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Hematology Clinical Medicine - I

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1. Mild forms of thalessemia need to be differentiated from...
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Genetic and rare or acquired
98% - alpha and beta
MCV - index for classifying anemia - Norma: 80-100

2. Hematopoeisis in adulthood is limited to....
The flat bones: sternum - pelvis - proximal ends of the long bones
Parasite infections
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

3. beta globin chain genetic
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
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
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
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

4. Normocytic
MCV: 80-100 - sickle cell anemia - G6PD
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
MCV - index for classifying anemia - Norma: 80-100
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

5. IL-2
T and B lymph
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Fetal Hg - 2 alpha and 2 gamma chains - 1%

6. Neutropenia
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
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
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets

7. ecchymosis
Confluent areas of bleeding right below the skin
GF produced by liver and stimulates production of megakariocytes
7th month
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation

8. Inherited Hemoglobinopathy
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
1-2% - alpha and 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
Male: 14-17 Female: 12-15

9. Hematopoiesis
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Process by which all blood cells form - develop - and are replaced in the body - blood production

10. Apoptosis
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
XRT (radiation and Chemo - inherited immune disorders
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
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.

11. microcytic hypochromic anemia
Skin - tend to bleed also into the muscles and joints
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Type of anemia characterized by smaller paler than usual RBC

12. RBC
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
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

13. Composition of HgB
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
GF produced by liver and stimulates production of megakariocytes
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
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

14. Agranulocytes
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Abnormal size of cells and vary in abnormality
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
150 -000-450 -000

15. Progenitor cells
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
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Variation in shape
Fetal Hg - 2 alpha and 2 gamma chains - 1%

16. Plasma
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
55% of blood plasma - contains all the blood cells
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

17. Basophils are present in....
Parasite infections
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Variation in size
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)

18. anisocytosis
GF produced by liver and stimulates production of megakariocytes
Variation in size
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe

19. Blood cells transport mechanism
Breaking open of the RBC's and release of HgB (spleen)
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
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
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

20. Major Adult Hgb
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
HbA-2alpha and 2 beta chains
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
Breaking open of the RBC's and release of HgB (spleen)

21. Bacteria that patients with sickle cell anemia are at risk for
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Encapsulated bacteria: Strep pneumonia and H. Influenza
150 -000-450 -000
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

22. HgB/ HCT is decreased with....
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Acquired or inhereited
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

23. Poikilocytosis
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)
Autoimmnr hypersplensm
Abnormally shaped cells - schiztocyte - tear drop - oval
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

24. Eosinophilia Causes
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
GF produced by liver and stimulates production of megakariocytes

25. Hemolytic 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
Programmed cell death (cyto C. and caspases)
In the bone marrow
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

26. Iron Serum test
M- 75-175 F- 65-165
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Variation in size
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

27. Macrocytic cells
Programmed cell death (cyto C. and caspases)
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Abnormal size of cells and vary in abnormality
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

28. Leukapenia
Male: 14-17 Female: 12-15
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)

29. petechiae
O2 bearing molecule and carries 02 throughout the body
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
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
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it

30. Platelet Count
150 -000-450 -000
Sickle cell - G6PD - thalessemia
HbF: 2 alpha and 2 gamma
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

31. Serum Ferritin
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
What is stored in body M: 18-270 W: 18-160
M- 75-175 F- 65-165
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

32. Albumin
O2 bearing molecule and carries 02 throughout the body
98% - alpha and beta
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Most abundant protein in the plasma and helps establish the osmotic gradient

33. Granulocytes
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
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:
XRT (radiation and Chemo - inherited immune disorders
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

34. 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)
8% of body weight- 5L in women and 5.5L in males
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.
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)

35. HbA
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
Autoimmnr hypersplensm
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

36. Bleeding disoders can be....
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
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Acquired or inhereited
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

37. Alpha globin chain genetics
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
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)

38. Coagulation factor deficiency
Skin - tend to bleed also into the muscles and joints
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)
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
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

39. Hemolytic Anemia
O2 bearing molecule and carries 02 throughout the body
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
Autoimmnr hypersplensm
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe

40. Blood Facts
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
55% of blood plasma - contains all the blood cells
8% of body weight- 5L in women and 5.5L in males

41. When is a CBC with difference ordered?
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
4.5-10
Confluent areas of bleeding right below the skin

42. INR
Standard for reporting the PT
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
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
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma

43. GM-CSF
N - M - Meg - RBC
In the bone marrow
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
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

44. Blood clot formation
7th month
T lymph - stem cell
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen

45. WBC Count
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
4.5-10
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
T and B lymph

46. Genetic defects
HbA-2alpha and 2 beta chains
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
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population

47. Platelet problem
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
low platelet count - skin bleeding - mucosa: especially bleeding of gums
150 -000-450 -000
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

48. Microcytic cells
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
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.

49. Function of Hgb
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
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)
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
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)

50. Megakariocytes/ Thrombocytes
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Confluent areas of bleeding right below the skin
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
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