tissues and the body doesn't know it is because of the reduced RBCs so it thinks that you aren't breathing enough. You start breathing shorter and faster to compensation
Why wouldn't you want to use a venipuncture tube with sodium fluoride if you were checking the sodium levels in your patient?
You wouldn't be able to tell if the sodium came from the tube or from the blood
What is hematopoiesis?
formation of blood cells (RBC and WBC)
What is the most common type of anemia?
iron deficiency anemia
What WBCs are granulocytes?
neutrophils, eosinophils, basophils
What is erythropoiesis?
production of RBCs
What is TIBC?
total iron binding capacity fully saturated transferrin
How much iron does your body lose per day?
~1-2 mg/day due to epithelial cell shedding
