7/23/2019 RBC Studies Midterm

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RBC series of maturation1. Rubriblast

! also known as normoblast, pronormoblast! makes up 5 to 10% of the total nucleated red cell in bone

marrow! youngest form of RBCs

! cytoplasm

deeply basophilicand relatively of smallamout

! nucleus

relatively large, round or slightly oval with1-2 nucleoli

! nucleus to cytoplasm ratio

8:1

2. Prorubricyte! also known as basophilic normoblast

! cytoplasm

intensely basophilic and relatively smallamount

! nucleus relatively large, round and slightly oval

centrally located if there's a presence of nucleoli they are

not visible! nucleus to cytoplasm ratio

6:1

3. Rubricyte! also known as polychromatophilic normoblast

! cytoplasm

gray-blue to pink in color

shows a wide range of colors because ofthe start in hemoglobin formation

! nucleus

still round, nucleoli in absent! nucleus to cytoplasm ratio

4:1

4. Metarubricyte! also known as acidophilic normoblast, orthochromic

normoblast! fully hemoglobinated red cell that comprises 50% of the

total nucleated RBC in the bone marrow.! Last to contain nucleus

! cytoplasm pink to orange in color (similar to adult red

cell.! nucleus

having a pyknotic nucleus, relatively small! nucleus to cytoplasm ratio

1:2

5. Reticulocyte! also known as retics, polychromatophilic erythrocyte! you will observed basophilic fine reticulum of RNA in the

cytoplasm! this is demonstrated by the supravital stain.

! nucleus

none! cytoplasm

pink to reddish brown" fibro" Wright stain most commonly used stain in Hematology

" Methylene alcohol as FIXATIVE; w/o will washed

away" Methylene blue used to stain NUCLEUS (acidic)" Eosin" Phosphate Buffer saline

" Supravital stain stains the living cells" New Methylene Blue" Brilliant Cresyl Blue

6. Erythrocyte! Aka mature RBC

! size

8.2 m (or cubic micra)! thickness

biconcave disc shape (0.8-2.8u3)! life span

120 days

*transfused RBCs 120days lifespan

! for every 100 rbc there is approximately 3-8platelets found

! for every 1000 rbc there is one WBC! Normal Value

Female: 4.5 5.5Million

/ mm3

Male: 5.5 6.5Million

/ mm3

increase level of testosterone (MALE)

Objectives used:" HPO WBC; factor 2,000" OIO Platelets; 20, 0000

Hirisutism excessive hairs (FEMALE)! Cytoplasm

biconcave disc shape with orange to pinkcolor that is pale staining at the venterthat occupies 1/3 of cell size of rbc area.

! RBCis compose of protein lipid stroma thatcontains Hb in solution and condense in lipid richperipheral cell membrane." >!Hypochromia

" < !Hyperchromia" Normal Value:

" 0.5 1.5% found in circulation" 98.5 99.5% found in bone

marrow

Requirements for the maturation of RBC1. There must be adequate amount of hematopoeitic factor2. There must be an adequate supply of Fe in usuable form.3. There must be an adequate amount of protoporphyrin(Protoporphyrin 94. There must be an adequate supply of globin (Protein)

Statistical factor that could affect the RBC count1) Posture

r there is a decrease around 5.7% of hemoglobin andhematocrit level in the recumbent position.

2) Exercise/emotion/excitedr may increase the RBC count.

3) Dehydrationr may also attribute to increase the RBC count

4) Ager the younger the patient the higher the value of hemoglobin,

hematocrit5) Gender

r Male: may increase RBC count6) Altitude

r High altitude

# decrease of oxygen, the BM will produce moreRbc to compensate the decrease of oxygen.

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RBC anomalies

I. Anisocytosis variation in sizea) Normocyte

# normal RBC size: 6.2-8.2 umb) Microcyte

# less than 6.2um small rbcc) Macrocyte

# large RBC, greater than 9umd) Megalocyte

# giant rbc seen in megalocytic anemia due todeficiency of vitamin B12 (cyanocobalamin)orfolic acid.

# Size: from 12-21um

II. Poikilocytosis variation shape of RBCa) Acanthocytes

# Also known as Thorn cell, spur cell# Round rbc with around 5-10irreversible thorn like

projection

# Indicative of permanent cell damage# Found in patient with abetalipoproteinemia

" Abetalipoproteinemia" absence of Low Density Lipoprotein;" if NOLDL will cause permanent cell damage because

LDL is responsible for the distribution of cholesterol

b) Burr cell

# RBC with reversible thorn-like projectionandis some what elongated.

c) Crenated RBC

# Also known as echinocyte

# RBC with short blunt spicules found all over thecell.

# Finely serrated RBC# No clinical significance, this condition only occurs

in RBC that has been placed underhypertonic NaCl solution$> 0.9 %

" Normal Saline Solution (0.85 0.9% NaCl solution)

d) Elliptocytes

# Elliptical shape of rbc (also called ovalocytes)# Found in Pernicious Anemia

%Hypersegmented neutrophil* > 5 lobules

e) Blister cell

# RBC with thin peripheralcell membrane.# Found in microangiopathic hemolytic anemia

f) Helmet cell

# (triangle cell, keratocyte of bessis /contracted RBC)

# Results after the blistered or ruptured blister cell

that would become a helmet/triangle cell.

g) Sickle cell

# (drepanocyte, meniscocyte)# C shape, crescent shape, sickled RBC# Occurs in the presence of Hb S and found in

sickle cell anemia

# Refers also as resistant cell, irreversible reaction

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h) Spherocyte

# Small, round, darkly staining rbc found inhereditary spherocytosis and some hemolyticanemia.

# Fragile cell# Erythrocyte Osmotic Fragility Test (EOFT)

"Useful in identifying fragile cell and resistantcell

"If spherocyte or sickle cell identification."Use different concentration of hypotonic NaCl

solution. (0.5 % NaCl 50-85)

i) Schistocyte

# Fragmenting or disintegrating RBCfound inhemolytic anemia, patient with severe burns andwho suffers in DIC (Diffuse IntravascularCoagulation syndrome)

j) Stomatocyte

# Mouth cell# RBC with mouth-like clear central area found in

hereditary stomatocytosis, alcoholism and liverdiseases.

k) Stellar cell

# (Astrocyte)# Star-like RBCfound in some anemias

l) Tear drop RBC

# Dacrocytes, pear-shaped# Found in thalassemia

m) Racket cell

# Similar to tear drop except that it has a longer taiforming like a racket handle

n) Pyknotic cell (pyknocyte)

# Irregular contracted distorted rbc# Found among infants less that 3 months old.

o) Target cell

# RBC with peripheral and central condensation ofHb. With clear zone in between.

# Found in thalassemia.

III. Anisochromasia variation in color of RBCa) Normochromic/ normochromasia

# Normal hb content of RBC

b) Hypochromic/ hypochromasia# Decrease of hb content and normally RBCs are

with pale central areac) Hyperchromic/ hyperchromasia

# Increase hb content due to a thick cell wall.d) Polychromic/ polychromasia

# RBC with uneven distribution of Hb so the RBCstains unevenly

e) Anulocyte

# (pessary cells, ghost cell)# RBC with thin rim of hb with clear central area

seen in Fe deficiency anemia% Lacks Intrinsic Factor (IF)% Absorption site of Fe Duodenum% Absorption site of Folate Jejunum% Absorption site of Vitamin B12 Ileum

f) Target cell

# May categorized as poikilocytosis

Dont let anyone look down on you because you are young, butset an example for the believers in speech, in life, in love, in faith

and in purity.

1 Timothy 4:12