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Hematology Clinical Medicine - I

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1. Lymphopenia Causes
Standard for reporting the PT
Variation in size
XRT (radiation and Chemo - inherited immune disorders
8% of body weight- 5L in women and 5.5L in males

2. 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
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
In the bone marrow
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

3. WBC Count
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Sickle cell - G6PD - thalessemia
4.5-10

4. Acquired Disorders
Asymptomatic until 4 months of life
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
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
Confluent areas of bleeding right below the skin

5. INR
Standard for reporting the PT
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
HbA-2alpha and 2 beta chains
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

6. Albumin
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Most abundant protein in the plasma and helps establish the osmotic gradient
Skin - tend to bleed also into the muscles and joints
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

7. beta globin chain genetic
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
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
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
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:

8. Clotting disorders
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:
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)

9. Mean Corpuscular Volume
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Variation in shape
volume % of RBC in blood - Female: 36-48 - Males: 42-52
MCV - index for classifying anemia - Norma: 80-100

10. Extrinsic hemolytic anemia
Autoimmnr hypersplensm
Vit B 12 and folic acid deficiency
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

11. petechiae
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
7th month
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

12. Platelets
Asymptomatic until 4 months of life
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
T lymph - stem cell
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages

13. Transferrin
Autoimmnr hypersplensm
Plasma protein that binds to Fe and helps absorb it - 200-400
N - M - Meg - RBC
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

14. Anisocytosis
Abnormal size of cells and vary in abnormality
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
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
Male: 14-17 Female: 12-15

15. Eosinophilia Causes
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
In the bone marrow
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
Plasma protein that binds to Fe and helps absorb it - 200-400

16. RBC
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Genetic and rare or acquired
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)

17. When is a CBC with difference ordered?
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Thalessemia - and sickle cell
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs

18. IL- 3
7th month
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
N - M - Eo - Meg - B - RBC - stem

19. Hemolysis

20. Platelet problem
Autoimmnr hypersplensm
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
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Encapsulated bacteria: Strep pneumonia and H. Influenza

21. Bleeding/ Hypercoagulation disorders
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
Plasma protein that binds to Fe and helps absorb it - 200-400
150 -000-450 -000

22. Lab findings for Hemolytic anemia
1-2% - alpha and gamma
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

23. Elevated MCV
Vit B 12 and folic acid deficiency
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
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Most abundant protein in the plasma and helps establish the osmotic gradient

24. HgB/ HCT is decreased with....
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
55% of blood plasma - contains all the blood cells
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
98% - alpha and beta

25. Bleeding disoders can be....
Standard for reporting the PT
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
Palpable - slightly raised areas of bleeding
Acquired or inhereited

26. Alpha globin chain genetics
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
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
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
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

27. Liver disease
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
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:
Growth factor that causes neutraphils to grow
Acquired or inhereited

28. Inherited Hemoglobinopathy
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
Variation in shape
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
7th month

29. Bone Marrow Cellularity
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
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)
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor

30. G-CSF
Growth factor that causes neutraphils to grow
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Vit B 12 and folic acid deficiency

31. purpura
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Palpable - slightly raised areas of bleeding
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

32. Reticulocyte count
T lymph - stem cell
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
Encapsulated bacteria: Strep pneumonia and H. Influenza
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

33. Mild forms of thalessemia need to be differentiated from...
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
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
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Humeral immunity: Ab production

34. HgB/ HCT is increased with....
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
MCV: 80-100 - sickle cell anemia - G6PD
Type of anemia characterized by smaller paler than usual RBC
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)

35. Decreased 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)
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
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

36. Proper O2 transport depends on...
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Abnormally shaped cells - schiztocyte - tear drop - oval
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

37. Hemolytic Anemia
Standard for reporting the PT
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
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
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

38. microcytic hypochromic anemia
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Cellular Immunity: helper - killer cells: affected with HIV
Type of anemia characterized by smaller paler than usual RBC
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

39. Abnormality in beta chain are present....
Most abundant protein in the plasma and helps establish the osmotic gradient
Genetic and rare or acquired
Asymptomatic until 4 months of life
Male: 14-17 Female: 12-15

40. Lymphocytosis Causes
volume % of RBC in blood - Female: 36-48 - Males: 42-52
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

41. Amount of Hb in Males and Females
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
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
Growth factor that causes neutraphils to grow

42. ecchymosis
Most abundant protein in the plasma and helps establish the osmotic gradient
Confluent areas of bleeding right below the skin
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
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)

43. Serum Ferritin
Male: 14-17 Female: 12-15
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
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.
What is stored in body M: 18-270 W: 18-160

44. von Willebrand Factor
Male: 14-17 Female: 12-15
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Autoimmnr hypersplensm
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

45. Major Adult Hgb
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
HbA-2alpha and 2 beta chains
In the bone marrow
The flat bones: sternum - pelvis - proximal ends of the long bones

46. Anemia
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
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)
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
Programmed cell death (cyto C. and caspases)

47. Agranulocytes
The flat bones: sternum - pelvis - proximal ends of the long bones
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

48. By what month in the fetus does the development of the RBC move to the bone marrow?
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Genetic and rare or acquired
Process by which all blood cells form - develop - and are replaced in the body - blood production
7th month

49. Neutophilia
Humeral immunity: Ab production
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Breaking open of the RBC's and release of HgB (spleen)
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning

50. Decreased MCV
Abnormally shaped cells - schiztocyte - tear drop - oval
N - M - Meg - RBC
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Erythrocytes - respond to tissue hypoxia and carry O2 to the body