AAB MT Hematology – Flashcards
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What is hemoglobin composed of?
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4 heme, 4 iron, 4 globins
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What disorder does a defect in heme synthesis lead to?
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Porphyria
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Porphyria
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Deficiency in the enzymes of the porphyrin pathway leads to insufficient production of heme. The principal problem in these deficiencies is the accumulation of porphyrins, the heme precursors, which are toxic to tissue in high concentrations.
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What is methemoglobin?
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Methemoglobin is a form of hemoglobin that contains ferric [Fe3+] iron and has a decreased ability to bind oxygen. However, the ferric iron has an increased affinity for bound oxygen. When methemoglobin concentration is elevated in red blood cells, tissue hypoxia can occur.
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What is the function of the enzyme methemoglobin-cytochrome C reductase in a red blood cell?
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To keep iron in the ferrous state
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What product is formed when ferrous iron of hemoglobin is oxidized to the ferric state?
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Methemoglobin
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What is carboxyhemoglobin?
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A stable complex of carbon monoxide and hemoglobin that forms in RBCs when carbon monoxide is inhaled or produced in normal metabolism. Large quantities of it hinder delivery of O2 to the body. Tobacco smoking (through carbon monoxide inhalation) raises the blood levels of COHb by a factor of several times from its normal concentrations.
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Which hemoglobin has a 200 times greater binding capacity for the hemoglobin molecule than oxygen?
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Carboxyhemoglobin
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Which hemoglobin derivative causes irreversible changes in RBCs?
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Sulfhemoglobin -- makes blood incapable of carrying oxygen.
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Which of the following hemoglobins is NOT normally present in a normal adult?
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Hb-S
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Which embryonic hemoglobin is normally found in newborns?
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Hb-F
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What is the most abundant hemoglobin in a newborn?
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Hb-F
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What is the molecular structure of Hemoglobin S?
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Valine replaces glutamic acid in the 6th position of the beta chain
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Which of the following hemoglobins is insoluble under lowered oxygen tension?
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Hb-S
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What laboratory test is used to confirm the specific diagnosis of sickle cell anemia?
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Hemoglobin electrophoresis
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In the solubility test for hemoglobin S, what is the reagent responsible for the reduction of the hemoglobin molecule?
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Sodium dithionite
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In hemoglobin C, what replaces glutamic acid?
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Lysine
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Which red blood cell inclusion is characteristic of hemoglobin C disease?
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Rod-shaped crystals
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What is hemoglobin F composed of?
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2 alpha and 2 gamma chains
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Which hemoglobin is resistant to alkali denaturation?
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Hb-F
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Which hemoglobins are differentiated by the Kleihauer-Betke technique?
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Hb-A1 from Hb-F
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What is the order of migration of hemoglobins, from fastest to slowest, on cellulose acetate at pH 8.4?
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A1, F, S, C
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Why is citrate agar used when abnormal hemoglobins are identified on cellulose acetate at pH 8.6?
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It separates hemoglobin S from hemoglobin D
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The cyanmethemoglobin method measures all hemoglobin pigments EXCEPT which one?
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Sulfhemoglobin
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What is the diluent used in the cyanmethemoglobin method for the determination of hemoglobin?
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Drabkin's solution
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What is the normal plasma hemoglobin concentration?
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2-3 mg/dL
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Which plasma protein binds free hemoglobin?
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Haptoglobin
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Which one of the following statements concerning hemolytic anemia is false?
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The serum haptoglobin is increased
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In this type of anemia RBCs are normocytic and normochromic. RBCs, hemoglobin, and hematocrit are decreased and the indirect bilirubin is increased.
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Hemolytic anemia
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Myoglobin can be separated from hemoglobin by saturating the specimen with which one of the following reagents?
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Ammonium sulfite
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The hematocrit is also known as which one of the following terms?
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Packed red blood cell volume
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The degree of packing of cells during centrifugation depends on all of the following EXCEPT which one?
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Bore size of the microhematocrit tube
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The degree of packing of cells during centrifugation depends on all of the following:
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Speed of the centrifugation, radius of centrifugation, and time of centrifugation.
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During examination of a spun hematocrit, in which layer are the white blood cells found?
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Buffy coat
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When performing a microhematocrit, where should one read the percentage of packed red blood cell column from a microhematocrit reading device?
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Below the buffy coat
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An increase in the erythrocyte sedimentation rate can be the result of an increase in the quantity of which of the following?
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Fibrinogen
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Which test is increased in acute infections?
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Osmotic fragility
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All of the following sources of error will falsely elevate the ESR EXCEPT which one?
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Polycythemia
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All of the following sources of error will falsely elevate the ESR?
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Tilted tube, macrocytes, and vibrations from a nearby centrifuge.
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What is the Westergren ESR reference range for males?
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0-15 mm/hr
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A cerebrospinal fluid has 285 RBCs counted in the 5 RBC squares after being diluted in a Unopette (1:100). What is the calculated RBC count per microliter?
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1,425,000 (285 x 100 x 5)
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Any cell that passes through the aperture will momentarily increase the resistance of the electrical flow between the electrodes, generating a pulse. This is the basic principle of which of the following?
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Electrical impedance
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Which principle utilizes laminar flow and hydrodynamic focusing to characterize cells based on granularity and reflectivity?
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Laser light scatter
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Scatterplots are created using all of the following EXCEPT which one?
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Fluorescence
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Scatterplots are created using all of the following:
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Scatter, volume, and conductivity
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Both nucleated RBCs and large platelents interfere with which one of the following parameters?
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WBC
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Lyse-resistant RBCs detected by automated hematology analyzers are seen in which clinical condition?
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Sickle cell anemia
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On automated hematology analyzers, which one of the following will affect both the RBC count and the PLT count?
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Schistocytes
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The WBC count is 10.5. There are 5 nRBCs seen on the 100 cell differential. What is the corrected WBC count?
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10
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On automated hematology analyzers, hemoglobin determinations may be falsely elevated due to the presence of which one of the following interfering substances?
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Lipemia
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The following CBC results are obtained: WBC 6.5 MCV 135.0 RBC 1.69 MCH 53.8 HGB 9.1 MCHC 39.9 HCT 22.8 What is the most likely cause of these results?
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Cold agglutinin
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All of the following may cause a falsely decreased platelet count EXCEPT which one?
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Schistocytes
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All of the following may cause a falsely decreased platelet count...
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Giant platelets, platelet clumps, and platelet satellitosis.
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A leukocyte count greater than the linearity of the automated analyzer will falsely elevate which other CBC parameter?
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HGB
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Fragile WBCs seen in leukemia patients may cause pseudoleukopenia, which in turn may cause automated WBC and WBC estimate not to match. What action should be taken if this occurs?
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Prepare a manual WBC hemacytometer count
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What is the dilution factor for performing a platelet count from a sodium citrate tube?
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1.1
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What is the formula for correcting a WBC count for the presence of nucleated RBCs?
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(WBC X 100)/(nRBC + 100)
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Smudge cells can cause the automated WBC and the WBC estimate not to match. What action can be taken to prevent this occurrence?
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Add 22% bovine albumin to stabilize the WBC
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If cryoglobulin causes WBC cellular interference, then what is the most appropriate action to take to resolve this interfering substance?
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Incubate the specimen at 37 degrees C for 15 minutes
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If a cold agglutinin is suspected to be causing erroneous results, then what is the most appropriate action to be taken before reporting results?
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Incubate the specimen at 37 degrees C for 15 minutes
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After centrifuging a microhematocrit, the presence of lipemia is noted. What is the most appropriate corrective action?
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Perform a saline replacement procedure
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Which one of the following can produce a normal MCV but hypochromic RBCs to appear on the peripheral blood smear?
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Hyperglycemia
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If a WBC count is performed on a 1:100 dilution and the number of cells counted in a total of 8 squares is 50, then what is the WBC count?
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6,250 (50/8 = 6.25 x 100 = 6,250)
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A blood smear shows 80 nucleated RBCs per 100 leukocytes. The total leukocyte count is 18.0 x 10^9/L. What is the corrected WBC count?
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10.0 (18.0 x 100/100 + 80)
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Which reagent is the fixative incorporated in the Wright's stain?
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Methanol
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How can the color of the Wright-stained RBCs be adjusted?
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Adjusting the pH of the buffer
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Malarial parasites in RBCs are best demonstrated by which stain
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Geimsa
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Which if the following RBC inclusions is NOT visible with Wright stain?
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Heinz bodies
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Which one of the following is a stain for iron?
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Prussian blue
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In which special cytochemical stain are homogeneously pink cells counted as positive?
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Kleihauer-Betke stain
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Which one of the following stains both specific and nonspecific granules in myelogenous cells?
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Prussian blue stain
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In the cytochemical stain for peroxidase, which cell stains negative?
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Lymphocytes
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The results on a leukemic patient are as follows: alpha-naphthol-As-D-acetate esterase (NASDA) 3+ NASDA with sodium fluoride (NaF) 1+ These results are suggestive of which type of leukemia?
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AMML
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In which leukemia are the blasts periodic acid-Schiff (PAS) stain positive?
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ALL
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Which of the following is a stain for neutral lipids?
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Oil red O
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Which stain is used to differentiate chronic myelogenous leukemia (CML) from a leukemoid reaction?
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Leukocyte alkaline phosphatase
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What stain is positive for hairy cell leukemia?
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Acid phosphatase
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What is the most reliable criterion for the estimation of a cell's age?
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Nuclear chromatin
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What is the last RBC precursor to retain the nucleus before it becomes an erythrocyte?
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Metarubricyte
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Which peripheral smear finding is consistent with reticulocytosis?
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Polychromatophilia
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What is the life span of an erythrocyte?
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120 days
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ALL of the following are indications of anemia:
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Decreased RBC, decreased HGB, and decreased HCT
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ALL of the following are indications of anemia, EXCEPT which one?
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Decreased PLT
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Which one of the patient's lab results are not consistent with anemia?
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Toddler HGB: 12.5 g/dL
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The following results were obtained from a CBC specimen: WBC 10.3 x 10^9/L MCV 95 fl RBC 4.19 x 10^12/L MCH 33.2 pg HGB 9.9 g/dL MCHC 33.1 % HCT 27.0% What is the most probable cause of these results?
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Anemia
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To calculate the mean corpuscular volume (MCV), what parameters must be known?
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RBC and HCT
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Given the following lab results, what is the calculated MCH? RBC 3.01 x 10^12/L HGB 9.4 g/dL HCT 27.5%
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31.2pg ((HGB/RBC) x 10)
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What is the calculation for MCH?
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MCH = ((HGB/RBC) x 10) Expressed in pg. Denotes HGB content in one cell. Normal 27-33pg.
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What is the calculation for MCV?
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MCV = ((HCT/RBC) x 10) Mean corpuscular volume (MCV) is the average volume of red cells in a specimen.The reference range for MCV is 80-96 fL/red cell in adult.
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What is the calculation for MCHC?
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MCHC = ((HGB/HCT%) x 100) Measure of the concentration of hemoglobin in a given volume of packed red blood cells. Reference ranges are 32 to 36%.
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What is the reference range for the mean corpuscular hemoglobin concentration?
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32%-36%
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Which CBC parameter is a numerical expression of anisocytosis?
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RDW
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What is the abnormal variation in the size of erythrocytes known as?
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Anisocytosis
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Which determination is considered a reliable assessment of effective erythropoiesis in the bone marrow?
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Reticulocyte count
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To calculate the reticulocyte production index, other than the reticulocyte count (%), what other hematological parameter is needed?
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HCT
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What are erythrocytes with a diameter of 9-12 microns referred to as?
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Macrocytes
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What causes the red cell color of immature erythrocytes to appear polychromatophilic?
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Residual RNA
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What is abnormal variation in the shape of erythrocytes known as?
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Poikilocytosis
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What does the peripheral blood smear show in a patient with iron deficiency anemia?
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Microcytic, hypochromic cells with poikilocytosis present
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Which one of the following is a characteristic finding in iron deficiency anemia?
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Low ferritin, low iron, high TIBC, high transferrin
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Which RBC shows a peripheral rim of hemoglobin with a dark staining central area?
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Leptocyte (also known as a Target cell)
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Target cells are present in ALL of the following conditions:
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Thalassemia, liver disease, and postsplenectomy
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Target cells are present in all of the following conditions EXCEPT which one?
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Myelofibrosis
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Basophilic stippling refers to which one of the following?
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Aggregated RNA in the RBC
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Which RBC inclusion is described as a threadlike oval or figure-eight shaped?
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Cabot rings
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Which of the following inclusions represents a remnant of nuclear DNA in an RBC?
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Howell-Jolly body
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RNA remnants in RBCs are visualized by which supravital stain?
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New methylene blue
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What are RBCs that contain iron-stained granules termed?
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Siderocytes
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Chronic blood loss can lead to what type of anemia?
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Iron deficiency anemia
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Increased iron in the mitochondria of normoblasts is characteristic of which type of anemia?
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Sideroblastic anemia
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A peripheral blood smear from a patient with thalassemia would exhibit which of the following?
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Target cell, basophilic stippling, and teardrop cells
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What lab results are found in iron deficiency anemia but not in thalassemia?
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Low serum iron and high total iron binding capacity
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A macrocytic anemia characteristically accompanies all of the following EXCEPT which one?
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Iron deficiency
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A macrocytic anemia characteristically accompanies all of the following:
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Fish tapeworm infection, vitamin B12 deficiency, folate deficiency
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Which one of the following is NOT typically seen in the peripheral smear in megaloblastic anemia?
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Spherocytes
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The following are typically seen in the peripheral smear in megaloblastic anemia?
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Oval macrocytes, decreased platelets, and hypersegmented neutrophils.
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What is the most characteristic change seen in the WBCs of the megaloblastic anemia bone marrow?
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Giant metamyelocytes
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Which of the following is true of hereditary elliptocytosis?
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Osmotic fragility and autohemolysis are usually normal
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An increased osmotic fragility is typically seen in which type of hemolytic anemia?
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Hereditary spherocytosis
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All of the following tests are associated with the diagnosis of paroxysmal nocturnal hemoglobinuria EXCEPT which one?
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Osmotic fragility test
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All of the following tests are associated with the diagnosis of paroxysmal nocturnal hemoglobinuria:
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Sugar water test, sucrose hemolysis, and acidified serum test
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What is the most common thalassemia in the US?
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Beta thalassemia minor
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Substitution of valine for glutamine as the 6th amino acid in the beta chain results in the production of which hemoglobin?
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Hb-S
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Which disorder is associated with an enzyme defect of aerobic glycolysis (HMP shunt pathway)?
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G-6-PD deficiency
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Pancytopenia is most commonly associated with which type of anemia?
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Aplastic anemia
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Panhyperplasia of the bone marrow is associated with which type of anemia?
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Polycythemia vera
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Leukopenia can occur in all of the following conditions:
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Leukemia, viral infection, chemotherapy
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Leukopenia can occur in all of the following conditions EXCEPT one:
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Leukemoid reaction
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Which one of the following is a characteristic of immature RBCs?
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Presence of euchromatin
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Toxic granulation of neutrophils is usually associated with which one of the following?
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Severe bacterial infections
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Dohle bodies are found in the cytoplasm of which cells?
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Neutrophils
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At what stage will specific (secondary) granules of polymorphonuclear cells appear?
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Myelocytes
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What is the immediate precursor of the band polymorphonuclear neutrophil?
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Metamyelocyte
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What WBC is least often seen on a normal peripheral smear?
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Basophil
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What is the largest leukocyte seen on a normal peripheral blood smear?
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Monocyte
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Which anomaly is characterized by bi-lobed nuclei?
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Pelger-Huet anomaly
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Of the following, which is a WBC inclusion?
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Dohle bodies
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Which of these statements is NOT consistent with toxic granulation of neutrophils?
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Accompanies hypersegmentation
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These statements are consistent with toxic granulation of neutrophils...
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Appears with a shift to the left, may be accompanied by Dohle bodies, may be accompanied by vacuolization of PMNs.
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In lupus, which cell phagocytizes the nucleoprotein?
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Neutrophil
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Which of the following cells are commonly seen in chronic lymphocytic leukemia?
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Smudge cells
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Reactive leukocytosis is present when the absolute count of granulocytes reaches what value?
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>7.0 x 10^9/L
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A "shift to the left" refers to which of the following?
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Immature myelogenous cells
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Eosinophilia may be seen in all of the following conditions EXCEPT which one?
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Erythroleukemia
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Eosinophilia may be seen in all of the following conditions:
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Allergic reaction, parasitic infection, or chronic myelogenous leukemia
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Which cell is characteristically increased in the peripheral smear of a patient with infectious mononucleosis?
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Lymphocyte
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Acute leukemias are associated with all of the following:
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Blasts, anemia, and thrombocytopenia
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Acute leukemias are associated with all of the following EXCEPT:
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Smudge cells
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Acute lymphocytic leukemias that have a predominance of homogenous cells with a high N/C ratio belong to which FAB group?
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L1
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Which FAB classification of the acute lymphocytic leukemias has prominent cytoplasmic vacuolation?
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L3
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In acute myelocytic leukemia, which FAB classification of type II blasts distinguishes them from type I blasts?
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Few cytoplasmic granules
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Auer rods are typically found in the cells of which leukemia?
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Acute myelogenous leukemia
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What specific cytological finding can differentiate acute myelogenous leukemia from acute lymphocytic leukemia?
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Presence of Auer rods
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Which FAB classification of acute myelogenous leukemias is frequently associated with disseminated intravascular coagulopathy?
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M3
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Which stain differentiates acute myelocytic leukemia from acute lymphocytic leukemia?
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Myeloperoxidase
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Which leukemia does not have peroxidase activity?
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Acute lymphocytic leukemia
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The results of a leukemia patient are as follows: NASDA 3+ blasts NASDA with sodium fluoride 1+ These results are consistent with which type of leukemia?
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Acute myelomonocytic leukemia
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Which leukemia can be identified by a positive periodic acid-Schiff stain?
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Acute lymphocytic leukemia
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The Philadelphia chromosome is associated with which leukemia?
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Chronic myelogenous leukemia
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What leukemia has increased basophils and/or eosinophils in the early stages?
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Chronic myelogenous leukemia
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Which stain can be used to differentiate chronic myelogenous leukemia from a leukemoid reactions?
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Leukocyte alkaline phosphatase
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Which one of the following findings is is characteristic of chronic lymphocytic leukemia?
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Lymphocytosis
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A peripheral blood smear demonstrating an absolute increase in small, mature lymphocytes and smudge cells is indicative of which clinical condition?
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Chronic lymphocytic leukemia
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Most chronic lymphocytic leukemias are neoplasms of which subset of lymphocytes?
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B cells
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Tartrate resistant acid phosphatase stain is useful in the diagnosis of which leukemia?
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Hairy cell leukemia
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All of the following are characteristic of a bone marrow of Waldentrom's macroglobulinema:
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Increased plasma cells, marked rouleaux formation, relative/absolute lymphocytosis
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All of the following are characteristic of a bone marrow of Waldentrom's macroglobulinema EXCEPT which one?
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Increased megakaryocytes
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Reed-Sternberg cells are diagnostic for which clinical condition?
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Hodgkin's disease
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Which laboratory results are consistent with a diagnosis of Hodgkin's lymphoma?
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High WBC count, neutrophilia, elevated ESR rate, low fibrinogen, low serum iron
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Giant, bizarre platelets, nRBCs, and teardrop RBCs are associated with which clinical condition?
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Myelofibrosis
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Which other abnormal laboratory finding is seen in myeloid metaplasia?
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Increased uric acid
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Hemostasis involves all of the following functions:
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Adhesion, aggregation, and vasoconstriction
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Hemostasis involves all of the following functions EXCEPT:
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Vasodilation
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Factor XII is most commonly activated by exposure to which one of the following?
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Subendothelium
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Which coagulation family is dependent on vitamin K synthesis?
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Prothrombin
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Which of the following factors does not require vitamin K for its production by the liver?
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VIII
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Which activated coagulation factor is NOT a serine protease?
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VIII
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What is the precursor of thrombin?
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Prothrombin
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Which activated coagulation factor converts fibrinogen to fibrin?
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Thrombin
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The end result of most coagulation tests is the production of which one of the following?
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Fibrin clot
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Factor X is associated with which coagulation pathway?
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Common pathway
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All of the following factor activations occur in the alternate pathway EXCEPT
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Factor VII activates prekallikrein
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What does the prothrombinase complex consist of?
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Xa-Va-phospholipid-CA++
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What is the inactive form of plasmin?
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Plasminogen
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In the process of fibrinolysis, which one of the following acts on fibrin?
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Plasmin
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Which inhibitor degrades Factor Va and Factor VIIIa?
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Protein C
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Which inhibitor acts as a cofactor and accelerates the inactivation of Factor Va and Factor VIIIa?
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Protein S
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Which protein is the primary inhibitor of the fibrinolytic system?
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Alpha2-antiplasmin
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What is the principal inhibitor of thrombin and Factor Xa?
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Antithrombin III
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What is the most frequently acquired inhibitor in hereditary deficiencies?
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Anti-VIII
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Which inhibitor inactivates coagulation factors through phospholipoprotein components?
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Lupus-like anticoagulant
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Results on a 25 year-old male patient: PT 13.4 s (11.0-13.5) INR 1.2 PTT 56.8 s (30.0-37.0) A mixing study was performed; the corrected results are: PTT unincubated 55.8 s PTT incubated 57.0 s
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The results indicate the presence of a: Circulating anticoagulant
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If a coagulation test is prolonged due to a deficiency of plasma coagulation factor, then the test should be corrected by the addition of which one of the following?
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Normal plasma
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Diagnosis of von Willebrand's disease can be made from all the following test results EXCEPT which one?
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Decreased platelet count
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Diagnosis of von Willebrand's disease can be made from all the following test results:
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Decreased VIII:C, decreased VIIIR:Co, prolonged bleeding time
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Desmopressin acetate (DDAVP) is used in the treatment of which disorder?
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von Willebrand's disease
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Disseminated intravascular coagulopathy is associated with all of the following disorders EXCEPT which one?
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Hemophilia
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Disseminated intravascular coagulopathy is associated with all of the following disorders:
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Acute promyelocytic leukemia, placenta previa, and snakebites
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A 27 year-old female complains of mucous membrane bleeding. PT 42.0 s INR 4.0 PTT 158.5 s Fibrinogen 73 mg/dL D-dimer 5.46
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Consistent with: Disseminated intravascular coagulopathy
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A 27 year-old female patient results are available: PT 20.5 s (11.0-13.0 s) INR 2.0 PTT 43.0 s (30.0-36.0) Fibrinogen 141 mg/dL (200-400)
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Results are suggestive of: Liver disease
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What is the origin of platelets in the bone marrow?
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Megakaryocytes
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Which coagulation factors are labile?
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Factors V and VIII
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Which coagulation factors are monitored in severe liver disease?
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Factors I and V
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Classic hemophilia is the result of a deficiency of which coagulation factor?
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Factor VIII
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What is the normal plasma concentration of fibrinogen?
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300-400 mg/dL
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Which coagulation factor is known as the Christmas factor?
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Factor IX
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What is the average life span of a platelet?
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8-11 days
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What is the normal range for a platelet count?
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140,000-440,000/microliter
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Which one of the following is a hereditary platelet disorder characterized by decreased platelet production accompanied by the presence of Dohle bodies in polymorphonuclear cells?
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May-Hegglin anomaly
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Idiopathic thrombocytopenic purpura is usually characterized by which of the following?
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Increased platelet desctruction
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A prolonged bleeding time with a normal platelet count indicates all of the following EXCEPT which one?
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Bernard-Soulier syndrome
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A prolonged bleeding time with a normal platelet count indicates all of the following:
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von Willebrand's disease, Glanzmann's disease, aspirin ingestion
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Bernard-Soulier syndrome is a platelet disorder that has what type of abnormality associated with it?
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Abnormal adhesion
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Which platelet disorder is associated with abnormal primary aggregation?
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Glanzmann's disease
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Wiskott-Aldrich is a qualitative platelet disorder that is associated with which one of the following?
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Abnormal secondary aggregation
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Thrombocythemia is most commonly associated with which myeloproliferative disorder?
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Polycythemia vera
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While performing a platelet estimate using 1000X magnification, how many platelets are associated with a normal platelet count?
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8-20
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What do a low platelet count and a normal bleeding time indicate?
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Autoimmune thrombocytopenia
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What is the only coagulation test that is sensitive to Factor VII deficiency?
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Prothrombin time
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The activated partial thromboplastin time (APTT) serves as a screening procedure for which plasma factor deficiencies?
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XII, IX, XI, VIII, X, V, II, I
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Which test can monitor Heparin therapy, increased levels of fibrin split products, and quantitative and qualitative fibrinogen abnormalities?
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Thrombin time
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Which coagulation methodology is monitored by a photoelectric system?
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Optical
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Which automated assay is used to detect Fragment D and Fragment E?
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D-Dimer
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Which coagulation test is used to differentiate between a factor deficiency and the presence of a circulating anticoagulant?
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Mixing study
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Which one of the following is a quantitative method for determining the amount of Factor VIII present?
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Factor assay
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Hemoglobin A
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The most common in adults with a normal amount over 95%.
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Hemoglobin F
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Seen in the fetus. However, the level of Hb F can be elevated in adults with sickle-cell disease and beta-thalassemia.
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Hemoglobin S
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A variant form of hemoglobin found in people with sickle cell disease. There is a variation in the β-chain gene, causing a change in the properties of hemoglobin, which results in sickling of red blood cells.
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Hemoglobin C
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Another variant due to a variation in the β-chain gene. This variant causes a mild chronic hemolytic anemia. Target cells, microspherocytes and HbC crystals (rod shaped) are found in a blood smear from a homozygous patient.
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Hemoglobin A2
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Synthesis begins late in the third trimester and in adults, it has a normal range of 1.5-3.5%.
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Hemoglobin E
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Normal embryonic hemoglobin (with subtypes Gower1, Gower2, and Portland Hb) disappears before birth.
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Hemoglobin D disease
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People who have hemoglobin D disease have RBCs that contain mostly Hb D. Too much Hb D can reduce the number and size of RBCs in your body, causing mild anemia. Hb D disease is rare and usually does not cause serious health problems.
