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Hematology Chapter 8
Introduction to Anemia
69
Biology
11/12/2012

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Term
Anisocytosis
Definition
general variation in erythrocyte size
Term
Poiklocytosis
Definition
presence of variation in shape of erythrocytes
Term
MCH
Definition
indicative of amount of hemoglobin
Term
MCHC
Definition
indicative of concentration of hemoglobin
Term
MCV
Definition
indicative of size of red blood cell
Term
Absolute reticulocyte count
Definition
retic count (fraction) x total RBC count (x 10^6/ uL)
Term
Reticulocyte production index
Definition
(retic count/maturation time) X (patient hct %/45)

RPI > 2 = adequate mone marrow response
RPI < 2 = inadequate bone marrow response
Term
Basophillic Stippling
Definition
cells wth black-bluish granular inclusions distributed across their entire cell area
Term
Cabot rings
Definition
violet inclusions occuring the formation of a figure 8
Term
Howell-Jolly Bodies
Definition
dark purple or violet spherical granules
Term
Pappenheimer bodies
Definition
clusters of small granules
Term
Heinz Bodies
Definition
need supravital stains
Term
Sideroblasts
Definition
are nucleated erythrocytes that contain iron granules, identified by Prussian blue iron stain
Term
Stacking or aggregation of erythrocytes on stained smear
Definition
associated with pathologic states
Term
Laboratory tests to evaluate erythrocyte destruction
Definition
marrow cellularity, RPI, serum unconjugated bilirubin
Term
morphological classification
Definition
RBC average size and hb concentration
Term
Polychromatophilia
Definition
larger RBCs with a bluish tinge, causes by residual RNA in the cytoplasm. Associated with erythroid hyperplasic marrow due to decreased RBC survival and/or hemmorrhage
Term
Adaptations to anemia (3)
Definition
increase oxygenated blood flow
increase in oxygen utilization by tissues
different responses to change in hemoglobin
Term
Patient symptoms associated with increase in oxygenated blood flow as an adaptation to anemia
Definition
body deepens amount of inspiration and increases respiration rate, amount of peripheral blood decreases
Term
Patient symptoms associated with increase in oxygen utilization by tissue
Definition
buildup of lactic acid due to scarcity of oxygen at cellular levels because tissues are extracting more oxygen from the blood
Term
Patient symptoms associated with changes in hemoglobin
Definition
oxygen requirements of the individual change
Term
History of Patients with Anemia
Definition
Weakness and fatigue
vertigo, headache, syncope, dyspnea (due to drop in hemoglobin)
blood loss
family history for rare hereditaory hematologic disorders
Term
Clincal symptoms of patients with anemia
Definition
changes in epithelial tissue due to oxygen deprivation, hypotension (low bp), heart abnormalities, organomegaly of spleen and liver, defect in hemostatis
Term
RDW Results
Definition
RDW tells about variations in red cell sizes, Anisocytosis
Normal: 11.5-14.5%
Abnormalities show increased RDW = more variation in size of red blood cells
Term
Bone marrow response measured by Retics
Definition
RPI > 2 appropriate response, bone marrow is releasing retics because of the increased need
RPI < 2 inappropriate response, Bone marrow is not releasing enough RBCs
Term
How are acanthocytes formed?
Definition
RBCs have altered lipid content
Term
What is the clincal significance of acanthocytes?
Definition
they have a normal life span but a decreased osmotic fragility, seen in liver disease and congenital acanthocytosis
Term
How are teardrop cells formed?
Definition
formed when RBCs containing inclusions traverse the spleen (inclusion has trouble passing and cell is stretched)
Term
What is the clincal significace of Target cells?
Definition
decreased osmotic fragility, seen in disorders with increases membrane lipids (liver diseae), decreased cellular hemoglobin (IDA and thalassemia), and hemoglobinopathies (sickle cell, Hb C disease)
Term
What is the clincal significance of teardrop cells?
Definition
) seen in thalassemia, also in myelofibrosis and metastatic cancer to the bone marrow
Term
How are echinocytes formed?
Definition
related to increase in the area of the outer leaflet of the RBC membrane
Term
What is the clincal significance of echinocytes?
Definition
seen in liver disease, PK deficiency, peptic ulcers, cancer of the stomach, and heparin therapy
Term
How are ellitocytes formed?
Definition
formed after cells leave bone marrow, involve alterations in RBC membrane skeleton
Term
What is the clincal significance of elliptocytes?
Definition
unknown
Term
How are helmet cells formed?
Definition
produced by impalement on a fibrin strand
Term
What is the clincal significance of helmet cells?
Definition
associated with microangiopathic hemolytic anemias, heart-valve hemolysis, Heinz-body hemolytic anemia, glomerulonephritis, and cavernous hemangiomas
Term
How are schistocytes formed?
Definition
caused by mechanical damage, fibrin formation RBC gets hung up on fibrin and releases fragments,
Term
What is the clincal signifance of schitocytes?
Definition
found when blood vessel pathology is present, seen in microangiopathic hemolytic anemias, heart-valve hemolysis, DIC, severe burns and uremia
Term
How are sphereocytes formed?
Definition
decrease in surface to volume ratio
Term
What is the clincal significance of spherocytes?
Definition
increased osmotic fragility and increased autohemolysis. Decreased life span because they are removed by spleen. Seen in hereditary spherocytosis, immune hemolytic anemias, sever burns, ABO incompatability, Heinz body hemolytic anemias
Term
How are stomatocytes formed?
Definition
increase in lipid content or area of the inner leaflet
Term
What is the clincal signifance of stomatocytes?
Definition
seen in hereditary stomatocytosis or sphereocytosis, alcoholic cirrhosis, anemia associated with rH null disease, lead intoxication, and neoplasms
Term
MCV > 100 fl =
Definition
Macrocytosis
Term
MCV < 80 fl =
Definition
microcytosis
Term
RDW > 14.5 =
Definition
anisocytosis
Term
Clincal significance of basophilic stippling
Definition
lead poisoning, anemia associated with abnormal hb synthesis, thalassemia
Term
Clincal significance of cabot rings
Definition
severe anemias and dyserythropoiesis
Term
Clincal significane of Howel-Jolly Bodies
Definition
associated with nuclear maturation abnormalities, seen in post-splenectomy, megaloblastic anemias, some hemolytic anemias, function asplenia and severe anemias
Term
Clincal significance of pappenheimer bodies
Definition
sideroblastic anemias, thalassemias, and severe anemias
Term
Stain for pappenheimer bodies
Definition
Needs Romanowsky stain (stains protein matrix) and perl’s Prussian blue stain (stains iron)
Term
Clincal significance of Heinz bodies
Definition
G6PD deficiency, unstable hemoglobin disorders, oxidizing drugs or toxins, and post-splenectomy
Term
stain for heinz bodies
Definition
Does not stain with Romanowsky stain, appears with supravital stain
Term
Agglutinations
Definition
irregular clustering of RBCs, can be prevented by keep blood at 37°C
Term
Rouleaux
Definition
alignment of RBCS in stacks- caused by letting blood stand in tubes for too long, also associated with increase in fibrinogen and globulins
Term
How is a morphological classification made?
Definition
classified by RBC average size and hemoglobin concentration via use of RBC indices
Term
Morphological classification categories?
Definition
macrocytic normochromic, normocytic normochromic and microcytic hypochromic
Term
How is functional classification made?
Definition
classified by reticulocyte count, IRF or RPI and serum iron
Term
Functional classification categories?
Definition
proliferative defects- decrease in maturation of RBCS and decreased release rates of RBCs in response to anemia
Maturation defect- disruption of orderly process of nuclear development or cytoplasmic development
Survival defect- loss of circulating RBCs
Term
Koilonychia
Definition
IDA
Term
Smooth Tongue
Definition
Megaloblastic anemia
Term
Jaundice
Definition
Hemolytic anemia
Term
Bone deformaties
Definition
herediatry hemoglobinopathies
Term
neurologica dysfunction
Definition
pernicious anemia
Term
microcytosis
Definition
defective hemoglobin formation
Term
macrocytosis
Definition
impaired DNA synthesis
Term
characteristic findings in proliferative defect
Definition
normochromic normocytic RBCs
decreased retic count
decreased immature retic fration
RPI < 2
Bm is hypocellular with normal or increased iron stores
normal or decreased bilirubin
Term
characteristic findings in maturation defects (nuclear development)
Definition
macrocytic RBCs
increased BM production of RBCs
decreased absolute retic, IRF
RPI < 2
pancytopenia
megaloblastic maturation
Term
characteristic findings in maturation defects (cytoplasmic development)
Definition
microcytic RBCs
BM production increased of RBC
decreased absolute retic and IRF
RPI < 2
seen only in RBCs
Term
characteristic findings of survival defects
Definition
increased absolute retic
RPI > 2
polychromatophilic macrocytes
schistocytes
spherocytes
increased serum bilirubin
decreased haptoglobin
blood in urine and stool