Red Cell Membrane Proteins Quiz

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Questions and Answers

What type of lattice is formed by spectrin tetramers, hexamers, or double tetramers?

  • Cubic lattice
  • Square lattice
  • Hexagonal lattice (correct)
  • Triangular lattice

Which molecule is bound to spectrin filaments approximately 80 nm from their distal ends?

  • Protein 4.1
  • Globular actin
  • Ankyrin structures (correct)
  • F-actin filaments

What is contained within cross-linking junctional complexes?

  • Skeletal muscle proteins
  • Long actin filaments
  • Short F-actin filaments (correct)
  • Collagen fibers

Which technique is used for separating the proteins listed in the properties of selected red cell membrane proteins?

<p>SDS–PAGE (D)</p> Signup and view all the answers

What is the primary focus of the table about red cell membrane proteins?

<p>Properties of selected red cell membrane proteins (B)</p> Signup and view all the answers

What abnormality is noted in the peripheral blood smear of a patient with hereditary pyropoikilocytosis (HPP)?

<p>Bizarre micropoikilocytosis and red cell budding (B)</p> Signup and view all the answers

Which finding is characteristic of Southeast Asian ovalocytosis (SAO)?

<p>Spoon-shaped oval cells with a band across the central area (A)</p> Signup and view all the answers

In hereditary elliptocytosis (HE) and hereditary pyropoikilocytosis (HPP), what is the typical finding regarding MCHC in infants?

<p>Normal or slightly elevated in both conditions (C)</p> Signup and view all the answers

What is the osmotic fragility test result typically observed in patients with hereditary elliptocytosis (HE)?

<p>Normal osmotic fragility (D)</p> Signup and view all the answers

What is the typical MCV result in a patient with hereditary pyropoikilocytosis (HPP)?

<p>Decreased (D)</p> Signup and view all the answers

What does an RPI greater than 2.5-3.0 indicate?

<p>Hemolytic anemia (C)</p> Signup and view all the answers

What is the significance of a reticulocyte production index (RPI)?

<p>It corrects hemoglobin levels in determining red cell production. (D)</p> Signup and view all the answers

What is indicated by the presence of Prussian blue-positive deposits of hemosiderin in urine?

<p>Excessive iron accumulation (B)</p> Signup and view all the answers

When assessing red blood cell production, what would a reduction in the myeloid-to-erythroid (M:E) ratio from 3-4:1 to 1:1 suggest?

<p>Erythroid hyperplasia (C)</p> Signup and view all the answers

Which of the following tests is used to assess the osmotic fragile nature of red blood cells?

<p>Osmotic fragility test (C)</p> Signup and view all the answers

In acute intravascular hemolysis, what would you expect to see in urine samples?

<p>Hemoglobinuria of varying severity (A)</p> Signup and view all the answers

What conclusion can be drawn if reticulocyte maturation times are found to be prolonged?

<p>Possible hypoproduction of red cells (C)</p> Signup and view all the answers

Which of the following statements about hemoglobinuria is accurate?

<p>It can occur after physical exertion. (D)</p> Signup and view all the answers

What is the primary defect leading to spherocytes in hereditary spherocytosis?

<p>Defect in a vertical interaction (B)</p> Signup and view all the answers

What percentage of RBCs can be uniform elliptocytes in mild hereditary elliptocytosis (HE)?

<p>Usually more than 30% (D)</p> Signup and view all the answers

What lab finding indicates severe cases of hereditary elliptocytosis (HE) and hereditary pyropoikilocytosis (HPP)?

<p>Features of extravascular hemolysis (B)</p> Signup and view all the answers

In hereditary pyropoikilocytosis (HPP), cells show increased sensitivity to what condition?

<p>Thermal conditions (A)</p> Signup and view all the answers

What feature is typically seen in spherocytic hereditary elliptocytosis (HE)?

<p>Presence of spherocytes and microspherocytosis (D)</p> Signup and view all the answers

What is the morphology of peripheral smear in hereditary elliptocytosis (HE) during a mild case?

<p>High percentage of uniform elliptocytes (C)</p> Signup and view all the answers

In stomatocytic hereditary elliptocytosis, how do the elliptocytes appear?

<p>Round and oval with a transverse bar (D)</p> Signup and view all the answers

Which condition is associated with increased thermal sensitivity and misshapen budding in red blood cells?

<p>Hereditary pyropoikilocytosis (HPP) (C)</p> Signup and view all the answers

What is the morphology described in the peripheral blood smear for Hst?

<p>Stomatcytosis with a tendency toward macrocytosis (B)</p> Signup and view all the answers

In the context of red cell indices, how does MCHC differ between Hst and Hxe?

<p>Decreased in Hst and increased in Hxe (B)</p> Signup and view all the answers

What is a characteristic finding in Osmotic fragility tests for Hst?

<p>Increased fragility (C)</p> Signup and view all the answers

Hereditary Acanthocytosis is inherited in which manner?

<p>Autosomal recessive (D)</p> Signup and view all the answers

What is a key feature associated with the condition of Hereditary Acanthocytosis?

<p>Increased cholesterol: lecithin ratio in the membrane (D)</p> Signup and view all the answers

Which enzyme deficiency is the most common in the hexose monophosphate shunt?

<p>Glucose-6-Phosphate Dehydrogenase (B)</p> Signup and view all the answers

What is the main source of energy for nucleated red cells?

<p>Anaerobic glycolysis (D)</p> Signup and view all the answers

What is a consequence of G6PD deficiency regarding glutathione levels?

<p>Reduced glutathione levels are not maintained (C)</p> Signup and view all the answers

Which condition is most consistent with hemolytic episodes caused by anti-malarial drugs in a patient with congenital non-spherocytic hemolytic anemia?

<p>G-6-PD deficiency (C)</p> Signup and view all the answers

What are the red cell inclusions in hemolytic anemia primarily caused by?

<p>Hemoglobin denaturation (D)</p> Signup and view all the answers

Hereditary pyropoikilocytosis is characterized by the presence of which type of red blood cells?

<p>Pencil-shaped cells (B)</p> Signup and view all the answers

What symptom indicates a potential hemolytic event in a patient taking primaquine?

<p>Black urine (D)</p> Signup and view all the answers

Anti-malarial drugs can precipitate hemolysis in which of the following conditions?

<p>Glucose-6-phosphate dehydrogenase deficiency (C)</p> Signup and view all the answers

Which of the following is not typically associated with congenital hemolytic anemias?

<p>Fatty liver disease (B)</p> Signup and view all the answers

What is the main mechanism behind hemolytic episodes precipitated by anti-malarial drugs in sensitive individuals?

<p>Oxidative stress (D)</p> Signup and view all the answers

Which of the following is a characteristic finding in hereditary pyropoikilocytosis?

<p>Pencil-shaped cells (D)</p> Signup and view all the answers

Flashcards

Hemoglobinuria

The presence of hemoglobin in the urine, indicating red blood cell breakdown.

Prussian blue stain

A stain used to identify hemosiderin deposits in tissues, particularly in urine sediment.

Reticulocyte count

A measure of the percentage of young red blood cells (reticulocytes) in the blood, reflecting red blood cell production rate.

Reticulocyte Production Index (RPI)

A measure of the number of reticulocytes produced in the bone marrow, adjusted for the level of anemia.

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BM erythroid hyperplasia

An increase in the number of red blood cells in the bone marrow, a sign of increased red blood cell production.

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M:E ratio

The ratio of immature to mature red blood cells in the bone marrow.

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Osmotic Fragility Test

A test that measures the red blood cell's resistance to lysis (breakdown) in a hypotonic solution.

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Red Survival Studies

Studies that analyze the survival of red blood cells in the bloodstream, often using radio-labeled red blood cells.

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Red Blood Cell (RBC) Membrane Skeleton

A protein complex that forms a lattice-like network beneath the plasma membrane of red blood cells, providing structural support and flexibility.

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Spectrin Lattice

The hexagonal lattice structure of the RBC membrane skeleton, composed of spectrin tetramers, hexamers, or double tetramers, linked by junctional complexes.

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Junctional Complexes

Protein complexes within the spectrin lattice that connect spectrin filaments to actin filaments, providing structural integrity and flexibility to the RBC.

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Ankyrin

A globular protein that binds to spectrin filaments, anchoring them to the plasma membrane of the RBC.

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Protein 4.1

A protein that interacts with both spectrin and actin filaments, contributing to the stability and flexibility of the RBC membrane.

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What is Hereditary Pyropoikilocytosis (HPP)?

Hereditary pyropoikilocytosis (HPP) is a rare genetic blood disorder characterized by small, irregularly shaped red blood cells (poikilocytes), red cell budding, and very few elliptocytes.

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What is Southeast Asian Ovalocytosis (SAO)?

Southeast Asian Ovalocytosis (SAO) is a genetic blood disorder found predominantly in Southeast Asian populations. It is characterized by oval-shaped red blood cells with a central band.

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What is Hereditary Elliptocytosis (HE)?

Hereditary elliptocytosis (HE) is a genetic blood disorder characterized by abnormally shaped red blood cells that are elongated and oval-shaped (elliptocytes).

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What are the red blood cell fragility and autohemolysis in HE?

In hereditary elliptocytosis (HE), the osmotic fragility test and autohemolysis are typically normal, although a few patients may have elevated autohemolysis.

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What are the red blood cell indices in HPP?

In hereditary pyropoikilocytosis (HPP), the mean corpuscular volume (MCV) is decreased, and the mean corpuscular hemoglobin concentration (MCHC) is usually elevated.

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What is Hereditary Elliptocytosis?

Hereditary elliptocytosis (HE) is a genetic blood disorder characterized by red blood cells that have an oval or elliptical shape.

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What is Hereditary Pyropoikilocytosis?

Hereditary pyropoikilocytosis (HPP) is a rare, severe form of hereditary elliptocytosis, causing red blood cells to be irregularly shaped and fragile.

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What causes the abnormal shape of red blood cells in HE?

In HE, a defect in horizontal protein interactions within the red blood cell membrane causes the cells to stretch out and elongate, giving them an elliptical shape.

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How does HPP differ from HE in terms of the red blood cell membrane?

In HPP, which is a severe form of HE, the red blood cells are even more irregular and fragile than in HE. These abnormalities are caused by a more significant defect in the horizontal protein interactions within the cell membrane.

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What are the lab findings in mild cases of HE?

Mild cases of HE may only show a slight increase in reticulocytes, which are immature red blood cells, and a decrease in haptoglobin, a protein that binds to free hemoglobin.

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What happens in severe cases of HE?

Severe cases of HE can lead to extravascular hemolysis, which means destruction of red blood cells outside the bloodstream. This can cause symptoms like anemia, jaundice, and fatigue.

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How is a peripheral blood smear useful in diagnosing HE?

Peripheral blood smears are used to examine the shape and size of red blood cells. In mild cases of HE, more than 30% of the red blood cells appear as elliptocytes.

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What are the characteristic features of red blood cells in HPP?

In HPP, red blood cells show increased thermal sensitivity, meaning they break down more easily when exposed to heat. They are also misshapen with budding, which are small projections on the cell surface.

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Hereditary Acanthocytosis

A condition characterized by abnormally shaped red blood cells (acanthocytes) which have spiky projections due to lipid abnormalities.

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Abetalipoproteinemia

An inherited condition where the body lacks the ability to produce and transport certain lipids properly, resulting in a buildup of cholesterol in the blood and affecting red blood cell membrane.

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Anaerobic Glycolysis

The metabolic process that produces energy for red blood cells in the absence of oxygen.

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RBC Metabolic Pathways

A group of metabolic processes within red blood cells, essential for the production of energy and protection from oxidative stress.

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Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)

A common enzyme deficiency in the hexose monophosphate shunt pathway, involved in red blood cell protection from oxidative damage.

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Pyruvate Kinase (PK) Deficiency

A deficiency of an enzyme vital for glucose utilization in red blood cells, leading to red blood cell breakdown and anemia.

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Main Glycolytic Pathway

The main pathway for energy production in red blood cells, undergoing a series of steps to convert glucose into energy.

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Ancillary Pathways

Alternative metabolic pathways that provide additional energy and protection for red blood cells.

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G6PD deficiency

A genetic condition where red blood cells are abnormally susceptible to breakdown, especially when exposed to certain drugs, causing hemolytic anemia.

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Thalassemia major

A severe form of a genetic disorder that affects hemoglobin production. People with thalassemia major experience a lifelong need for blood transfusions.

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Paroxysmal Nocturnal Hemoglobinuria (PNH)

A disease that affects the blood stem cells, causing a deficiency in red blood cell production and an increased risk of blood clots due to abnormal red blood cell shape.

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Hereditary Pyropoikilocytosis (HP)

A rare inherited blood disorder affecting red blood cell membrane stability, causing abnormal shaped red blood cells that are prone to premature destruction.

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Primaquine

A drug used to prevent malaria, often prescribed to travelers going to regions with malaria, can cause hemolytic anemia especially in individuals with G6PD deficiency.

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Hemolytic anemia

Having an insufficient amount of healthy red blood cells, leading to fatigue and weakness.

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Study Notes

Hemolytic Anemia

  • Hemolytic anemia (HA) is a group of normocytic normochromic anemias characterized by premature destruction of red blood cells (RBCs) or shortened RBC lifespan.
  • Bone marrow (BM) often increases output 6-8-fold to compensate for the loss of RBCs. This corresponds to a normal RBC lifespan of 15-20 days.

Classification of Hemolytic Anemia

  • Intracorpuscular defects
    • Hereditary defects: Defects in RBC membrane, enzymes, hemoglobinopathies, & thalassemia syndrome.
    • Acquired defects: Paroxysmal nocturnal hemoglobinuria (PNH)
  • Extracorpuscular defects
    • Immune hemolytic anemia
    • Infections
    • Exposure to chemicals and toxins
    • Exposure to physical agents
    • Microangiopathic and macroangiopathic hemolytic anemias
    • Splenic sequestration (hypersplenism)
    • General systemic disorders (where hemolysis isn't the primary feature of the disorder)

Diagnosis of Hemolytic Anemia (HA)

  • Tests reflecting increased red cell destruction:
    • Serum un-conjugated (indirect) bilirubin
    • Hemoglobinemia
    • Hemoglobinuria
    • Hemosiderinuria
    • Methemalbumin in the blood (Schumm's test)
    • Methemoglobinemia
    • Serum hemopexin
    • Serum haptoglobin
    • Urine urobilinogen and fecal stercobilinogen increased

Degradation of Hb After Intra- & Extra-vascular Hemolysis

  • Breakdown of hemoglobin (Hb), releasing iron, globin, and bilirubin (which enters the liver) is dependent on whether hemolysis is intravascular or extravascular.

Tests Reflecting Increased Red Cell Production

  • Reticulocyte count: Measures immature RBCs
  • Reticulocyte production index (RPI): Adjusts reticulocyte count to account for RBC maturation time in relation to hematocrit.

Red Cell Morphology

  • Red blood cell deformability depends on biconcave disc shape maximizing surface area-to-volume ratio
  • Cytoplasmic viscosity determined by mean cell hemoglobin concentration (MCHC)
  • Viscoelastic properties depend on membrane skeleton integrity.

RBC Membrane Proteins

  • Integral Proteins: Glycophorin A, B, C, D, anion exchange channel protein (band 3).
  • Peripheral Proteins: Spectrin, actin (band 5), ankyrin (band 2.1), band 4.1 & 4.2, adducin, p55.
  • Mutations in these proteins can lead to various hereditary hemolytic anemias.

Hereditary Defects of the Red Cell Membrane

  • Genetic mutations affect the RBC membrane, impacting shape, function, and lifespan.
    • Hereditary spherocytosis (HS)
    • Hereditary elliptocytosis (HE), including hereditary pyropoikilocytosis (HPP) and Southeast Asian ovalocytosis (SAO).
    • Hereditary stomatocytosis
    • Hereditary xerocytosis
    • Hereditary acanthocytosis

Assessment Questions

  • Questions on hemolytic anemia characteristics cover common diagnoses, including hereditary spherocytosis, elliptocytosis, stomatocytosis, and paroxysmal nocturnal hemoglobinuria.
  • Further questions assess understanding of specific hemolytic anemias like G6PD deficiency and pyruvate kinase (PK) deficiency.

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