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Hematology Clinical Medicine - I

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1. Neutophilia
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
XRT (radiation and Chemo - inherited immune disorders
T lymph - stem cell
Vit B 12 and folic acid deficiency

2. Bone Marrow Cellularity
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
98% - alpha and beta
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Asymptomatic until 4 months of life

3. Apoptosis
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Less than 1 persent
Programmed cell death (cyto C. and caspases)
low platelet count - skin bleeding - mucosa: especially bleeding of gums

4. Lymphopenia Causes
HbA-2alpha and 2 beta chains
XRT (radiation and Chemo - inherited immune disorders
Confluent areas of bleeding right below the skin
low platelet count - skin bleeding - mucosa: especially bleeding of gums

5. Thallassemia Syndormes
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
Complete blood count with differential: tells what percentage of cells make up the blood
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
volume % of RBC in blood - Female: 36-48 - Males: 42-52

6. Anisocytosis
Abnormal size of cells and vary in abnormality
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
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)
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

7. RBC
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
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
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

8. Reticulocyte
HbF: 2 alpha and 2 gamma
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
Vit B 12 and folic acid deficiency
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

9. Blood clot formation
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
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
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)

10. G-CSF
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
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Growth factor that causes neutraphils to grow
Programmed cell death (cyto C. and caspases)

11. PE for anemia
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

12. CBC with differential
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Complete blood count with differential: tells what percentage of cells make up the blood
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

13. Lymphocytosis Causes
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Male: 14-17 Female: 12-15
Thalessemia - and sickle cell
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)

14. Neutropenia
Skin - tend to bleed also into the muscles and joints
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:
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Palpable - slightly raised areas of bleeding

15. Production of Hemoglobin
O2 bearing molecule and carries 02 throughout the body
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
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Variation in size

16. T 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)
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Cellular Immunity: helper - killer cells: affected with HIV
Lymphoid Leukemia - Mono - acute infections a/w viral diseases

17. Granulocytes
150 -000-450 -000
Growth factor that causes neutraphils to grow
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size

18. Hemolytic Anemia
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
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
Humeral immunity: Ab production
Breaking open of the RBC's and release of HgB (spleen)

19. Agranulocytes
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Confluent areas of bleeding right below the skin
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

20. When is a CBC with difference ordered?
1-2% - alpha and gamma
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
MCV - index for classifying anemia - Norma: 80-100

21. microcytic hypochromic anemia
Fetal Hg - 2 alpha and 2 gamma chains - 1%
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
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Type of anemia characterized by smaller paler than usual RBC

22. Microcytic cells
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
Most abundant protein in the plasma and helps establish the osmotic gradient
XRT (radiation and Chemo - inherited immune disorders

23. 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.
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Asymptomatic until 4 months of life
98% - alpha and beta

24. Coagulation factor deficiency
Skin - tend to bleed also into the muscles and joints
Variation in size
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Lymphoid Leukemia - Mono - acute infections a/w viral diseases

25. anisocytosis
Lymphoid Leukemia - Mono - acute infections a/w viral 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)
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
Variation in size

26. Detection of hemoglobinopathy
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
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

27. Mild forms of thalessemia need to be differentiated from...
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
HbA-2alpha and 2 beta chains
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Encapsulated bacteria: Strep pneumonia and H. Influenza

28. What is the life span of blood cells?
Cellular Immunity: helper - killer cells: affected with HIV
98% - alpha and beta
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
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:

29. Hematopoiesis
Parasite infections
Process by which all blood cells form - develop - and are replaced in the body - blood production
T lymph - stem cell
Type of anemia characterized by smaller paler than usual RBC

30. Hemoglobin
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
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
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
O2 bearing molecule and carries 02 throughout the body

31. Plasma
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
Breaking open of the RBC's and release of HgB (spleen)
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
55% of blood plasma - contains all the blood cells

32. PE of bleeding patient
HbA-2alpha and 2 beta chains
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)
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
Variation in shape

33. Normal Hbg Count
What is stored in body M: 18-270 W: 18-160
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Process by which all blood cells form - develop - and are replaced in the body - blood production
Male: 14-17 Female: 12-15

34. petechiae
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
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)
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it

35. Major Adult Hgb
8% of body weight- 5L in women and 5.5L in males
HbA-2alpha and 2 beta chains
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
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

36. Leukapenia
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
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

37. monocytes are present in....
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
N - M - Meg - RBC
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Severe infections

38. B Cell
Humeral immunity: Ab production
O2 bearing molecule and carries 02 throughout the body
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
T and B lymph

39. von Willebrand Factor
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

40. Thrombopoietin
Less than 1 persent
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)
GF produced by liver and stimulates production of megakariocytes
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

41. Extrinsic hemolytic anemia
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Autoimmnr hypersplensm
MCV: 80-100 - sickle cell anemia - G6PD
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

42. purpura
In the bone marrow
Palpable - slightly raised areas of bleeding
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
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

43. Gestation HgB
HbA-2alpha and 2 beta chains
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
HbF: 2 alpha and 2 gamma
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

44. Proper O2 transport depends on...
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
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
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)

45. Hgb anatomy
Growth factor that causes neutraphils to grow
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
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)
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

46. Serum Ferritin
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
7th month
What is stored in body M: 18-270 W: 18-160
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

47. Blood consists of what cellular elements
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
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.
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)

48. Iron Serum test
Complete blood count with differential: tells what percentage of cells make up the blood
M- 75-175 F- 65-165
Fetal Hg - 2 alpha and 2 gamma chains - 1%
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

49. Hemobglobin A
Severe 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
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
98% - alpha and beta

50. Liver disease
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:
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
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
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection