Red Blood Cell Formation and Characteristics
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Questions and Answers

What is the term used to describe the total mass of red blood cells circulating in the peripheral blood and the bone marrow?

  • Erythron (correct)
  • RBC Mass
  • Erythrokinesis
  • Anisochromia

    • Erythropoiesis is the process of RBC formation that primarily takes place in the yellow marrow.

    False

    What is the chief stimulatory cytokine for red blood cells known as?

    erythropoietin

    Deficiency in Vitamin B12 leads to ______________, which is characterized by MACROCYTIC, NORMOCHROMIC ANEMIA.

    <p>macrocytic</p> Signup and view all the answers

    What is the earliest recognizable erythroid precursor visible using the light microscope?

    <p>Proerythroblast</p> Signup and view all the answers

    What is the characteristic feature used to identify the stage of RBC precursors?

    <p>N:C ratio</p> Signup and view all the answers

    Basophilia pertains to the pinkness of a particular part of the cell.

    <p>False</p> Signup and view all the answers

    _______ is the last stage in which the RBC has its nucleus.

    <p>Metarubricyte</p> Signup and view all the answers

    What is the process called when small fragments of the nucleus are left behind after the extrusion of the nucleus in RBCs?

    <p>Howell-Jolly bodies</p> Signup and view all the answers

    What is the term used to refer to decreased reticulocyte counts?

    <p>reticulocytopenia</p> Signup and view all the answers

    Which staining method is more preferred for staining reticulocytes?

    <p>New Methylene Blue</p> Signup and view all the answers

    Hemosiderin can be found in the mitochondria of cells.

    <p>False</p> Signup and view all the answers

    The Corrected Reticulocyte Count formula is CRC = Reticulocyte (%) x ____.

    <p>0.45 L/L</p> Signup and view all the answers

    Match the hematocrit range with its corresponding maturation time in days:

    <p>40-45 = 1.0 35-39 = 1.5 25-34 = 2.0 15-24 = 2.5</p> Signup and view all the answers

    What is the term used to describe RBCs with a thin rim of hemoglobin and a large, clear center?

    <p>Anulocyte</p> Signup and view all the answers

    Spherocytes are almost spherical in shape and lack central pallor.

    <p>True</p> Signup and view all the answers

    What is the condition characterized by an elongated RBC with a slit-like central area?

    <p>Stomatocyte</p> Signup and view all the answers

    Echinocytes are also known as _______ due to their spiculated surface.

    <p>spiculated</p> Signup and view all the answers

    What is the condition characterized by renal failure, thrombocytopenia, schistocytes, and severe mucocutaneous hemorrhage?

    <p>Hemolytic Uremic Syndrome (HUS)</p> Signup and view all the answers

    Which term is used for the aggregated RNA inclusions that are visualized with Wright stain and are associated with conditions like lead poisoning and arsenic poisoning?

    <p>Basophilic stippling</p> Signup and view all the answers

    Basophilic stippling is a visualized feature that is commonly seen in malaria and conditions with overt hemolysis.

    <p>True</p> Signup and view all the answers

    ______ is the main component of the red blood cell and serves as the respiratory pigment.

    <p>Hemoglobin</p> Signup and view all the answers

    In an acidic environment, the FASTEST hemoglobin is H (composed of 4 beta globin chains).

    <p>Hb H</p> Signup and view all the answers

    In normal individuals, the fastest hemoglobin is identified as ___A1.

    <p>Hb A1</p> Signup and view all the answers

    What does Hb A1 migrate faster than in an acidic environment?

    <p>Hb H</p> Signup and view all the answers

    Hb H is slower than Hb A if coexisting in the same environment.

    <p>False</p> Signup and view all the answers

    Match the following hemoglobins with their migration speed in an acidic environment:

    <p>Hb C = Slowest Hb A2 = Slowest Hb E = Slowest Hb CHarlem = Slowest Hb OArab = Slowest</p> Signup and view all the answers

    What is another name for the condition characterized by the presence of xerocytes?

    <p>xerocytosis</p> Signup and view all the answers

    Which genetic disorder is associated with defective apo B synthesis?

    <p>Abetalipoproteinemia</p> Signup and view all the answers

    TTP is characterized by obstruction of small blood vessels by platelet aggregates.

    <p>True</p> Signup and view all the answers

    Drepnocytes are also referred to as ______________ or ______________.

    <p>sickle cells, menisocytes</p> Signup and view all the answers

    Match the following RBC shapes with their respective conditions:

    <p>Schistocyte = Patients with artificial heart valves, uremia, severe burns Acanthocyte = Bassen-Kornzweig syndrome and Hereditary Acanthocytosis Leptocyte = Liver disease and certain hemoglobinopathies</p> Signup and view all the answers

    What are acute phase reactants (APRs) and what is their function?

    <p>Proteins that increase in inflammation.</p> Signup and view all the answers

    Which protein levels increase in the blood in response to inflammation? Select all that apply.

    <p>Globulins</p> Signup and view all the answers

    Anemia is defined as the decrease below normal of one or more of the following: Number of red blood cells, hemoglobin, volume of packed red cells (hematocrit), and _______.

    <p>Reticulocytopenia</p> Signup and view all the answers

    Hemolysis is explained by decreased production of erythrocytes.

    <p>False</p> Signup and view all the answers

    What is the primary function of hemoglobin?

    <p>Delivery of oxygen to the tissues, to carry waste product CO2 away to the lungs, binding, inactivation, and transport of NO (Nitric Oxide)</p> Signup and view all the answers

    The complete adult hemoglobin molecule is composed of 4 different constituents: 1) A protein component (______) composed of two sets of two different polypeptide chains.

    <p>globin</p> Signup and view all the answers

    Which of the following are constituents of the complete adult hemoglobin molecule?

    <p>Two sets of two different polypeptide chains</p> Signup and view all the answers

    Hemoglobinometry involves measuring hemoglobin levels using Drabkin's reagent.

    <p>True</p> Signup and view all the answers

    Match the hemoglobin structure with its description:

    <p>PRIMARY = Amino acid sequence of the polypeptide chains SECONDARY = Chain arrangements in helices and nonhelices TERTIARY = Arrangement of configuration or formation QUATERNARY (TETRAMER) = Complete hemoglobin molecule with heme groups</p> Signup and view all the answers

    Study Notes

    Erythropoiesis

    • Erythropoiesis is the process of RBC formation, which takes place inside the bone marrow.
    • The site of formation is the red marrow, and related terms include:
      • Erythron: the total mass of RBCs circulating in the peripheral blood and the bone marrow RBC precursors.
      • RBC mass: the erythrocytes in the circulation, total population present inside the circulation (blood vessel only).
      • Erythrokinesis: a term that describes the dynamics of RBC creation and destruction.

    Reticulocytes

    • Reticulocytes are immature RBCs that have a network of ribosomal RNA.
    • Methods of counting reticulocytes include:
      • Supravital staining (e.g., methylene blue, brilliant cresyl blue)
      • Wright's staining

    Erythrocytes

    • RBC count is an important parameter in blood tests.
    • RBC metabolic pathways include:
      • Anaerobic glycolysis ( Embden-Meyerhof pathway)
      • Hexose monophosphate shunt
      • Pentose phosphate pathway
    • RBC anomalies include:
      • Anisocytosis (abnormal variation in RBC size)
      • Anisochromia (abnormal variation in RBC color)
      • Poikilocytosis (abnormal RBC shape)
      • RBC inclusion bodies (e.g., Howell-Jolly bodies, Cabot rings)

    Hemoglobin

    • Hemoglobinometry is the measurement of hemoglobin levels in the blood.
    • Hemoglobin electrophoresis is a laboratory technique used to separate and identify hemoglobin types.
    • Hemoglobin synthesis occurs in the bone marrow and is stimulated by erythropoietin.
    • Hemoglobin derivatives include:
      • Carboxyhemoglobin (COHb)
      • Methemoglobin (MetHb)

    Hematocrit and ESR

    • Hematocrit is the proportion of RBCs in the blood.
    • Hematocrit determination is done using a microhematocrit centrifuge.
    • ESR (Erythrocyte Sedimentation Rate) is a measure of the rate at which RBCs settle at the bottom of a test tube.
    • Rule of Three: a rough estimate of the RBC count, hemoglobin, and hematocrit.
    • Erythrocyte Indices: a set of calculated values that describe the size and hemoglobin content of RBCs.
    • Erythrocyte sedimentation rate (ESR): a measure of the rate at which RBCs settle at the bottom of a test tube.

    Hemoglobinopathies

    • Hemoglobinopathies are genetic disorders affecting hemoglobin structure or function.
    • Examples include:
      • Sickle cell disease (HbS)
      • Thalassemia (α-thalassemia, β-thalassemia)

    Thalassemia

    • Thalassemia is a genetic disorder affecting hemoglobin production.
    • Types of thalassemia include:
      • α-thalassemia (defective α-globin chain synthesis)
      • β-thalassemia (defective β-globin chain synthesis)
    • Erythropoietin (EPO) is the chief stimulatory cytokine for RBCs.
    • EPO is produced by the kidneys and stimulates the bone marrow to produce RBCs.
    • Testosterone, growth hormone, and prolactin also stimulate erythropoiesis.
    • Estrogen, on the other hand, inhibits erythropoiesis.

    RBC Stages of Maturation

    • BFU-E (Burst Forming Unit-Erythroid) is the earliest recognizable erythroid precursor.
    • RBC maturation stages include:
      • Rubriblast (Pronormoblast)
      • Prorubricyte (Basophilic Normoblast)
      • Rubricyte (Polychromatic Normoblast)
      • Metarubricyte (Orthochromatic Normoblast)
      • Reticulocyte (mature RBC)

    Nomenclature Systems

    • There are three nomenclature systems used to describe RBC precursors:

      • Rubriblast, Normoblast, Erythroblast
      • Pronormoblast, Basophilic Normoblast, Polychromatic Normoblast, Orthochromatic Normoblast
      • Rubricyte, Metarubricyte, Reticulocyte### Reticulocyte

    • An immature, non-nucleated RBC containing >2 blue-stained, granulofilamentous materials (reticulum) after supravital staining

    • Continues to generate hemoglobin (last stage of hemoglobin synthesis)

    • Normal maturation time in blood: 1 day

    • Production of reticulocytes: 50 x 10^9/L/day

    Reticulocyte Count

    • Permits effective assessment of RBC production by the bone marrow
    • Reference ranges:
      • Adults: 0.5-1.5%
      • Newborns: 1.8-5.8% (by 1-2 weeks of age, reference values are the same as for adults)

    Reticulocytosis

    • Increased reticulocyte count, considered as the first sign of accelerated erythropoiesis
    • Observed in hemolytic anemias, iron deficiency anemia, thalassemia, and in acute and chronic blood loss

    Mature Erythrocyte

    • Shape: biconcave disk
    • Thickness: 1.5-2.5 um
    • Normal ratio of RBCs to WBCs: approximately 600:1
    • Normal ratio of RBCs to Platelets: approximately 15:1

    Methods of Counting Reticulocytes

    • Routine Light Microscope Method
    • Calibrated Miller Disk Method
    • Flow Cytometry

    Reticulocyte Count Calculation

    • Total Reticulocytes observed / Total RBCs counted x 100

    Corrected Reticulocyte Count (CRC)

    • Corrects for the degree of anemia
    • Formula: CRC = Reticulocyte count (%) x 0.45 L/L (Hct)

    Absolute Reticulocyte Count (ARC)

    • Actual number of reticulocytes in 1 liter of whole blood
    • Formula: ARC = Reticulocyte count (%) x RBC count (x10^9/L)

    Reticulocyte Production Index (RPI)

    • Provides a further refinement of the CRC
    • Calculation: RPI = CRC x Maturation time (in days)

    Anemias

    • Hemolytic anemia: ARC and IRF increase
    • Chronic renal disease: ARC and IRF decrease
    • Nutritional anemia: ARC and IRF may increase or decrease

    Red Blood Cell Inclusions

    • Howell-Jolly bodies: nuclear fragments

    • Heinz bodies: denatured and precipitated hemoglobin

    • Pappenheimer bodies: hemosiderin in the mitochondria

    • Hemoglobin H: greenish-blue bodies### Abnormal Red Blood Cells

    • Spherocytes: almost spherical in shape, lack central pallor, hereditary spherocytosis, autoimmune hemolytic anemia, burns, ABO HDN, and transfusion of stored blood

    • Ovalocytes: oval-shaped RBCs, hereditary ovalocytosis, Southeast Asian ovalocytosis

    • Elliptocytes: elliptical (cigar-shaped) RBCs, hereditary elliptocytosis, thalassemia, Mediterranean anemia

    Stomatocytes

    • Hereditary stomatocytosis
    • Dehydrated hereditary stomatocytosis
    • Xerocytes: dehydrated form of stomatocytes, appear to have puddled at one hand (half-dark, half-light), abetalipoproteinemia, McLeod syndrome
    • Dacryocytes: pear-shaped or teardrop-shaped RBCs, primary myelofibrosis (PMF), myeloid metaplasia, chronic idiopathic myelofibrosis

    Acanthocytes

    • Irregularly spiculated surface, "Bassen-Kornzweig syndrome" and hereditary acanthocytosis
    • Characterized by defective apo B synthesis, VLDL, LDL, chylomicron not found in plasma, McLeod syndrome, pyruvate kinase deficiency

    Drepanocytes

    • Sickle- or crescent-shaped RBCs, sickle cell anemia, hemoglobin SC disease, etc.
    • Two forms of drepanocytes: 1) ISC (irreversible sickle cells) with crescent-shaped projections, 2) OAT-shaped cells with less pronounced projections

    Schistocytes

    • Fragmented RBCs, patients with artificial heart valves, uremia, severe burns, microangiopathic hemolytic anemias (MAHAs)
    • Characterized by RBC fragmentation and thrombocytopenia, major MAHAs include TTP, HELLP, HUS, and DIC

    Leptocytes

    • RBCs with a centrally stained area with a thin outer rim of hemoglobin, liver disease, certain hemoglobinopathies, thalassemia, Mediterranean anemia

    Other Abnormalities

    • Bite cells: demonstrate a semicircular defect in their edge, resembles a bite mark, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
    • Biscuit cells: folded RBCs, hemoglobin SC disease
    • Semilunar bodies: as large as leukocytes, pale-pink staining ghost of the red cell, malaria and other conditions causing overt hemolysis
    • Bronze elliptocytes: bipolar/central distribution of Hgb, sickle cell anemia
    • RBC inclusion bodies: basophilic stippling, aggregated RNA, Wright stain (deep blue to purple), lead poisoning, arsenic poisoning, pyrimidine-5'-nucleotidase deficiency, anemias with ineffective erythropoiesis

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