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Hematology Clinical Medicine - I

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1. Clotting disorders
Vit B 12 and folic acid deficiency
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Complete blood count with differential: tells what percentage of cells make up the blood
Thalessemia - and sickle cell

2. Leukapenia
Parasite infections
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
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
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

3. 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
1-2% - alpha and gamma
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning

4. Hematopoiesis
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
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
Process by which all blood cells form - develop - and are replaced in the body - blood production
Variation in size

5. Iron Serum test
M- 75-175 F- 65-165
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Autoimmnr hypersplensm
Skin - tend to bleed also into the muscles and joints

6. Apoptosis
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA

7. Intrinsic hemolytic anemia
M- 75-175 F- 65-165
Thalessemia - and sickle cell
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)

8. Hemolysis

9. INR
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Standard for reporting the PT
Variation in size
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

10. Hemoglobin
O2 bearing molecule and carries 02 throughout the body
In the bone marrow
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

11. IL-2
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)
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
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
T and B lymph

12. Hemobglobin A
Severe infections
Encapsulated bacteria: Strep pneumonia and H. Influenza
98% - alpha and beta
Complete blood count with differential: tells what percentage of cells make up the blood

13. PE for anemia
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
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.

14. Neutophilia
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
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
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases

15. Hemoglobin A2
Severe infections
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
1-2% - alpha and gamma
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

16. Specific disease of anemia
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)
Sickle cell - G6PD - thalessemia
Less than 1 persent
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

17. Blood is produced....
In the bone marrow
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
HbA-2alpha and 2 beta chains
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

18. purpura
1-2% - alpha and gamma
XRT (radiation and Chemo - inherited immune disorders
Abnormally shaped cells - schiztocyte - tear drop - oval
Palpable - slightly raised areas of bleeding

19. Proper O2 transport depends on...
8% of body weight- 5L in women and 5.5L in males
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
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances

20. Hemocrit
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
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
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

21. microcytic hypochromic anemia
150 -000-450 -000
Type of anemia characterized by smaller paler than usual RBC
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor

22. Eosinophilia Causes
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
low platelet count - skin bleeding - mucosa: especially bleeding of gums

23. Elevated MCV
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
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
Vit B 12 and folic acid deficiency
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)

24. Anemia
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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)
Palpable - slightly raised areas of bleeding

25. Fibrin
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
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets

26. Gestation HgB
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
HbF: 2 alpha and 2 gamma
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
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

27. Classification of anemia
N - M - Eo - Meg - B - RBC - stem
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

28. Basophils are present in....
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Parasite infections
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

29. 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)
N - M - Meg - RBC
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Growth factor that causes neutraphils to grow

30. Erythropoietin
volume % of RBC in blood - Female: 36-48 - Males: 42-52
T and B lymph
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
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

31. Major Adult Hgb
Plasma protein that binds to Fe and helps absorb it - 200-400
HbA-2alpha and 2 beta chains
Sickle cell - G6PD - thalessemia
Abnormally shaped cells - schiztocyte - tear drop - oval

32. Decreased MCV
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.
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
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning

33. Bleeding/ Hypercoagulation disorders
What is stored in body M: 18-270 W: 18-160
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
1-2% - alpha and gamma

34. 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
Confluent areas of bleeding right below the skin
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
In the bone marrow

35. Hemoglobin F
98% - alpha and beta
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Less than 1 persent
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

36. Transferrin
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Plasma protein that binds to Fe and helps absorb it - 200-400
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

37. Progenitor cells
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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
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
Sickle cell - G6PD - thalessemia

38. Albumin
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
4.5-10
98% - alpha and beta
Most abundant protein in the plasma and helps establish the osmotic gradient

39. Leukocytosis
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
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
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

40. Poikilocytosis
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
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Humeral immunity: Ab production
Abnormally shaped cells - schiztocyte - tear drop - oval

41. Platelets
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Fetal Hg - 2 alpha and 2 gamma chains - 1%
M- 75-175 F- 65-165
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages

42. Plasma
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
55% of blood plasma - contains all the blood cells
N - M - Meg - RBC
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)

43. Function of Hgb
Variation in shape
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
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
Complete blood count with differential: tells what percentage of cells make up the blood

44. Bleeding disoders can be....
HbA-2alpha and 2 beta chains
55% of blood plasma - contains all the blood cells
Acquired or inhereited
Growth factor that causes neutraphils to grow

45. T cell
Sickle cell - G6PD - thalessemia
55% of blood plasma - contains all the blood cells
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
Cellular Immunity: helper - killer cells: affected with HIV

46. Thallassemia Syndormes
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
XRT (radiation and Chemo - inherited immune disorders
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
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

47. Amount of Hb in Males and Females
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

48. G-CSF
Palpable - slightly raised areas of bleeding
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Growth factor that causes neutraphils to grow

49. Megakariocytes/ Thrombocytes
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Severe infections
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions

50. Anisocytosis
Autoimmnr hypersplensm
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:
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Abnormal size of cells and vary in abnormality