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clin lab 1
hematology and iron
132
Anatomy
Graduate
06/10/2010

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Cards

Term
What is the study of blood and its related disorders?
Definition

Hematology

 

Term
The average adult has what blood volume?
Definition
4-6 L
Term
What is the composition of the blood?
Definition
55% plasma and 45% cellular elements
Term
Are reference values the same for every person?
Definition
no they vary
Term
What is maturation in bone marrow through metarubricyte that takes 5 days?
Definition
erythropoiesis
Term
How long does it take for reticulocytes to mature in peripheral circulation?
Definition
1-2 days
Term
What does a Rubricyte do?
Definition
begins to synthesize hemoglobin
Term
 Describe a metarubricyte?
Definition

maximum hemoglobin synthesis

has ejected nucleus

gives cell characteristic biconcave shape when mature

Term
At what rate do erythrocytes enter the blood stream?
Definition
2M/sec
Term
Where is erythropoietin produced and why?
Definition
produced by the kidneys in response to tissue hypoxia
Term
Why is the membrane of RBCs highly elastic?
Definition

ease of responding rapidly to applied stresses of fluid forces

capable of undergoing large membrane extensions without fragmentation

permeable 

very pliable

lose or absorb fluid readily

Term
Cholesterol composes what percentage of the RBC membrane lipids?
Definition
25%
Term
Why are increased levels of membrane cholesterol associated with decreased RBC survival and abnormal RBC morphologies such as target cells and acanthocytes?
Definition
membrane cholesterol is continually exchanged with plasma cholesterol and too much damages the cells
Term
What reference values usually remain constant?
Definition
white cells count and platelets
Term
What is the hydrophilic layer of the RBC membrane composed of?
Definition
proteins, glycolipids, glycoproteins
Term
What does the hydrophobic central layer contain?
Definition
cholesterol, phospholipids, and proteins
Term
What percentage of the RBC membrane is composed of cholesterol?
Definition
25%
Term
THe inner hydrophilic layer is composed of what type of network?
Definition
cytoskeleton network of proteins
Term
What is spectrin and what does it form?
Definition

binds with other membrane proteins to form a skeletal network of microfilaments.

-controls biconcave shape

-controls pliability

- provides stability to lipid bilayer

Term
What percent of the blood formed elements is made up but RBCs?
Definition
98%
Term
What is the function of RBC?
Definition
delivering oxygen from the lungs to body tissues via the blood
Term
What is the major metabolic pathway for RBC?
Definition
glycolysis
Term
What purpose does the hexose monophosphate shunt serve?
Definition
NADPH prevents RBC from becoming denatured
Term
What purpose does methemoglobin reductase pathway serve?
Definition
keeps RBC in 2+ state
Term
What purpose does the Luebering-rapaport pathway serve?
Definition
produces 23 DPG helps prevent oxidation
Term
What is the life span of a RBC?
Definition
120 days
Term
What removes RBC and which organ is primarily responsible (extravascularly)?
Definition
macrophages and the spleen
Term
How many tests compose the CBC?
Definition

9

WBC, HgB, MCV, MCHC, PLT, RBC, Hct, MCH, RDW, retic

Term
What is the function of the RBC count?
Definition

provides a cell count of the number of red blood cells present in a specimen

-also serves as indirect estimate of the hemoglobin contents of the blood

Term
How is the RBC count reported?
Definition
RBCs/uL
Term
What is the function of the WBC count?
Definition
provides a count of the number of white blood cells present in the specimen
Term
An abnormal WBC count can indicate?
Definition
immune or inflammatory condition but can have infection or immune response without an elevated count
Term
What is the function of the Platelet count?
Definition
provides a count of the number of platelets present in the specimen
Term
What is the purpose of the Hgb count?
Definition
index of the oxygen carrying capacity of blood
Term
In the Hgb count what does the total blood hemoglobin depend on?
Definition
the number of RBCs and the amount of hemoglobin in each RBC
Term
How is the platelet count recorded?
Definition
plts/uL
Term
How is the Hgb reported?
Definition
Hgb/uL
Term
What does the hematocrit (Hct) test provide?
Definition
the proportion of blood volume that is occupied by RBCs
Term
What is the function of the hematocrit count?
Definition
serves as an indirect estimate of the number of RBCs and is an indirect estimate of the amount of hemoglobin
Term
How is the hematocrit recorded?
Definition
% of blood that is red cell mass
Term
What is the function of the Mean corpuscular volume (MCV)
Definition

average RBC volume

-useful in classifying anemias as normocytic, microcytic, or macrocytic

Term
What is the function of the mean corpuscular hemoglobin (MCH)?
Definition
estimates the average weight (density) of hemoglobin in each RBC
Term
What is the function of the mean corpuscular hemoglobin concentration (MCHC)?
Definition

estimates the concentration of Hgb in each RBC

-provides a ratio of the weight of Hgb to the volume of RBC

Term
How is the MCHC claculated?
Definition
dividing the hemoglobin b the hematocrit value
Term
What is the function of the red cell distribution width (RDW)?
Definition
measure of anisocytosis
Term
What is the function of the reticulocyte count?
Definition
serves as an index of RBC production by the bone marrow
Term
Sickle cell anemia, G6PD deficiency, auto or isoimmune antibody formation, and actute or chronic bleeding are example of what type of disorder?
Definition

reticulocytosis

-elevated reticulocytes

Term
Aplastic anemia, thalassemias, and sideroblastic anemias are examples of?
Definition

reticulocytopenia

-lowered RBC

Term
What does the WBC tell us?
Definition
infection, inflammation, leukemia, myelodysplastic syndromes
Term
What does the RBC/Hgb/Hct tell us?
Definition
anemias
Term
What does the MCV tell us?
Definition
anemias
Term
What does the MCH/MCHC tell us?
Definition
confim anemias
Term
What does the PLT tell us?
Definition
bleeding disorders
Term
What does RDW tell us?
Definition
degree of anisocytosis
Term
What function do iron provide?
Definition

carry O2 to tissues and CO2 to lungs

help with acid/base balance

Term
What form is iron usually present in?
Definition

in RBC in stored form

2/3 present in Hgb

1/3 as stored tissue iron

Term
What percent of iron is stored as ferritin or hemosiderin?
Definition
90%
Term
What is the most common form of iron in the diet?
Definition
ferric ion Fe3+
Term
Is iron readily and easily absorbed?
Definition
no harder to absorb but once absorped very hard to get rid of it when have too much
Term
What state must iron be in to be absorbed?
Definition

ferrous state Fe2+

if in the ferric state it must be reduced before it can be absorbed

Term
Where does iron absorption occur?
Definition
duodenum
Term
What is the transport protein for iron?
Definition
transferrin
Term
Where does iron remain after eaten if not transported and what happens to iron if it isn't transported?
Definition
remains in the intestinal cells and is lost through sloughing if not transported
Term
Where is total iron controlled?
Definition
mucosal level
Term
What state of iron does transferrin transport?
Definition
Fe3+
Term
What type of protein is transferrin and where is it produced?
Definition
beta-globulin produced by the liver
Term
What percent of transferrin binding sites are usually bound with iron?
Definition

1/3

-important bc has binding sites that are readily available to grab iron when needed

Term
What is the most common state of iron?
Definition
ferritin the storage form
Term
Ferritin in the blood serum is in ______ with ferritin stored in reticuloendothelial cells
Definition
equilibrium
Term
After RBC life span over what occurs primarily in the spleen?
Definition
iron liberated and bound to transferrin and recycled for use
Term
Who loses the most iron?
Definition
pregnant women and kids
Term
What are porphyrins?
Definition

metal-free tertapyrroles found in greatest quantity in bone marrow and liver

-serve as intermediates in heme synthesis

Term
How does heme synthesis take place?
Definition
aerobically and mostly in the bone marrow and liver
Term
What type of pathway is heme synthesis?
Definition

one way 

-if deficient in one process the process is halted from there after

Term
Is heme synthesis a negative or positive pathway?
Definition
negative
Term
Synthesis of heme begins and ends where?
Definition
begins in the mitochondria then to the cytosol then back to the mitochondria
Term
What is the final product of heme synthesis?
Definition
protoporphyrin IX
Term
In what stage of heme synthesis is iron added to make heme?
Definition
final step
Term
What are the steps in heme synthesis?
Definition

-glycine + succinyl CoA under the presence of ALA synthase cofactor w/ vitamin B6 in the mitochondria

-moves out to the cytosol

-back to the mitochondria as protoporphyrin IX where Fe2+ added to produce heme

Term
Where do bad things usually occur in the globin chains?
Definition
beta chain
Term
What types of chains are present in Hgb?
Definition
2 alpha and 2 beta
Term
What is normal hemoglobin production dependent on?
Definition

-adequate iron delivery and supply

-adequate synthesis of Protoporphyrin IX

-adequate globin chain synthesis

Term
What is meant by globin chain coordination?
Definition
deficiency of one type results is reduced rate of synthesis of other type
Term
does heme synthesis affect the rate of synthesis of the globin chains?
Definition
yes
Term
What are the function of Hgb?
Definition

-uptake and delivery of O2

-controlling accumulation of hydrogen ions in the RBC

-as Hgb unloads O2 in tissues it binds free H ions generated by dissociation of H2CO3 inside RBC

Term
Where does most RBC catabolism take place?
Definition
extravascular by macrophages in the spleen
Term
What are the organs involved in extracellular catabolism?
Definition
spleen, liver, and bone marrow
Term
What happens during catabolism?
Definition

globin chains broken down and ammino acids are recycled into new protein synthesis

-iron recycled for new hemoglobin synthesis

-protoporphyrin IX biproduct of RBC catabolism

Term
What is the result of intravascular destruction?
Definition
within blood vessels results Hgb release into circulation and free Hgb will be bound by heptoglobin the prevent renal secretion
Term
What happens to metheme exceeding hemopexin levels?
Definition
bound by albumin
Term
The most common recognized case of hypochromic anemia is?
Definition
iron deficiency anemia
Term
What are some causes of iron deficiency anemia?
Definition

inadequate dietary intake of iron

decreased absorption

chronic bleeding

gastrointestinal bleeding

heavy menstration

pregnancy

lactation

chronic hemoglobinuria

Term
What is an iron abnormality?
Definition
iron needs of body aren't met, body sotres of iron are depleted, and anemia of increasing severity develops
Term
What are signs in a RBC slide of iron deficiency?
Definition

less hemoglobin

microcydic

less stained

wider central palor

Term
What are examples of chronic systemic anemia diseases?
Definition

chronic infection or inflammation

cancer

liver disease

renal disease

Term
What do chronic disease states do in chronic anemia?
Definition
block the transfer of storage iron to maturing erythroid precursors within the bone marrow
Term
What are sideroblastic anemias?
Definition
group of disorders which cause defective heme synthesis
Term
What are some causes of sideroblastic anemias?
Definition

sex-linked or autosomal recessive (inherited)-rare

myelodysplasia (RARS)- primary

acquired (secondary)- alcohol abuse, exposure to certain drugs which inhibit vit B6, lead poisoning

Term
What is the abnormality caused by sideroblastic anemia?
Definition

interfering with normal heme synthesis prevents iron's insertion into prophyrin structure with sunsequent accumulation of iron in mitochondria of RBC precursors

 

Term
What is hemochromatosis?
Definition

inherited autosomal recessive disorder causing idiopathic excess intestinal iron absorption not matched by increased excretion

-slow chronic buildup of iron results in accumulation of iron and injury to many orans (liver, kidney, heart, pancreas, testes, adrenals, and pituitary.

Term
What is the abnormality caused by hemochromatosis?
Definition
abnormal increase in iron absorption by GI results in iron storage outside normal RE cell stores
Term
What is transfusion iron overload?
Definition

caused by frequent blood transfusions adding 200-250 mg of iron to the body per transfusion

causes iron overloading 

Term
What is the abnormality caused by hemosiderosis?
Definition
lacking normal physiologic route to excrete excess iron, abnormal iron accumulation occurs
Term
What is characteristic of iron deficiency anemia?
Definition

serum iron- decreased

serum transferrin- increased

serum ferritin- decreased

TIBC- increased

% saturation- decreased

Term
What is characterized by anemia of chronic disease?
Definition

serum iron- decreased

serum transferrin- decreased

serum ferritin- normal to increased

TIBC- decreased

% saturation- decreased

Term
What is characteristic of sideroblastic anemia?
Definition

serum iron- increased

serum transferrin- normal

serum ferritin- increased

TIBC- normal to decreased

% saturation- normal to increased

Term
What is characteristic of hemochromatosis?
Definition

serum iron- increased

serum transferrin- decreased

serum ferritin- increased

TIBC- decreased

% saturation- increased

Term
What is characteristic of hemosiderosis?
Definition

serum iron- increased

serum transferrin- decreased

serum ferritin- increased

TIBC- decreased

% saturation- increased

Term
What is a structural qualitative abnormality?
Definition

quality not there

amino acid sequence of one othe globin chain types is altered as a result of an incorrect DNA code caused b a point mutation

-single nucleotid substitution

Term
What abnormalities create the most clinically significant structural hemoglobinopathies?
Definition
beta chains
Term
Do structural globin chain abnormalities affect the amount of Hgb produced?
Definition
no
Term
What is the cause of structural abnormalities?
Definition
autosomal recessive disorders in B gene results in formation of abnormal beta-globin chains 
Term
What is the result of the structural abnormality?
Definition
HgS, C, or E
Term
In what population is Hgb S most commonly found?
Definition
black population
Term
Which form of sickle cell is trait and disease state?
Definition

SS- disease

AS- trait

Term
What does prolonged sickle cellepisodes cause?
Definition
irreversible membrane damage and removal of cells from circulation by the spleen ( hemolytic anemia)
Term
Sickle cells that are unable to circulate through small capillaries result in?
Definition

blockage 

tissue hypoxia

extreme pain in area of blockage

finally tissue death

Term
What is common in the spleen in Hgb S?
Definition
infarctions of the spleen with necrosis and scarring leading to nonfunctional spleen
Term
What effect does Hgb S have on malaria?
Definition
protection from parasites, particularly those causing malria
Term
What is Hgb C?
Definition
found in west african and american black population 
Term
What population is Hgb E found?
Definition
southeast asian 
Term
What are the test used for testing for Hgb S?
Definition
sickle dex or sickle prep
Term
What are synthesis (quantitative) abnormalities?
Definition
production of one or more of the globin chains is reduced or absent resulting in an imbalance in globin chain production
Term
What does reduced chain synthesis cause?
Definition
hypochromic, and micrcytic anemia
Term
What are alpha-thalassemias?
Definition

autosomal dominant disorder with decreased production of alpha globin chains due to deletion of a globin genes

-autosomal dominant caused by genetic point mutation

Term
What types of alpha-thalassemias are there?
Definition

silent- deletion of one gene

trait- deletion of 2 genes

hemoglobin H disease- deletion of 3 genes

deletion of all 4 genes is incompatible with life

Term
When alpha thalassemias exist what is the percent decrease that occurs as deletions increase?
Definition

1-75%

2-50%

3-75%

4-0%

chain formation decreases together accordingly until reaches 75% then the B chains will try and make up the difference but the difference in hemeglobin affinity makes it inefficient

Term
What are beta thalassemias?
Definition
mutations result in premature chain termination or in problems with transcription of RNA and result in reduced or absent B globin chain synthesis
Term
What types of beta thalassemias exist?
Definition

b-thalassemia minor

(null or plus)

-heterozygous

b-thalassemia major

(null or plus)

-homozygous

Term
How is b-thalassemia tested for?
Definition

Hgb electrophoresis

screening

Kleihauer-Betke test

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