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Hematology Clinical Medicine - I

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Answer 50 questions in 15 minutes.
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1. Normocytic
MCV: 80-100 - sickle cell anemia - G6PD
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:
Male: 14-17 Female: 12-15
O2 bearing molecule and carries 02 throughout the body

2. petechiae
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
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances

3. PE for anemia
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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

4. Transferrin
Cellular Immunity: helper - killer cells: affected with HIV
Plasma protein that binds to Fe and helps absorb it - 200-400
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Autoimmnr hypersplensm

5. Hemolysis

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6. purpura
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
Palpable - slightly raised areas of bleeding
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
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

7. CBC with differential
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
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
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

8. Fibrin
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects 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)
Type of anemia characterized by smaller paler than usual RBC

9. Blood consists of what cellular elements
Type of anemia characterized by smaller paler than usual RBC
Less than 1 persent
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma

10. HbF
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
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
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)

11. Platelet problem
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
low platelet count - skin bleeding - mucosa: especially bleeding of gums
GF produced by liver and stimulates production of megakariocytes

12. Abnormality in beta chain are present....
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Cellular Immunity: helper - killer cells: affected with HIV
Asymptomatic until 4 months of life
Programmed cell death (cyto C. and caspases)

13. Acquired Disorders
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
98% - alpha and beta
In the bone marrow
150 -000-450 -000

14. Inherited Hemoglobinopathy
Growth factor that causes neutraphils to grow
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
GF produced by liver and stimulates production of megakariocytes
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

15. Hematopoiesis
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
HbF: 2 alpha and 2 gamma
Process by which all blood cells form - develop - and are replaced in the body - blood production
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation

16. Production of Hemoglobin
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
Abnormally shaped cells - schiztocyte - tear drop - oval
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
low platelet count - skin bleeding - mucosa: especially bleeding of gums

17. Lab findings for Hemolytic anemia
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
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
8% of body weight- 5L in women and 5.5L in males
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

18. Proper O2 transport depends on...
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
MCV - index for classifying anemia - Norma: 80-100
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
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances

19. Microcytic cells
Encapsulated bacteria: Strep pneumonia and H. Influenza
Programmed cell death (cyto C. and caspases)
Humeral immunity: Ab production
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

20. Detection of hemoglobinopathy
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
55% of blood plasma - contains all the blood cells
Breaking open of the RBC's and release of HgB (spleen)
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

21. Heme- Heme interction
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
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
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
T and B lymph

22. When is a CBC with difference ordered?
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
4.5-10

23. Reticulocyte
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
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
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
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

24. Hemoglobin A2
1-2% - alpha and gamma
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
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

25. B12
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
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
Sickle cell - G6PD - thalessemia
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

26. Hemobglobin A
Vit B 12 and folic acid deficiency
N - M - Meg - RBC
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
98% - alpha and beta

27. Erythropoiesis
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
T and B lymph
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

28. Patient with Anemia c/o
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Programmed cell death (cyto C. and caspases)
Sickle cell - G6PD - thalessemia

29. Hematopoeisis in adulthood is limited to....
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
The flat bones: sternum - pelvis - proximal ends of the long bones
Skin - tend to bleed also into the muscles and joints
Complete blood count with differential: tells what percentage of cells make up the blood

30. Elevated MCV
N - M - Meg - RBC
Vit B 12 and folic acid deficiency
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Sickle cell - G6PD - thalessemia

31. Genetic defects
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

32. Plasma
55% of blood plasma - contains all the blood cells
N - M - Meg - RBC
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
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

33. monocytes are present in....
Severe infections
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases

34. Eosinophilia Causes
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
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

35. Composition of HgB
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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

36. Hemoglobin
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
O2 bearing molecule and carries 02 throughout the body
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

37. Lymphocytosis Causes
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Male: 14-17 Female: 12-15
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

38. 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
1-2% - alpha and gamma
Humeral immunity: Ab production
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

39. beta globin chain genetic
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Sickle cell - G6PD - thalessemia
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
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

40. Progenitor cells
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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 clot formation
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
N - M - Meg - RBC

42. Bleeding disoders can be....
Acquired or inhereited
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
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

43. Hemoglobin F
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Less than 1 persent
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

44. Extrinsic hemolytic anemia
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
4.5-10
Autoimmnr hypersplensm
Less than 1 persent

45. Amount of Hb in Males and Females
Abnormal size of cells and vary in abnormality
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

46. Coagulation factor deficiency
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
98% - alpha and beta
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
Skin - tend to bleed also into the muscles and joints

47. von Willebrand Factor
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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
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)
M- 75-175 F- 65-165

48. GM-CSF
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Cellular Immunity: helper - killer cells: affected with HIV
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
N - M - Meg - RBC

49. Platelet Count
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
150 -000-450 -000
Acquired or inhereited

50. Approach to a bleeding patient
Programmed cell death (cyto C. and caspases)
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
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
N - M - Eo - Meg - B - RBC - stem