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Hematology Clinical Medicine - I

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1. Genetic defects
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
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
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
N - M - Eo - Meg - B - RBC - stem

2. ecchymosis
1-2% - alpha and gamma
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Confluent areas of bleeding right below the skin

3. Blood cells transport mechanism
150 -000-450 -000
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
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
Encapsulated bacteria: Strep pneumonia and H. Influenza

4. Eosinophilia Causes
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
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
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

5. Hgb anatomy
Autoimmnr hypersplensm
98% - alpha and beta
1-2% - alpha and gamma
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)

6. Mild forms of thalessemia need to be differentiated from...
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
O2 bearing molecule and carries 02 throughout the body
N - M - Meg - RBC
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

7. petechiae
The flat bones: sternum - pelvis - proximal ends of the long bones
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Process by which all blood cells form - develop - and are replaced in the body - blood production
Parasite infections

8. Platelets
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
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
T and B lymph

9. Blood Facts
8% of body weight- 5L in women and 5.5L in males
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
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

10. Reticulocyte count
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
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

11. Intrinsic hemolytic anemia
Acquired or inhereited
Complete blood count with differential: tells what percentage of cells make up the blood
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Thalessemia - and sickle cell

12. INR
Standard for reporting the PT
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
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
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

13. HgB/ HCT is increased with....
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
7th month
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

14. Classification of anemia
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
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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

15. Lab findings for Hemolytic anemia
Male: 14-17 Female: 12-15
98% - alpha and beta
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)

16. Detection of hemoglobinopathy
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
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Growth factor that causes neutraphils to grow
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

17. By what month in the fetus does the development of the RBC move to the bone marrow?
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
7th month
4.5-10
Variation in size

18. Amount of Hb in Males and Females
Most abundant protein in the plasma and helps establish the osmotic gradient
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Parasite infections
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)

19. Blood is produced....
1-2% - alpha and gamma
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
55% of blood plasma - contains all the blood cells
In the bone marrow

20. Basophils are present in....
Thalessemia - and sickle cell
Parasite infections
O2 bearing molecule and carries 02 throughout the body
Growth factor that causes neutraphils to grow

21. Erythrocytes
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.
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
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
Humeral immunity: Ab production

22. What is the life span of blood cells?
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Variation in shape
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

23. Neutropenia
Growth factor that causes neutraphils to grow
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
8% of body weight- 5L in women and 5.5L in males
Severe infections

24. Megakariocytes/ Thrombocytes
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Male: 14-17 Female: 12-15
Breaking open of the RBC's and release of HgB (spleen)

25. Decreased Platelets
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
Acquired or inhereited
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
M- 75-175 F- 65-165

26. Transferrin
Plasma protein that binds to Fe and helps absorb it - 200-400
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
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
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

27. Anisocytosis
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Abnormal size of cells and vary in abnormality
Less than 1 persent
4.5-10

28. Serum Ferritin
What is stored in body M: 18-270 W: 18-160
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
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
HbF: 2 alpha and 2 gamma

29. microcytic hypochromic anemia
Type of anemia characterized by smaller paler than usual RBC
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
Parasite infections
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

30. Apoptosis
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
4.5-10

31. 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
T lymph - stem cell
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
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

32. Hemoglobin F
Less than 1 persent
98% - alpha and beta
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Palpable - slightly raised areas of bleeding

33. Hemoglobin
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
O2 bearing molecule and carries 02 throughout the body
HbF: 2 alpha and 2 gamma

34. Bacteria that patients with sickle cell anemia are at risk for
Encapsulated bacteria: Strep pneumonia and H. Influenza
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Abnormal size of cells and vary in abnormality
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

35. Anemia
Variation in shape
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)
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
GF produced by liver and stimulates production of megakariocytes

36. Specific disease of anemia
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Sickle cell - G6PD - thalessemia
Most abundant protein in the plasma and helps establish the osmotic gradient

37. Neutophilia
M- 75-175 F- 65-165
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
T and B lymph

38. RBC
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Plasma protein that binds to Fe and helps absorb it - 200-400

39. Pathology for Thallessemia
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
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
Cellular Immunity: helper - killer cells: affected with HIV

40. Hemoglobinopathies
Less than 1 persent
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.
Autoimmnr hypersplensm
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)

41. Hemolytic Anemia
Male: 14-17 Female: 12-15
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Growth factor that causes neutraphils to grow
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions

42. Hypercoagulable states are...
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
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
Genetic and rare or acquired

43. 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
Vit B 12 and folic acid deficiency
HbA-2alpha and 2 beta chains
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

44. Coombs Antiglobulin Test
HbA-2alpha and 2 beta 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
N - M - Eo - Meg - B - RBC - stem
low platelet count - skin bleeding - mucosa: especially bleeding of gums

45. Leukocytosis
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Abnormally shaped cells - schiztocyte - tear drop - oval
N - M - Eo - Meg - B - RBC - stem
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

46. monocytes are present in....
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Severe infections
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
Autoimmnr hypersplensm

47. Platelet Count
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Variation in shape
150 -000-450 -000
M- 75-175 F- 65-165

48. Bleeding/ Hypercoagulation disorders
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
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:

49. IL-1
In the bone marrow
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
T lymph - stem cell

50. Hemocrit
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances