Condensed Case

cells were artifactual. What are the potential causes for artifactually induced burr cells?


Burr cells can be artifactual if (1) the blood smears that are made are forced to air dry through repeated shaking or (2) the buffer used in staining is not at the proper pH.

Summary Points

• Red cell production is under the control of erythropoietin (EPO), a hormone released from the kidney

• The main sites of adult erythropoiesis are the sternum and iliac crest.

• Each pronormoblast produces 16 mature red cells.

• As they mature, red cells decrease in size, become less basophilic in their cytoplasm, develop the orange tinge of hemoglobin, and lose their nucleus.

Another name for an orthochromic normoblast is a nucleated red blood cell (nRBC). The red cell membrane is a trilaminar structure containing glycolipids, glycoproteins, cholesterol, and proteins that anchor the cell and provide deforma-bility such as spectrin and ankyrin. Integral proteins start from the cytoskeleton and expand through the entire red cell membrane.

• Peripheral proteins are confined to the red cell cytoskeleton.

• Sodium and potassium migrate from the plasma across the red cell membranes in an organized fashion controlled by cationic pumps.

• Deformability and elasticity are crucial properties of the red cell membrane, which must be able to extend is surface area up to 117% to accommodate its passage through arterioles and capillary space.

• The Embden-Meyerhof pathway provides 90% of cellular ATP necessary for anaerobic red cell metabolism.

• Microcytes and macrocytes represent size changes in the red cells determined by abnormal pathologies

• Microcytes are seen in iron deficiency anemia, tha-lassemic conditions, iron loading processes, and, in some individuals, with the anemia of inflammation.

• Macrocytes are associated with megaloblastic processes, liver disease, and high reticulocyte counts.

• Polychromasia is the peripheral cell response to accelerated erythropoiesis.

• Hypochromia is a color variation in the red cell determined by lack of hemoglobin synthesis.

• Sickle cells are observed when hemoglobin S is part of the hemoglobin component; there are two types

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