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Hematology Clinical Medicine - I

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1. Variations with HbA
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
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

2. Plasma
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
55% of blood plasma - contains all the blood cells

3. Hemocrit
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
volume % of RBC in blood - Female: 36-48 - Males: 42-52
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
Standard for reporting the PT

4. Hematopoeisis in adulthood is limited to....
The flat bones: sternum - pelvis - proximal ends of the long bones
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Variation in shape
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)

5. Bleeding D/O laboratory testing
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Standard for reporting the PT
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
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

6. Progenitor cells
Vit B 12 and folic acid deficiency
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)
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

7. Megakariocytes/ Thrombocytes
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
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:
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
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

8. Thrombopoietin
Standard for reporting the PT
8% of body weight- 5L in women and 5.5L in males
N - M - Eo - Meg - B - RBC - stem
GF produced by liver and stimulates production of megakariocytes

9. Hgb anatomy
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
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)
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages

10. Lab findings for Hemolytic anemia
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Encapsulated bacteria: Strep pneumonia and H. Influenza
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

11. INR
HbF: 2 alpha and 2 gamma
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
55% of blood plasma - contains all the blood cells
Standard for reporting the PT

12. PE for anemia
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Asymptomatic until 4 months of life

13. Albumin
Most abundant protein in the plasma and helps establish the osmotic gradient
Acquired or inhereited
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)

14. Mean Corpuscular Volume
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
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
MCV - index for classifying anemia - Norma: 80-100
150 -000-450 -000

15. Alpha globin chain genetics
Humeral immunity: Ab production
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
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
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

16. Platelet Count
Type of anemia characterized by smaller paler than usual RBC
Genetic and rare or acquired
150 -000-450 -000
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

17. Transferrin
Plasma protein that binds to Fe and helps absorb it - 200-400
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs

18. Serum Ferritin
What is stored in body M: 18-270 W: 18-160
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Asymptomatic until 4 months of life

19. Classification of anemia
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Process by which all blood cells form - develop - and are replaced in the body - blood production
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

20. Platelets
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Encapsulated bacteria: Strep pneumonia and H. Influenza
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
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:

21. Hemoglobin A2
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Skin - tend to bleed also into the muscles and joints
1-2% - alpha and gamma
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)

22. Function of Hgb
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
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
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe

23. Decreased Platelets
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Acquired or inhereited
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Growth factor that causes neutraphils to grow

24. Inherited Hemoglobinopathy
The flat bones: sternum - pelvis - proximal ends of the long bones
What is stored in body M: 18-270 W: 18-160
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
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

25. By what month in the fetus does the development of the RBC move to the bone marrow?
XRT (radiation and Chemo - inherited immune disorders
7th month
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

26. Platelet problem
Most abundant protein in the plasma and helps establish the osmotic gradient
Sickle cell - G6PD - thalessemia
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

27. HgB/ HCT is increased with....
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

28. Coombs Antiglobulin Test
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
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

29. Basophils are present in....
Parasite infections
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
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

30. Hemostasis
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Thalessemia - and sickle cell
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)

31. Eosinophilia Causes
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
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
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

32. Mild forms of thalessemia need to be differentiated from...
Process by which all blood cells form - develop - and are replaced in the body - blood production
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
XRT (radiation and Chemo - inherited immune disorders
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

33. petechiae
Complete blood count with differential: tells what percentage of cells make up the blood
1-2% - alpha and gamma
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
O2 bearing molecule and carries 02 throughout the body

34. IL-2
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 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Variation in size
T and B lymph

35. purpura
M- 75-175 F- 65-165
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
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)
Palpable - slightly raised areas of bleeding

36. monocytes are present in....
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Severe infections
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
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)

37. Poikilocytosis
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Abnormally shaped cells - schiztocyte - tear drop - oval
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

38. Hematopoiesis
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)
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
T lymph - stem cell
Process by which all blood cells form - develop - and are replaced in the body - blood production

39. Clotting disorders
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
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

40. Liver disease
Thalessemia - and sickle cell
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:
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Palpable - slightly raised areas of bleeding

41. GM-CSF
HbA-2alpha and 2 beta chains
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
N - M - Meg - RBC
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:

42. Production of Hemoglobin
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)
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

43. Pathology for Thallessemia
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
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
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
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)

44. 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
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Parasite infections
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

45. 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
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)
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
low platelet count - skin bleeding - mucosa: especially bleeding of gums

46. Hemoglobin F
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Less than 1 persent
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
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

47. WBC Count
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%
N - M - Meg - RBC
4.5-10

48. CBC with differential
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
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:
Complete blood count with differential: tells what percentage of cells make up the blood
Programmed cell death (cyto C. and caspases)

49. Elevated MCV
Standard for reporting the PT
Vit B 12 and folic acid deficiency
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

50. G-CSF
Variation in size
Growth factor that causes neutraphils to grow
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
8% of body weight- 5L in women and 5.5L in males