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Hematology Clinical Medicine - I

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1. IL- 3
N - M - Eo - Meg - B - RBC - stem
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
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

2. Transferrin
Thalessemia - and sickle cell
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Plasma protein that binds to Fe and helps absorb it - 200-400
What is stored in body M: 18-270 W: 18-160

3. Blood cells transport mechanism
MCV: 80-100 - sickle cell anemia - G6PD
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
Thalessemia - and sickle cell
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

4. Megakariocytes/ Thrombocytes
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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
N - M - Meg - RBC
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

5. HbF
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Fetal Hg - 2 alpha and 2 gamma chains - 1%
7th month
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease

6. Basophils are present in....
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
Parasite infections
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

7. Hemobglobin A
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
98% - alpha and beta
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)
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

8. Eosinophilia Causes
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
N - M - Eo - Meg - B - RBC - stem

9. Hemocrit
Asymptomatic until 4 months of life
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Cellular Immunity: helper - killer cells: affected with HIV

10. Neutophilia
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Variation in shape
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

11. Heme- Heme interction
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)
8% of body weight- 5L in women and 5.5L in males
Complete blood count with differential: tells what percentage of cells make up the blood
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

12. bleeding disorders
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Plasma protein that binds to Fe and helps absorb it - 200-400
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

13. Hematopoietic Stem cells
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Encapsulated bacteria: Strep pneumonia and H. Influenza
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
volume % of RBC in blood - Female: 36-48 - Males: 42-52

14. IL-1
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
In the bone marrow
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
T lymph - stem cell

15. Bone Marrow Cellularity
Standard for reporting the PT
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
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. Hematopoiesis
Process by which all blood cells form - develop - and are replaced in the body - blood production
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

17. Thallassemia Syndormes
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Standard for reporting the PT
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
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

18. HgB/ HCT is increased with....
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
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)

19. Major Adult Hgb
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
HbA-2alpha and 2 beta chains
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Humeral immunity: Ab production

20. Fibrin
Palpable - slightly raised areas of bleeding
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
N - M - Meg - RBC
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)

21. Progenitor cells
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
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
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%

22. anisocytosis
M- 75-175 F- 65-165
Variation in size
T lymph - stem cell
Breaking open of the RBC's and release of HgB (spleen)

23. Specific disease of anemia
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
1-2% - alpha and gamma
Sickle cell - G6PD - thalessemia

24. Plasma
55% of blood plasma - contains all the blood cells
98% - alpha and beta
Sickle cell - G6PD - thalessemia
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

25. Decreased MCV
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)
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
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Parasite infections

26. Approach to a bleeding patient
98% - alpha and beta
Male: 14-17 Female: 12-15
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
Abnormally shaped cells - schiztocyte - tear drop - oval

27. Function of Hgb
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
low platelet count - skin bleeding - mucosa: especially bleeding of gums
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
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

28. Intrinsic hemolytic anemia
Skin - tend to bleed also into the muscles and joints
Thalessemia - and sickle cell
HbA-2alpha and 2 beta chains
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin

29. Variations with HbA
In the bone marrow
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Breaking open of the RBC's and release of HgB (spleen)
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population

30. Bleeding D/O laboratory testing
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
Type of anemia characterized by smaller paler than usual RBC
Variation in size
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

31. Hemostasis
Variation in shape
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Humeral immunity: Ab production
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population

32. Acquired Disorders
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
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Palpable - slightly raised areas of bleeding
1-2% - alpha and gamma

33. Granulocytes
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size

34. IL-2
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.
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
T and B lymph

35. Apoptosis
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Sickle cell - G6PD - thalessemia
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

36. Liver disease
Male: 14-17 Female: 12-15
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
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:

37. Pathology for Thallessemia
T and B lymph
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)
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
Less than 1 persent

38. Blood is produced....
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
In the bone marrow
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Acquired or inhereited

39. Bleeding disoders can be....
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Acquired or inhereited
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
The flat bones: sternum - pelvis - proximal ends of the long bones

40. Blood consists of what cellular elements
98% - alpha and beta
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

41. Hemoglobinopathies
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
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.
1-2% - alpha and gamma
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages

42. Mean Corpuscular Volume
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
MCV - index for classifying anemia - Norma: 80-100
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
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

43. Gestation HgB
Encapsulated bacteria: Strep pneumonia and H. Influenza
Most abundant protein in the plasma and helps establish the osmotic gradient
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
HbF: 2 alpha and 2 gamma

44. Microcytic cells
Vit B 12 and folic acid deficiency
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
150 -000-450 -000
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

45. Erythrocytes
Severe 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
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

46. Serum Ferritin
7th month
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
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

47. Production of 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
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)
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

48. Macrocytic cells
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:
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
98% - alpha and beta

49. GM-CSF
N - M - Meg - RBC
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages

50. 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
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
O2 bearing molecule and carries 02 throughout the body
Parasite infections