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Hematology Clinical Medicine - I

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1. petechiae
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

2. Variations with HbA
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
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
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.
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma

3. B Cell
Humeral immunity: Ab production
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
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Variation in shape

4. microcytic hypochromic anemia
MCV: 80-100 - sickle cell anemia - G6PD
Type of anemia characterized by smaller paler than usual RBC
The flat bones: sternum - pelvis - proximal ends of the long bones
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

5. Hemobglobin A
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
98% - alpha and beta
Type of anemia characterized by smaller paler than usual RBC
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

6. Bleeding disoders can be....
Breaking open of the RBC's and release of HgB (spleen)
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Programmed cell death (cyto C. and caspases)
Acquired or inhereited

7. HbF
1-2% - alpha and gamma
Male: 14-17 Female: 12-15
Fetal Hg - 2 alpha and 2 gamma chains - 1%
HbF: 2 alpha and 2 gamma

8. IL- 3
N - M - Eo - Meg - B - RBC - stem
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Vit B 12 and folic acid deficiency

9. Hemoglobinopathies
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
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.
150 -000-450 -000
Cause by increase destruction of RBC in the peripheral blood faster than the bone marrow can produce them - decstruction is intrinsic: defect in production - extrinsic: produced healthy

10. WBC Count
Vit B 12 and folic acid deficiency
4.5-10
Less than 1 persent
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

11. Hemoglobin
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
O2 bearing molecule and carries 02 throughout the body
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.
GF produced by the kidney and is a glycoprotein - stimulates the production of RBC in response to tissue hypoxia - binds to specific receptors on the surface of RBC precursors

12. HgB/ HCT is increased with....
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
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
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
What is stored in body M: 18-270 W: 18-160

13. Megakariocytes/ Thrombocytes
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Abnormal size of cells and vary in abnormality
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances

14. Normal Hbg Count
T and B lymph
Male: 14-17 Female: 12-15
Abnormal size of cells and vary in abnormality
Abnormally shaped cells - schiztocyte - tear drop - oval

15. Bleeding/ Hypercoagulation disorders
Plasma protein that binds to Fe and helps absorb it - 200-400
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation

16. Iron Serum test
M- 75-175 F- 65-165
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
In the bone marrow
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

17. Hemoglobin A2
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
8% of body weight- 5L in women and 5.5L in males
1-2% - alpha and gamma
liver produces most coagulation factors excepts for VIII - vWF - - liver damage: impaired synthesis of most clotting factors - fibrinogen - plasminogen - malabsoprtion of vitamen K - portal HTN - Labs: prolonged PT - advanced increase PT - PTT - Tx:

18. von Willebrand Factor
Parasite infections
O2 bearing molecule and carries 02 throughout the body
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

19. Hemostasis
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Humeral immunity: Ab production
The flat bones: sternum - pelvis - proximal ends of the long bones
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size

20. bleeding disorders
Acquired or inhereited
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
MCV: 80-100 - sickle cell anemia - G6PD
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

21. GM-CSF
Humeral immunity: Ab production
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
N - M - Meg - RBC
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

22. Microcytic cells
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
T lymph - stem cell
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

23. G-CSF
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)
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Confluent areas of bleeding right below the skin
Growth factor that causes neutraphils to grow

24. Granulocytes
Severe infections
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
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
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

25. Gestation HgB
Type of anemia characterized by smaller paler than usual RBC
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
HbF: 2 alpha and 2 gamma
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

26. Reticulocyte
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
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
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
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

27. poikilocytosis
8% of body weight- 5L in women and 5.5L in males
Variation in shape
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
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

28. Hgb anatomy
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)
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Autoimmnr hypersplensm
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

29. Plasma
7th month
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
55% of blood plasma - contains all the blood cells

30. By what month in the fetus does the development of the RBC move to the bone marrow?
7th month
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Less than 1 persent
Palpable - slightly raised areas of bleeding

31. Heme- Heme interction
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
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Severe infections
Parasite infections

32. Anemia
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Standard for reporting the PT
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
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)

33. Neutropenia
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
XRT (radiation and Chemo - inherited immune disorders
In the bone marrow
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)

34. Hemolytic Anemia
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
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
Cause by increase destruction of RBC in the peripheral blood faster than the bone marrow can produce them - decstruction is intrinsic: defect in production - extrinsic: produced healthy
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)

35. Hematopoietic Stem cells
Standard for reporting the PT
Less than 1 persent
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Complete blood count with differential: tells what percentage of cells make up the blood

36. Lymphopenia Causes
MCV - index for classifying anemia - Norma: 80-100
XRT (radiation and Chemo - inherited immune disorders
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
Programmed cell death (cyto C. and caspases)

37. IL-1
The flat bones: sternum - pelvis - proximal ends of the long bones
8% of body weight- 5L in women and 5.5L in males
Fetal Hg - 2 alpha and 2 gamma chains - 1%
T lymph - stem cell

38. Liver disease
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
liver produces most coagulation factors excepts for VIII - vWF - - liver damage: impaired synthesis of most clotting factors - fibrinogen - plasminogen - malabsoprtion of vitamen K - portal HTN - Labs: prolonged PT - advanced increase PT - PTT - Tx:
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
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

39. Detection of hemoglobinopathy
7th month
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)
Confluent areas of bleeding right below the skin
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

40. Clotting disorders
M- 75-175 F- 65-165
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
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
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

41. Blood Facts
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
4.5-10
8% of body weight- 5L in women and 5.5L in males
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

42. Hypercoagulable states are...
Programmed cell death (cyto C. and caspases)
Genetic and rare or acquired
Severe infections
low platelet count - skin bleeding - mucosa: especially bleeding of gums

43. Inherited Hemoglobinopathy
Autosomal co-dominant traits who inherit a different abnormal allele from each parent - Alpha chain is present in HbA - HbA2 - HbF: alpha chain mutations cause abnormalities in all three - beta chains are present in HbA and HbA2
Encapsulated bacteria: Strep pneumonia and H. Influenza
Skin - tend to bleed also into the muscles and joints
Male: 14-17 Female: 12-15

44. Specific disease of anemia
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
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
Sickle cell - G6PD - thalessemia
Programmed cell death (cyto C. and caspases)

45. ecchymosis
Confluent areas of bleeding right below the skin
MCV: 80-100 - sickle cell anemia - G6PD
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

46. Lab findings for Hemolytic anemia
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Variation in size
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

47. Mean Corpuscular Volume
MCV - index for classifying anemia - Norma: 80-100
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
T lymph - stem cell
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning

48. Proper O2 transport depends on...
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Variation in size
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
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

49. Hemoglobin F
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
MCV: 80-100 - sickle cell anemia - G6PD
M- 75-175 F- 65-165
Less than 1 persent

50. PE of bleeding patient
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
Confluent areas of bleeding right below the skin
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)
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