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Questions :
• What is
unusual
about
some of
these red
cells?
• What are
the
unusual
cells
called?
Answers :
• cells are
fragment
ed
• burr
cells,
helmet
cells,
triangle
cells
Bone marrow
aspirate
Questions :
• How is
an
aspirate
obtained?
• What are
the cells
with
nuclei?
Answer :
• Aspirates
are
obtained
through a
needle
positione
d usually
into the
posterior
iliac crest
(pelvis)
or
sternum
(obviousl
y more
risky).
• The cells
with
nuclei are
progenito
r cells of
the blood
which
divide
and
differenti
ate in the
bone
marrow.
Note the
nucleate
red blood
cell.
Red blood cells contain haemoglobin which is an oxygen-carrying molecule. The red cells travel through the lungs
where the haemoglobin becomes loaded with oxygen and bright red in colour. The red cells are then pumped by the
heart to the rest of the body where the haemoglobin gives up its oxygen to the tissues and becomes dark blue in the
process. 'Anaemia' means that the amount of red cells, and therefore of haemoglobin, in the blood is abnormally low.
This causes the oxygen-carrying capacity of blood to be reduced.
Anaemia may be caused by excessive loss of blood, by destruction of red cells or by decreased red cell production.
Only the first two of these causes will be discussed here (see separate factsheet for anaemia caused by decreased red
blood cell production). Excessive loss of blood may be sudden:
• Accidents
• Childbirth
• Surgery
• A ruptured blood vessel
Excessive blood loss may also occur over a long period of time (chronic bleeding):
• Heavy menstruation
• Bleeding cancer or polyps (benign growths) in the gut
• Bleeding gastric or duodenal ulcers
• Nosebleeds
• Bleeding haemorrhoids (piles)
Increased destruction of red blood cells occurs in hereditary conditions in which either the haemoglobin molecules or
the red cells themselves are abnormal:
These hereditary conditions are fairly common throughout the world but different types are more common in different
races.
Increased destruction of red blood cells also occurs in conditions in which the immune system produces antibodies
(molecules normally produced to kill bacteria and viruses) that bind to and destroy red cells. This is called 'autoimmune
haemolytic anaemia' and many people with this type of anaemia have an underlying condition such as an infection,
primary autoimmune disease or leukaemia. Any condition in which the spleen is enlarged also causes destruction of red
cells.
The symptoms will depend on the severity of the anaemia. Pallor (a pale complexion) is a poor indication of the degree
of anaemia. If the excessive bleeding is chronic, such as from a stomach ulcer or heavy periods, there may be no
symptoms at all or there may be:
• Tiredness
• Faintness
• Dizziness (especially when standing)
If the blood loss is more severe or more rapid (as in an accident) there may be:
• Thirst
• Sweating
• Severe fatigue
• Breathlessness
• Chest pain
• Heart attack
• Stroke (due to lack of oxygen to the brain)
In people who have increased red cell destruction, the breakdown products of haemoglobin may cause jaundice (a
yellow colouring of the skin and eyes).
Anaemia is identified and defined by simple blood tests measuring the number of red blood cells and the amount of
haemoglobin in the blood. Once somebody is found to be anaemic, there is a wide range of other tests which may be
needed to find out the cause.
In the case of sudden bleeding, the diagnosis is often obvious from the circumstances. If the bleeding is chronic, then
investigations will be performed to find the site of the bleeding. This may include a careful menstrual history and
examination of the stools and urine for blood. Subsequent examination of the intestines (for ulcers, polyps or cancers)
or of the kidneys and bladder (for polyps or cancers) may be necessary.
In the hereditary disorders, the diagnosis is often clear from the history of the complaint and the family background.
Often 'electrophoresis' is performed. This is a blood test that detects the presence of abnormal haemoglobin. Sometimes
a more detailed genetic analysis is necessary.
Autoimmune haemolytic anaemia is diagnosed by the presence of antibodies in the blood that bind to red cells. Further
investigation for an underlying condition will also be undertaken.
The most important thing is to avoid any situations that may provoke anaemia. If the anaemia is
due to bleeding, this is often a difficult thing to predict but if you have any of the symptoms, you
should see your doctor. If you have any of the hereditary anaemias or autoimmune haemolytic
anaemia, avoid the triggers. These vary depending on the condition and should be discussed with
your doctor.
Medicines
The treatment of anaemia due to excessive bleeding depends on the severity of the blood loss and the degree of
anaemia. The best treatment for rapid blood loss or severe anaemia is blood transfusion, an oxygen mask and treating
the source of the bleeding. Iron supplements are also taken because iron, which is needed to make haemoglobin, is lost
during bleeding. If the bleeding is slow and the anaemia mild, simply treating the cause of the bleeding (with or without
the addition of iron supplements) may be enough.
Surgery
If the underlying cause of excessive bleeding is amenable to a surgical procedure, such as repair of a ruptured blood
vessel, this may be performed. In some of the hereditary anaemias, the spleen (an organ situated in the upper left part of
the abdomen) may be removed if it becomes excessively large. This is because the spleen 'collects' and breaks down red
blood cells: a larger spleen can take up more red cells, making the anaemia worse.
The outcome of anaemia depends entirely on its cause. However, uncomplicated anaemia due to excessive bleeding,
from a duodenal ulcer for example, is usually treated successfully. The hereditary disorders will be managed by a team
of specialists who will be able to advise you on appropriate therapies and outcome at each stage of the disease.
Have you found the information in this factsheet helpful? Do take a couple of moments to give us your
feedback.
We use expert sources of medical information to research all our health information and it is checked and approved
by medical professionals.
AA/MDS Glossary Home The Clean Diet Nutrition & Immunity Immune Recovery
Programs
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Foundation
AA & MDS Glossary
BAND CELL
Noun: also a band, a stab, a stab cell, a band form. See stab cell for
definition and pictures.
BASOPHIL
Noun: One of the three granular white blood cells. It produces a
product which prevents the blood from clotting.
This is an actual picture of a Basophil (in the centre) surrounded by
some red blood cells. The basophil is named after a basic dye that stains
it.
Greek básis = basic (from the basic dye that stains it)
Greek phîlos = lover
B CELL
Noun: An abbreviation for B Lymphocyte .
BIOPSY
Noun: The surgical removal of tissue from a living body for examination
and diagnosis. Also the medical examination of this tissue.
Greek bios = life
Greek ópsis = a viewing
BLAST
Noun: An immature cell.
Greek blastós = germ sprout
BLOOD
Noun: Blood is essential for life. Blood carries oxygen, nutrients,
hormones and chemicals to each of the sixty billion cells throughout the
body. It plays an essential part in protecting the body from infection.
Blood also helps the body remove waste and toxins. There are close to 30
trillion blood cells in an adult. Each cubic millimetre of blood contains
from 4 1/2 to 5 1/2 million red blood cells and an average total of 7,500
white blood cells.
All types of blood cells are produced by the bone marrow . The bone
marrow is the soft, spongy tissue found in the centre of the large bones
in the body. There are four main components of blood: red blood cells,
white blood cells, platelets, and liquid plasma . Since red and white
blood cells are continually being destroyed, they body must continue to
produce new ones in the bone marrow. About 2 1/2 million new red
blood cells are created every second.
BLOOD TEST
Noun: An action where one or more samples of blood are taken in order
to determine blood levels, illness, tissue type, blood type or
abnormalities.
The test result will have a number of abbreviations on it. I will outline
them here so you can understand what they are about. Percentages and
numbers are measured on the white blood cells so that by multiplying
the percentage by the total count we have an actual number of each type
of cell.
WBC This measures the number of white blood cells in a very small
quantity of blood (a billionth of a litre). It's the White Blood Cell Count
NE is the neutrophil count or percentage. 5060% is normal. Numbers
for these and the following measurements differ for men, women and
children. Those average figures can be found in booklets given to you by
the support group.
LY is the lymphocyte count or percentage. 2040% is normal
MO is the monocyte count or percentage. 29% is normal
EO is the eosinophil count or percentage. 1 4% is normal
BA is the basophil count or percentage. 0.5 2% is normal
RBC is the red blood count.
HGB is the haemoglobin count. It is considered a considerable
anaemia when the haemoglobin drops below 10 for an adult.
HCT is the haematocrit percentage of red blood cells in the sample.
MCV is the mean (average) corpuscular volume. This measures the
average volume of red blood cells. Normal is 84 to 99 fl (a femtolitre is a
quadrillionth of a litre). Don't ask me how they can measure anything so
small!
MCH is the mean corpuscular haemoglobin which is a measurement
of the amount of haemoglobin in an average cell. Normal is 26 to 32 pg
(a picogram is a trillionth of a gram).
MCHC is the mean corpuscular haemoglobin concentration which is a
measurement of the average concentration of haemoglobin in red blood
cells.
RDW is the red blood cell distribution width.
RET is the reticulocyte number or percentage. Don't want too many
immature red blood cells.
PLT is the platelet count. A count below 50 can result in spontaneous
bleeding, and below 5, patients are at risk of severe lifethreatening
haemorrhaging .
MPV is the mean (average) platelet volume which is a measurement of
the average volume of platelets in the sample.
B LYMPHOCYTE
Noun: The B cell. It is a type of lymphocyte that has matured in the bone
marrow and mainly deals with bacteria and viruses that have been
encountered before. Unlike Tcells , they do not circulate in the blood.
Their home is in the Lymphatic System . When an invader is present, T
cells or macrophages present the invaders antigen to the B lymphocyte
cell and it takes the invader into the tissues where it determines its exact
size and shape. It then makes an exactly fitting straitjacket called an
antibody that will fit that intruder and no other. Then it gets a
production line going to produce thousands more of these antibodies.
These move through the body and attach themselves to the micro
organisms which make them harmless and held until the macrophages
or neutrophils come along to devour them. Bcells work with Tcells,
macrophages and neutrophils to destroy harmful substances which have
entered the body. Bcells can memorise the invader's antigen and
become a long lived memory Bcell. This results in a quicker response to
an infection. Each memory Bcell is specific to one particular antigen.
English B = bone +
Latin lympha = clear water +
Greek kytos = anything hollow.
BMT
Abbreviation: Bone Marrow Transplant
BONE MARROW
Noun: The growth and development of normal cells are carefully
controlled in the bone marrow to produce the correct numbers of each
type of blood cell to keep the body healthy. Although, there are many
different types of blood cells, all cells made in the bone marrow start as
a single kind of cell called a stem cell . Stem cells make up only a very
small proportion of the cells in the bone marrow.
This is a picture of normal bone marrow at medium magnification.
About one half of the marrow is filled with red blood cells, white blood
cells, platelets,and the cells which produce them. The large white cells
are fat cells called steatocytes .
The bone marrow stores stem cells until the body needs a specific type
of mature blood cell. Then, by using the stem cells in reserve, the bone
marrow can rapidly produce many red cells, white cells or platelets. As
stem cells mature, their features become more and more distinct until
the stem cells develop into a specific type of blood cell. See
Haematopoiesis for a picture of the process.
BONE MARROW BIOPSY
The main bone marrow finding which defines aplastic anaemia is that
the few blood producing cells which are present, appear normal. The
cells in aplastic anaemia do not show chromosome abnormalities.
In myelodysplasia or myelofibrosis , the numbers of blood producing
cells are considerably reduced. The cells which are present in the bone
marrow in these diseases are very abnormal under the microscope.
These are some red blood cells from a patient with Myelodysplasia.
They are larger than normal and very irregular.
BONE MARROW TRANSPLANT
Verb: A procedure used to treat Aplastic Anaemia , Myelodysplasia ,
Acute Leukaemia and some rare birth disorders with varying success.
Healthy bone marrow is taken from the donor and infused into the
bloodstream of the recipient: from here, it 'homes' in on the bone
marrow, where it will grow. There is only a one in four chance that a full
brother or sister will be a match.
Bone marrow transplantation is a risky procedure but success rates as
high as 80% have been reported when the donor is a closely matched
brother or sister. See graftversushost disease for a full appraisal of the
risks.
The other major risk is that the immunosuppressant drugs used to
control GVHD make the patient more susceptible to infections.
Patients with aplastic anaemia should be transplanted without the use
of irradiation. Rejection of the graft is prevented by using a drug called
cyclophosphamide often together with antibodies including
antilymphocyte globulin which immunosuppress the recipient. The risk
of graft failure, that is rejection of the bone marrow transplant, is greater
for patients with aplastic anaemia than for patients with leukaemia .
There are some clear recommendations for treatment choices. Children,
adolescents and young adults with brothers or sisters who are matched
donors should be transplanted. Patients who have no brothers or sisters
who are able to donate should be treated with immunosuppressive
drugs. High risk patients, who have very low neutrophil counts, should
receive intensive supportive treatment of blood and platelets prior to
treatment.
For older patients who have brothers or sisters who are able to donate
their bone marrow, the opinion is more divided. Some specialists
recommend transplantation for any patient below the age of 50 years. In
Europe, I am told they only will recommend it for patients below the
age of 40 years. Other experts have recommended an initial trial of
immunosuppressive drugs followed by a bone marrow transplant if the
immunosuppressive drugs fail to work or if myelodysplasia or
leukaemia later develop. Patients who fall into this group should
discuss the choices carefully with their specialist before arriving at a
decision on treatment.
Any patient diagnosed with severe aplastic anaemia or myelodysplasia
should have rapid HLA tissue typing performed to identify possible
marrow donors. Blood transfusions from prospective marrow donors
should be avoided.
I have found a 45 minute movie on bone marrow transplants. It p
articularly deals with Haplo transplants .
This page will give you a brief guide to Sickle Cell Disorders and provide links to more detailed
information for different groups of users
Contents
The disorder affects the red blood cells which contain a special protein called
haemoglobin (Hb for short). The function of haemoglobin is to carry oxygen from
the lungs to all parts of the body.
People with Sickle Cell Anaemia have Sickle haemoglobin (HbS) which is different from the
normal haemoglobin (HbA). When sickle haemoglobin gives up its oxygen to the tissues, it
sticks together to form long rods inside the red blood cells making these cells rigid and sickle-
shaped. Normal red blood cells can bend and flex easily.
Because of their shape, sickled red blood cells can't squeeze through small blood vessels as
easily as the almost donut-shaped normal cells. This can lead to these small blood vessels
getting blocked which then stops the oxygen from getting through to where it is needed. This
in turn can lead to severe pain and damage to organs.
Everyone has two copies of the gene for haemoglobin; one from their mother and one from
their father. If one of these genes carries the instructions to make sickle haemoglobin (HbS)
and the other carries the instructions to make normal haemoglobin (HbA) then the person has
Sickle Cell Trait and is a carrier of the sickle haemoglobin gene. This means that this person
has enough normal haemoglobin in their red blood cells to keep the cells flexible and they
don't have the symptoms of the sickle cell disorders. They do however have to be careful
when doing things where there is less oxygen than normal such as scuba diving, activities at
high altitude and under general anaesthetics.
If both copies of the haemoglobin gene carry instructions to make sickle haemoglobin then
this will be the only type of haemoglobin they can make and sickled cells can occur. These
people have Sickle Cell Anaemia and can suffer from anaemia and severe pain. These severe
attacks are known as Crises. Over time Sickle Cell sufferers can experience damage to organs
such as liver, kidney, lungs, heart and spleen. Death can be a result.
Another problem is that red blood cells containing sickle haemoglobin do not live as long as
the normal 120 days and this results in a chronic state of anaemia. In spite of this, a person
with sickle cell disorder can attend school, college and work. People with sickle cell disorder
need regular medical attention particularly before and after operations, dental extraction and
during pregnancy. Many hospitals arrange follow-up appointments and it is advisable to
discuss with the doctors questions concerning schooling, strenuous exercise, family planning,
suitable types of employment and air travel. When a person is found to have a sickle cell
disorder it is important that all members of the family be tested. They will not necessarily
have sickle cell disorder but may be healthy carriers of a sickle cell trait.
Top
There are also other different types of haemoglobin such as HbC and beta thalassaemia, that
can combine with sickle haemoglobin to cause sickling disorders. When someone carries the
gene for beta-thalassaemia they cannot make as much HbA as they should. If this is combined
with the HbS gene then more of their total amount of haemoglobin is HbS and they can suffer
from what is usually a milder form of sickle cell disorder than sickle cell anaemia.
Top
The different kinds of SCD and the different traits are found mainly in people whose families
come from Africa, the Caribbean, the Eastern Mediterranean, Middle East and Asia.* In Britain
SCD is most common in people of African and Caribbean descent (at least 1 in 10-40 have
sickle cell trait and 1 in 60-200 have SCD). It is estimated there are over 6,000 adults and
children with SCD in Britain at present. There are other inherited conditions that mainly affect
other groups, e.g. Cystic Fibrosis in Europeans, and Tay-Sachs disease in Jewish people.
Top
A special blood test (haemoglobin electrophoresis) can tell you whether you have a sickle cell
disorder or are a healthy carrier, e.g. for sickle cell trait. Routine screening should take place
for people in the groups listed during pregnancy and before anaesthesia, either at hospital or
dental clinics.
Tests can be arranged by your general practitioner or at our local sickle cell centre. (Contact us
for an up-to-date list of centres in the UK.) After a blood test you may be told that you or your
child is `sickle positive' or has `sickle cell'. It is important to ask whether this means sickle
cell trait or a type of sickle cell disorder.
Top
It is now possible to test the unborn child to detect a haemoglobin disorder from as early as
11 weeks of pregnancy. For more information see the Prenatal Testing page and contact your
local sickle cell centre, local obstetrician, haematologist or general practitioner.
Top
People are often confused and disturbed by some of the incorrect information they have
received about SCD.
Sickle Cell Disorder is a condition which is inherited from both parents. This means that people
are born with it, just as they are born with other characteristics such as eye colour, hair
texture and height.
Top
• Day to day care for children and adults with Sickle Cell Disorders
• Inheritance and Prenatal Testing
• Information for Employees and Employers
• Teaching resources
• Facts for Health Professionals