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Hematology Clinical Medicine - I

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Answer 50 questions in 15 minutes.
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1. Hemoglobin A2
Standard for reporting the PT
1-2% - alpha and gamma
Sickle cell - G6PD - thalessemia
Severe infections

2. IL- 3
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
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
N - M - Eo - Meg - B - RBC - stem
low platelet count - skin bleeding - mucosa: especially bleeding of gums

3. Heme- Heme interction
Process by which all blood cells form - develop - and are replaced in the body - blood production
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
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
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

4. Specific disease of anemia
Asymptomatic until 4 months of life
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Sickle cell - G6PD - thalessemia
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

5. Hemolysis

6. Hgb anatomy
Less than 1 persent
Abnormal size of cells and vary in abnormality
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)
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

7. What do growth factors do?
4.5-10
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
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)
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

8. Apoptosis
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
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
What is stored in body M: 18-270 W: 18-160
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)

9. 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
HbF: 2 alpha and 2 gamma
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)

10. Mean Corpuscular Volume
MCV - index for classifying anemia - Norma: 80-100
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

11. Iron Serum test
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
M- 75-175 F- 65-165
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
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

12. Bone Marrow Cellularity
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
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)
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
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

13. When is a CBC with difference ordered?
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Standard for reporting the PT
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
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs

14. Erythropoiesis
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Variation in shape
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

15. What is the life span of blood cells?
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Programmed cell death (cyto C. and caspases)
Encapsulated bacteria: Strep pneumonia and H. Influenza

16. Hematopoietic Stem cells
Cellular Immunity: helper - killer cells: affected with HIV
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Skin - tend to bleed also into the muscles and joints
Growth factor that causes neutraphils to grow

17. Blood Facts
8% of body weight- 5L in women and 5.5L in males
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
T and B lymph
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

18. Drug Inducted Thrombocytopenia
Skin - tend to bleed also into the muscles and joints
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

19. Hemoglobin F
Parasite infections
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
Less than 1 persent
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma

20. Platelet problem
What is stored in body M: 18-270 W: 18-160
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Parasite infections

21. Gestation HgB
Complete blood count with differential: tells what percentage of cells make up the blood
1-2% - alpha and gamma
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
HbF: 2 alpha and 2 gamma

22. microcytic hypochromic anemia
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Type of anemia characterized by smaller paler than usual RBC
Confluent areas of bleeding right below the skin

23. Acquired Disorders
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
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
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

24. HgB/ HCT is increased with....
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
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
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

25. Platelet Count
150 -000-450 -000
In the bone marrow
Process by which all blood cells form - develop - and are replaced in the body - blood production
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

26. Thrombopoietin
GF produced by liver and stimulates production of megakariocytes
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.
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
What is stored in body M: 18-270 W: 18-160

27. Lymphopenia Causes
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
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.
XRT (radiation and Chemo - inherited immune disorders

28. Hemoglobinopathies
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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.
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

29. Classification of anemia
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
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
Severe infections
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size

30. Hemolytic Anemia
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Vit B 12 and folic acid deficiency
Type of anemia characterized by smaller paler than usual RBC
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe

31. Genetic defects
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
What is stored in body M: 18-270 W: 18-160
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

32. Fibrin
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

33. Basophils are present in....
Parasite infections
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
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
In the bone marrow

34. Patient with Anemia c/o
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
4.5-10
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

35. WBC Count
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
8% of body weight- 5L in women and 5.5L in males
4.5-10
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%

36. By what month in the fetus does the development of the RBC move to the bone marrow?
7th month
Breaking open of the RBC's and release of HgB (spleen)
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)
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

37. HgB/ HCT is decreased with....
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
HbA-2alpha and 2 beta chains
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
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

38. T cell
In the bone marrow
Variation in size
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)

39. Poikilocytosis
Abnormally shaped cells - schiztocyte - tear drop - oval
Cellular Immunity: helper - killer cells: affected with HIV
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
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)

40. Lymphocytosis Causes
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
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
XRT (radiation and Chemo - inherited immune disorders
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

41. Serum Ferritin
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
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
What is stored in body M: 18-270 W: 18-160
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)

42. monocytes are present in....
Severe infections
Standard for reporting the PT
4.5-10
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

43. Intrinsic Hemolytic anemia
8% of body weight- 5L in women and 5.5L in males
M- 75-175 F- 65-165
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
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

44. Coombs Antiglobulin Test
What is stored in body M: 18-270 W: 18-160
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
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)
Acquired or inhereited

45. CBC with differential
Sickle cell - G6PD - thalessemia
Complete blood count with differential: tells what percentage of cells make up the blood
Plasma protein that binds to Fe and helps absorb it - 200-400
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

46. petechiae
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
The flat bones: sternum - pelvis - proximal ends of the long bones
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
low platelet count - skin bleeding - mucosa: especially bleeding of gums

47. Lab findings for Hemolytic anemia
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
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
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

48. Granulocytes
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
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
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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

49. Amount of Hb in Males and Females
Humeral immunity: Ab production
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
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
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

50. Leukocytosis
Erythrocytes - respond to tissue hypoxia and carry O2 to 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
HbF: 2 alpha and 2 gamma
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -