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Hematology Clinical Medicine - I

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1. Blood clot formation
4.5-10
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

2. Erythrocytes
RBC - most munerous - Mature they are anucleated boconcave cells which allows more surface area for Hb - certain disease cause shape change: sickle cell anemia - ineffective erythropoiesis is a main feature in many blood diseases
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
N - M - Eo - Meg - B - RBC - stem
Sickle cell - G6PD - thalessemia

3. IL-1
Plasma protein that binds to Fe and helps absorb it - 200-400
T lymph - stem cell
HbA-2alpha and 2 beta chains
Growth factor that causes neutraphils to grow

4. GM-CSF
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Programmed cell death (cyto C. and caspases)
N - M - Meg - RBC
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning

5. WBC
Leukocytes - neutraphils - monocytes - basophils - lymphocytes - eosinophils--> 5 different cells divided into 3 classes - immune system and fights viral - bacterial - fungal - parasites - and allergens - classified by presence or absence of granules
MCV: 80-100 - sickle cell anemia - G6PD
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

6. Progenitor cells
lineage committed - create different blood cell lineages - can be very large - mostly all nucleaus. As they mature and differentiate - they become smaller in size and the nucleaus decreases in size - Ex: Lymphiod - meloid - and platelet lineage cells
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Most abundant protein in the plasma and helps establish the osmotic gradient
N - M - Meg - RBC

7. Bleeding D/O laboratory testing
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
CBC with Diff - PT: prothrombin time ***important it analyzes clotting ability of 5 plasma coagulation factors - INR: internatoinal normalized ratio (1-2) - PTT: partial thromboplastin time (30-45sec): analyzes the first stage of clotting - bleeding
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

8. Leukapenia
Leukocytes - neutraphils - monocytes - basophils - lymphocytes - eosinophils--> 5 different cells divided into 3 classes - immune system and fights viral - bacterial - fungal - parasites - and allergens - classified by presence or absence of granules
M- 75-175 F- 65-165
lineage committed - create different blood cell lineages - can be very large - mostly all nucleaus. As they mature and differentiate - they become smaller in size and the nucleaus decreases in size - Ex: Lymphiod - meloid - and platelet lineage cells
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)

9. IL-2
90-91% water - 6-7% are proteins like Albumin - Remaining 2-3%: electrolytes - carbohydrates and fats - chemical messengers (growth factors) and gases like O2 and CO2
Variation in size
T and B lymph
low platelet count - skin bleeding - mucosa: especially bleeding of gums

10. CBC with differential
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Complete blood count with differential: tells what percentage of cells make up the blood
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

11. Clotting disorders
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Plasma protein that binds to Fe and helps absorb it - 200-400
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances

12. Platelet problem
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
GF produced by liver and stimulates production of megakariocytes
low platelet count - skin bleeding - mucosa: especially bleeding of gums
1-2% - alpha and gamma

13. B Cell
Standard for reporting the PT
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Humeral immunity: Ab production
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

14. Coagulation factor deficiency
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Confluent areas of bleeding right below the skin
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Skin - tend to bleed also into the muscles and joints

15. Approach to a bleeding patient
Careful hx - age and sex of patient: some d/o are more common in certain sexes and age groups - onset and duration - site of bleeding - taking medication? Aspirin? Warfarin? Plavex - Antecedent trauma? - Recent infections? Strep or viral? - PMH: chro
group of disorders affecting the structure - function - or production of Hgb - Hgb is important for normal O2 delivery to the tissues. If there is an abnormality then can cause hypoxia of the tissue.
T and B lymph
1-2% - alpha and gamma

16. Anemia developes because
Detects presence of Ag-AB complex: direct or indirect - diagnostic for: hemolytic dz of a newborn - acquired hemolytic anemia - transfusion reaction - blood that sensitized patient. RBC
Primary function is to support O2 transport - hard to bind the first O2 to Hgb but once it does it becomes easier to bind - It must bind at the partial pressure of O2 of alveolus and then it releases it to the tissue at the partial pressure of O2 at
In the bone marrow
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

17. HbF
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Fetal Hg - 2 alpha and 2 gamma chains - 1%
MCV: 80-100 - sickle cell anemia - G6PD
Type of anemia characterized by smaller paler than usual RBC

18. Platelet Count
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
T and B lymph
150 -000-450 -000
low platelet count - skin bleeding - mucosa: especially bleeding of gums

19. purpura
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
150 -000-450 -000
Palpable - slightly raised areas of bleeding
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning

20. Genetic defects
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Programmed cell death (cyto C. and caspases)
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
CBC with Diff - PT: prothrombin time ***important it analyzes clotting ability of 5 plasma coagulation factors - INR: internatoinal normalized ratio (1-2) - PTT: partial thromboplastin time (30-45sec): analyzes the first stage of clotting - bleeding

21. Blood consists of what cellular elements
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Leukocytes - neutraphils - monocytes - basophils - lymphocytes - eosinophils--> 5 different cells divided into 3 classes - immune system and fights viral - bacterial - fungal - parasites - and allergens - classified by presence or absence of granules
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

22. Hematopoiesis
Variation in shape
55% of blood plasma - contains all the blood cells
Process by which all blood cells form - develop - and are replaced in the body - blood production
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

23. IL- 3
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
N - M - Eo - Meg - B - RBC - stem

24. Granulocytes
O2 bearing molecule and carries 02 throughout the body
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Breaking open of the RBC's and release of HgB (spleen)
Alpha genes are on chromosome 16 - 2 genes on chromosome 16 for every alpha globin chain - total of 4 genes responsible for the 2 alpha globin chains

25. Apoptosis
Autoimmnr hypersplensm
Programmed cell death (cyto C. and caspases)
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
7th month

26. Blood is produced....
group of disorders affecting the structure - function - or production of Hgb - Hgb is important for normal O2 delivery to the tissues. If there is an abnormality then can cause hypoxia of the tissue.
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
In the bone marrow
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)

27. Normocytic
Hereditary disorder than can vary from mild to severe life threatening - common in areas with malaria and causes a problem with the function and structure of Hb - seen in populations from: SE asia - China - Mediterranean - lesser extent: Africa
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
MCV: 80-100 - sickle cell anemia - G6PD
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

28. Abnormality in beta chain are present....
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
What is stored in body M: 18-270 W: 18-160
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Asymptomatic until 4 months of life

29. Hemolysis

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30. Blood Facts
Confluent areas of bleeding right below the skin
8% of body weight- 5L in women and 5.5L in males
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

31. Bleeding/ Hypercoagulation disorders
55% of blood plasma - contains all the blood cells
Deletion or point mutation of 1 or more globin genes - caused by reduced synthesis of 1 or more alpha globin chains or beta which leads to microcytic hypochromic anemia - means that the globin chain synthesis is defective from mutated or missing 1 or
Hgb in the blood is too low to fulfill the O2 demands of the body - can be a specific disease of a sign of disease progress (GI CA)
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation

32. Microcytic cells
Immature RBC right before it fully matures - Mature (spend 3 days in) red bone marrow and then circulate in the peripheral blood for 1 day and fully mature (extrusion of nucleaus) - 1% of RBC in the body
Beta genes are on chromosome 11 - 1 gene on chromosome 11 for each globin chain - totatl 2 genes responsible for the 2 beta globin chains
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
N - M - Eo - Meg - B - RBC - stem

33. Production of Hemoglobin
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
volume % of RBC in blood - Female: 36-48 - Males: 42-52
4.5-10

34. monocytes are present in....
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
The property inherent in the arrangement of the heme and globin units that allows for oxygenation acquisition and delivery over a narrow range of tension
Severe infections

35. PE of bleeding patient
Skin: hematomas - petechiae - nose and mouth/ throat bleeding - LN: usually not involved - HLA: look for enlarged spleen - liver - MSS: hemathrosis (bleeding into the joints - swollen - tender)
lineage committed - create different blood cell lineages - can be very large - mostly all nucleaus. As they mature and differentiate - they become smaller in size and the nucleaus decreases in size - Ex: Lymphiod - meloid - and platelet lineage cells
Parasite infections
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning

36. By what month in the fetus does the development of the RBC move to the bone marrow?
RBC - most munerous - Mature they are anucleated boconcave cells which allows more surface area for Hb - certain disease cause shape change: sickle cell anemia - ineffective erythropoiesis is a main feature in many blood diseases
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
7th month
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

37. HbA
Skin: hematomas - petechiae - nose and mouth/ throat bleeding - LN: usually not involved - HLA: look for enlarged spleen - liver - MSS: hemathrosis (bleeding into the joints - swollen - tender)
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
Asymptomatic until 4 months of life

38. Gestation HgB
CBC with Diff - PT: prothrombin time ***important it analyzes clotting ability of 5 plasma coagulation factors - INR: internatoinal normalized ratio (1-2) - PTT: partial thromboplastin time (30-45sec): analyzes the first stage of clotting - bleeding
Variation in shape
Autoimmnr hypersplensm
HbF: 2 alpha and 2 gamma

39. Iron Serum test
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
M- 75-175 F- 65-165
Abnormally shaped cells - schiztocyte - tear drop - oval
Process by which all blood cells form - develop - and are replaced in the body - blood production

40. Extrinsic hemolytic anemia
Asymptomatic until 4 months of life
Autoimmnr hypersplensm
Male: 14-17 Female: 12-15
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

41. Amount of Hb in Males and Females
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Severe infections
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Male: 14-17 Female: 12-15

42. Specific disease of anemia
Sickle cell - G6PD - thalessemia
Begins later in life - may be a medication related - may be related to underlying medical condition - may be idiopathic - may involve more than 1 system
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Male: 14-17 Female: 12-15

43. T cell
Cellular Immunity: helper - killer cells: affected with HIV
N - M - Meg - RBC
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Breaking open of the RBC's and release of HgB (spleen)

44. Megakariocytes/ Thrombocytes
O2 bearing molecule and carries 02 throughout the body
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
volume % of RBC in blood - Female: 36-48 - Males: 42-52
90-91% water - 6-7% are proteins like Albumin - Remaining 2-3%: electrolytes - carbohydrates and fats - chemical messengers (growth factors) and gases like O2 and CO2

45. Acquired Disorders
1-2% - alpha and gamma
Type of anemia characterized by smaller paler than usual RBC
Begins later in life - may be a medication related - may be related to underlying medical condition - may be idiopathic - may involve more than 1 system
Protein encasement of heme: 2 chains per globin- 1 alpha and 1 non alpha - 4 globin chains per tetrameter - 2 alpha chains and a pair of non-alpha chains (beta or gamma)

46. INR
Encapsulated bacteria: Strep pneumonia and H. Influenza
Deletion or point mutation of 1 or more globin genes - caused by reduced synthesis of 1 or more alpha globin chains or beta which leads to microcytic hypochromic anemia - means that the globin chain synthesis is defective from mutated or missing 1 or
Standard for reporting the PT
In the bone marrow

47. Bacteria that patients with sickle cell anemia are at risk for
HbA-2alpha and 2 beta chains
GF produced by liver and stimulates production of megakariocytes
Encapsulated bacteria: Strep pneumonia and H. Influenza
90-91% water - 6-7% are proteins like Albumin - Remaining 2-3%: electrolytes - carbohydrates and fats - chemical messengers (growth factors) and gases like O2 and CO2

48. Poikilocytosis
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Abnormally shaped cells - schiztocyte - tear drop - oval
Beta genes are on chromosome 11 - 1 gene on chromosome 11 for each globin chain - totatl 2 genes responsible for the 2 beta globin chains
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)

49. Lymphopenia Causes
Asymptomatic until 4 months of life
XRT (radiation and Chemo - inherited immune disorders
Acquired or inhereited
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)

50. Blood cells transport mechanism
90-91% water - 6-7% are proteins like Albumin - Remaining 2-3%: electrolytes - carbohydrates and fats - chemical messengers (growth factors) and gases like O2 and CO2
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
It is bound to intrinsic factor: protein produced and secreted by gastric parietal cells - B12 is absorbed in the terminal ilium and stored in the liver