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Hematology Clinical Medicine - I

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1. G-CSF
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Growth factor that causes neutraphils to grow
Encapsulated bacteria: Strep pneumonia and H. Influenza

2. Detection of hemoglobinopathy
HbA-2alpha and 2 beta chains
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
150 -000-450 -000
Asymptomatic until 4 months of life

3. ecchymosis
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Confluent areas of bleeding right below the skin
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:
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

4. Coagulation factor deficiency
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
7th month
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
Skin - tend to bleed also into the muscles and joints

5. Lymphopenia Causes
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
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
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
XRT (radiation and Chemo - inherited immune disorders

6. Approach to a bleeding patient
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
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
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
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

7. beta globin chain genetic
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
Sickle cell - G6PD - thalessemia
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
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA

8. CBC with differential
Complete blood count with differential: tells what percentage of cells make up the blood
In the bone marrow
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

9. monocytes are present in....
Type of anemia characterized by smaller paler than usual RBC
Severe infections
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
1-2% - alpha and gamma

10. Thrombopoietin
GF produced by liver and stimulates production of megakariocytes
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
HbF: 2 alpha and 2 gamma

11. Drug Inducted Thrombocytopenia
Skin - tend to bleed also into the muscles and joints
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Complete blood count with differential: tells what percentage of cells make up the blood

12. Elevated MCV
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Vit B 12 and folic acid deficiency
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

13. Bleeding D/O laboratory testing
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
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
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
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

14. Anemia
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
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)
Breaking open of the RBC's and release of HgB (spleen)
In the bone marrow

15. Macrocytic cells
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Programmed cell death (cyto C. and caspases)
volume % of RBC in blood - Female: 36-48 - Males: 42-52

16. Liver disease
MCV - index for classifying anemia - Norma: 80-100
What is stored in body M: 18-270 W: 18-160
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:
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets

17. Extrinsic hemolytic anemia
Encapsulated bacteria: Strep pneumonia and H. Influenza
98% - alpha and beta
Autoimmnr hypersplensm
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions

18. Coombs Antiglobulin Test
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
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

19. Normocytic
MCV: 80-100 - sickle cell anemia - G6PD
1-2% - alpha and gamma
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
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

20. Alpha globin chain genetics
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.
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
Most abundant protein in the plasma and helps establish the osmotic gradient

21. Hemolysis

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22. Neutophilia
T lymph - stem cell
8% of body weight- 5L in women and 5.5L in males
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases

23. Lymphocytosis Causes
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Skin - tend to bleed also into the muscles and joints

24. PE for anemia
Less than 1 persent
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
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)

25. Specific disease of anemia
55% of blood plasma - contains all the blood cells
Sickle cell - G6PD - thalessemia
Plasma protein that binds to Fe and helps absorb it - 200-400
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

26. IL-1
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
T lymph - stem cell
HbF: 2 alpha and 2 gamma
In the bone marrow

27. Reticulocyte
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
HbF: 2 alpha and 2 gamma
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
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

28. Decreased MCV
HbA-2alpha and 2 beta chains
Programmed cell death (cyto C. and caspases)
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
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

29. Mild forms of thalessemia need to be differentiated from...
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
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
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Fetal Hg - 2 alpha and 2 gamma chains - 1%

30. Fibrin
O2 bearing molecule and carries 02 throughout the body
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets

31. By what month in the fetus does the development of the RBC move to the bone marrow?
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
7th month
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
150 -000-450 -000

32. Hemoglobin
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Breaking open of the RBC's and release of HgB (spleen)
O2 bearing molecule and carries 02 throughout the body
Most abundant protein in the plasma and helps establish the osmotic gradient

33. Thallassemia Syndormes
Breaking open of the RBC's and release of HgB (spleen)
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
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

34. Normal Hbg Count
Process by which all blood cells form - develop - and are replaced in the body - blood production
Male: 14-17 Female: 12-15
Genetic and rare or acquired
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

35. Erythropoiesis
Male: 14-17 Female: 12-15
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Confluent areas of bleeding right below the skin

36. Mean Corpuscular Volume
T and B lymph
MCV - index for classifying anemia - Norma: 80-100
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Genetic and rare or acquired

37. Hemostasis
Autoimmnr hypersplensm
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
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)

38. HbA
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
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
Male: 14-17 Female: 12-15

39. 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
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)

40. Clotting disorders
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

41. Amount of Hb in Males and Females
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
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
4.5-10
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen

42. Leukocytosis
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
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
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances

43. Classification of anemia
Abnormally shaped cells - schiztocyte - tear drop - oval
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
Standard for reporting the PT

44. Blood consists of what cellular elements
Most abundant protein in the plasma and helps establish the osmotic gradient
150 -000-450 -000
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

45. Hemoglobinopathies
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.
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)

46. Bacteria that patients with sickle cell anemia are at risk for
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
T and B lymph
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Encapsulated bacteria: Strep pneumonia and H. Influenza

47. Major Adult Hgb
HbA-2alpha and 2 beta chains
Breaking open of the RBC's and release of HgB (spleen)
GF produced by liver and stimulates production of megakariocytes
Standard for reporting the PT

48. Hemolytic Anemia
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Cellular Immunity: helper - killer cells: affected with HIV
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

49. Gestation HgB
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
HbF: 2 alpha and 2 gamma
Parasite infections
7th month

50. Genetic defects
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Variation in shape
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites