Hematology: Chapter 10-11

Anisocytosis

Anemias associated with an increased R D W

Lab tests associated with anemia include

C B C., R B C indices: M C V, M C H, and M C H C., Retic count, R P I, IRF, Ret-He or C H r, blood smear examimation, bone marrow examination

M C H C

Mean Cell Hemoglobin Concentration is the ratio of hemoglobin mass to volume in which it is contained.

M C H

Mean Cell Hemoglobin is the measurement of the average weight of hemoglobin in individual erythrocytes.

M C V

Mean Cell Volume is the average volume of individual erythrocytes

young reticulocytes contain more

R N A than more mature retics

What test will give information about rate of erythrocyte production.

R P I

C H r is equivalent to

RET-he

R D W

Red Cell Distribution Width is the coefficient of variation of the Mean Cell volume and helps to identify anisocytosis

morphologic expressions can be the result of

a combination of factors that express a combination of morphologies visible in the blood smear.

functional anemia

a decrease in hemoglobin accompanied by a decrease in oxygen delivery to tissues

Anemia

a decrease in the competence of blood to carry oxygen to tissues. usually accompanied by a decrease in the normal concentration of hemoglobin and or erythrocytes

corrected reticulocyte count is

a means to adjust the countin proportion to the severity of anemia.

megaloblastic

abnormally large cells; characteristic of pernicious anemia.

normocytic with normal R D W include

acute hemorrhage. splenic pooling. chronic disease. chronic leukemia. renal disease.

an increase IRF indicates

adequate erythropoietic response

immature reticulocyte fraction

also called IRF. It is the index of reticulocyte maturity, used to evaluate bone marrow erythropoiesis response to anemia, or anemia therapy.

reticulocyte production index

also called R P I . It is a calculated value that indicates bone marrow response to anemia

acanthocytes

also called spur cells. are small spherical cells with irregular thorn like projections and no central pallor. sometimes shows bulb like tips.

codocytes

also called target cells.

reticulocyte hemoglobin

also known as RET-He. It is hemoglobin reported by automated analyzer; analogous to the M C H of mature erythrocytes

R P I greater than 2 indicates

an appropriate bone marrow response to anemia/therapy

immune mediated destruction can occur when

antibodies and or complement attach to the erythrocytes, resulting in their removal by macrophages in the spleen or liver.

Macrocytic normochromic cells

are associated with vitamin B12 or folate dificiency.

Microcytic hypochromic cells

are highly suggestive of iron-deficiency anemia

hemolysis due to extrinsic assault on R B C's include

autoimmune reaction. drug induced reaction. transfusion reaction.

proliferation defects can be caused by

bone marrow damage from radiation.,chemicals .or drugs. infiltration of fibrous, neoplastic granulomatous tissue. Stem cell or trophic issues.

Compensated hemolytic disease

bone marrow production increases to prevent anemia due to decreased life span of erythrocytes

Mean Cell Hemoglobin Concentration is calculated

by dividing Hemoglobin by Hematocrit

Serum ferritin level in microcytic hypochromic morphology due to cytoplasmic maturation defects

can be normal or increased. caused by chronic disease. thalassemia. hemoglobinopathies. sideroblastic anemia. lead poison. porphyria.

macrocytic with normal R D W include

chronic liver disease., aplastic anemia., chemotherapy., alcohol ingestion., antiviral medications

Mean cell volume is used to

classify cells as normocytic, microcytic or macrocytic

the functional classification of anemia with decreased serum ferritin

cytoplasmic maturation defect. which would been seen as microcytic hypochromic cells

pancytopenia

decrease of all types of blood cells in the blood

hemolysis

destruction of erythrocytes which results in the release of hemoglobin

site of hemolysis due to extrinsic defects

extra or intravascular depending on extent of cell damage.

site of hemolysis due to intrinsic defects

extravascular

Spherocytes seen in a blood smear indicates

extravascular hemolysis

immune hemolytic anemia is what type of defect

extrinsic defect

hemoglobinuria

free hemoglobin in the urine

erythrocyte indices

give important clues to the pathophysiology of anemia and help direct reflex testing.

M C V count for macrocytosis is

greater than 100 f L; usually due to impaired D N A sythesis.

what is the typical R P I for hemolytic anemia

greater than 2

normocytic normochromic due to survival defects has a R P I

greater than 2. Caused by hemolysis or hemorrhage

R P I for macrocytic -hemolytic anemia is

greater than 2. due to survival defect. such as hemolysis or hemorrhage

drops in hemoglobin can lead to

headache, vertigo, syncope, dyspnea and palpitations.

antihuman globulin test

helps identify erythrocytes sensitized with antibodies or complement attached to the cell membrane, which makes the cell a target for hemolysis.

hemoglobinemia

hemoglobin in the plasma

survival defects can be caused by

hemolysis and hemorrhage

antibodies directed against the erythrocyte commonly cause

hemolytic anemia associated with extravascular hemolysis.

microcytic with normal R D W include

herterozygous thalassemia., chronic disease., hemoglobin E. trait

R P I less than 2 indicates

hypoproliferation or ineffective bone marrow response to anemia/therapy

stress or shift reticulocytes are

immature reticulocytes released earlier than normal due to an increased need for erythrocytes in circulation.

macrocytic with increased R D W include

immune hemolytic anemia., B12 or folate deficiency., C L L with high lymph count., Cytotoxic chemotherapy., Chronic liver disease., myelodysplastic syndrome

normocytic with increased R D W include

immune hemolytic anemia., iron, B12 or folate deficiency., dimorphic anemia., sideroblastic anemia., myelofibrosis., sickle cell anemia., chronic liver disease., myelodysplastic syndrome.,

adaptations to anemia by an increase in oxygen utilization by tissues includes

increase in 2, 3 B P G in erythrocytes. decreased oxygen affinity of hemoglobin in tissues due to Bohr effect.

heterogeneous anemia

increased R D W

adaptations to anemia by increasing oxygenated blood flow include

increased and deeper breathing. increased heart rate and output. increased circulation rate and blood flow to vital organs.

microcytic with increased R D W include

iron dificiency., homozygous thalassemia., Hb S/Bthal Hb H disease Hemolytic anemia with schistocytes

hemosiderinuria

iron-containing protein in the urine due to intravascular hemolysis and disintegration of renal tubular cells

Microcytosis is associated with

iron-deficiency anemia; thalassemia; sideroblastic anemia, long standing anemia of chronic disease.

clinical finding common in a patient with hemolytic anemia is

jaundice

hemolytic anemia are associated with

jaundice and dark or red urine if intravascular hemolysis is present.

Normocytic normochromic due to proliferation defects has a R P I

less than 2. Caused by marrow damage, replacement or suppression by drugs or toxins. stem cell defect. chronic renal disease. endocrine hypofunction. chronic infection or inflammation. liver disease. malignancy.

R P I for macrocytic -megaloblastic anemia is

less than 2. due to nuclear maturation defects. Caused by vitamin deficiency, drugs, congenital defects or myelodysplasia.

R P I for macrocytic -nonmegaloblastic anemia is

less than 2. due to proliferation, maturation or survival defects. Caused by chronic liver disease. alcohol abuse. endocinopathy. aplastic anemia

M C V count for microcytosis is

less than 80 f L; usually due to defective hemoglobin formation or decreased M C H C and M C H

a patient with anemia has an R P I of 2.3 with and M C V of 103 f L. The class of anemia is

macrocytic

morphologic classifications include

macrocytic; normochromic; normocytic; normochromic; microcytic; hypochromic

normal hemoglobin or M C H C is characteristic of

macrocytosis

Macrocytosis is associated with

megaloblastic anemias; hemolytic anemia; acute hemorrhage; liver diease; asplenia; aplastic anemia; myelodysplasia; endocrinopathies; alcoholism

homogeneous anemia

normal R D W

What is increased with compensated hemolytic disease and an increased erythrocyte destruction

nothing. indices would be normal because the bone marrow has compensated for the loss of R B C's

maturation defects can be caused by

nuclear defects from vitamin B12 defiency or cytoplasmic defects from iron defiency, which affects heme production or thalassemia; which affects globin production.

The highest prevalence of anemia is in those

over 85 years of age due to blood loss, nutritional deficiency, chronic disease, inflammation or chronic renal failure. one third of occurrence is unexplained.

predominant morphology of aquired extrinsic hemolytic anemia

poikilocyte - schistocyte

Predominant morphology of inherited intrinsic hemolytic anemia

poikilocyte -spherocyte

hemolysis due to hereditary intrinsic defects of red blood cells include

red blood cell membrane disorders. red blood cell enzyme deficiencies. hemoglobinopathies. thalassemia.

discocyte

refers to the erythrocyte because of it biconcave shape.

C H r

reticulocyte hemoglobin content provided by Advia 120 and 2120 system by bayer diagnostics; analogous to the Mean Cell hemoglobin in erythrocytes

agglutination

seen with low power and forms irregular grape like clusters that are readily differentiated from rouleaux

satellitism

seen with low power and is a phenomenon when platelets adhere to neutrophils. This can be eliminated using sodium citrate as an anticoagulant.

rouleaux

seen with low power and is alignment of erythrocytes one on top of another resembling a stack of coins. This usually occurs when blood is allowed to stand in tubes.

smudge cells

seen with low power and is cells that have ruptured. they are often B lymphocytes and are characteristic of pathological conditions such as lymphocytic leukemia.

microcytic hypochromic morphology due to cytoplasmic defect has a decrease in

serum ferritin. caused by iron deficiency

decreased haptoglobin is a characteristic of what kind of anemia

severe intravascular hemolysis

adaptations to anemia are influenced by

severity of the anemia. competency of the cardiovascular and respiratory systems. oxygen needs due to physical and metabolic activity of patient. duration of anemia. underlying cause and presence of other diseases.

physical changes due to anemia include

skin pallor, hypotension, organomegaly of spleen and liver.

High hemoglobin levels are associated with

smoking and living in high altitudes

anemias are functionally classified using

the Immature Reticulocyte Fraction., Reticulocyte Production Index., and serum iron.

reticulocyte count indicates

the degree of effective bone marrow erythropoietic activity. It is the most useful and cost effective tests in monitoring anemia and response to therapy.

Mean Cell Hemoglobin does not take into account

the size of a cell. M C H should be interpreted in conjuction with the M C V due to the direct correlation in cell size with hemoglobin content.

Characteristics of stress or shift reticulocytes

they appear as large polychromatophilic cells on the romanowsky stained blood smear. they take longer to mature

Common symptoms of anemia

tiredness. muscles weakness and fatigue due to insufficient oxygen availability to burn for ATP production

functional iron-deficiency anemia

total body iron is adequate but cannot be mobilized fast enough for the needed increase in erythropoiesis

poikilocytosis

variation in shape of cells. sometimes due to improperly stained smears.

anisocytosis

variation in size of cells. Some variation is normal to due young cells being larger than older cells.

Normal Reference interval for reticulocytes is

0.5 to 2 percent. or 25 to 75 time 10 to the 9th

a patient has R B C count of 2.5 x 10 to the 12 and hemoglobine 5.3., hematocrit 0.17., retic count 1%. what are the absolute retic count and R P I?

25 x 10 to the 9th retic count, and 0.19 R P I

prevalence of anemia in African Americans over 65 is

3 times higher than in Caucasions.