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Hematology Clinical Medicine - I

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1. Intrinsic hemolytic anemia
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
Plasma protein that binds to Fe and helps absorb it - 200-400
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Thalessemia - and sickle cell

2. Erythrocytes
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
N - M - Eo - Meg - B - RBC - stem
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

3. Pathology for Thallessemia
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
1-2% - alpha and gamma
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
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

4. Bone Marrow Cellularity
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:
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
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

5. Hemolysis

6. Microcytic cells
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
8% of body weight- 5L in women and 5.5L in males
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
Lymphoid Leukemia - Mono - acute infections a/w viral diseases

7. Intrinsic Hemolytic anemia
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
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
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
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

8. IL-1
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Abnormal size of cells and vary in abnormality
Plasma protein that binds to Fe and helps absorb it - 200-400
T lymph - stem cell

9. Apoptosis
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe

10. Leukocytosis
T and B lymph
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
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
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

11. Bleeding disoders can be....
Acquired or inhereited
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
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
N - M - Meg - RBC

12. Bleeding D/O laboratory testing
55% of blood plasma - contains all the blood cells
7th month
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
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

13. Anisocytosis
Abnormal size of cells and vary in abnormality
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
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Thalessemia - and sickle cell

14. Lymphocytosis Causes
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Abnormally shaped cells - schiztocyte - tear drop - oval
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

15. HgB/ HCT is increased with....
HbF: 2 alpha and 2 gamma
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

16. Normocytic
HbF: 2 alpha and 2 gamma
MCV: 80-100 - sickle cell anemia - G6PD
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
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%

17. Hypercoagulable states are...
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
Sickle cell - G6PD - thalessemia
The flat bones: sternum - pelvis - proximal ends of the long bones
Genetic and rare or acquired

18. RBC
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
T and B lymph
N - M - Eo - Meg - B - RBC - stem
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

19. Drug Inducted Thrombocytopenia
What is stored in body M: 18-270 W: 18-160
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

20. Mean Corpuscular Volume
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 WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
MCV - index for classifying anemia - Norma: 80-100
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

21. Lab findings for Hemolytic anemia
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
1-2% - alpha and gamma
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
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

22. Blood is produced....
In the bone marrow
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size

23. Serum Ferritin
Palpable - slightly raised areas of bleeding
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
What is stored in body M: 18-270 W: 18-160
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

24. Anemia
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)
Humeral immunity: Ab production
Vit B 12 and folic acid deficiency
Fetal Hg - 2 alpha and 2 gamma chains - 1%

25. Alpha globin chain genetics
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
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
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
HbA-2alpha and 2 beta chains

26. Thallassemia Syndormes
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
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
XRT (radiation and Chemo - inherited immune disorders
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

27. Inherited Hemoglobinopathy
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
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
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
HbA-2alpha and 2 beta chains

28. Hematopoeisis in adulthood is limited to....
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
N - M - Eo - Meg - B - RBC - stem
The flat bones: sternum - pelvis - proximal ends of the long bones
Male: 14-17 Female: 12-15

29. Coagulation factor deficiency
8% of body weight- 5L in women and 5.5L in males
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Skin - tend to bleed also into the muscles and joints

30. Megakariocytes/ Thrombocytes
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Humeral immunity: Ab production

31. purpura
Palpable - slightly raised areas of bleeding
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
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

32. G-CSF
Abnormal size of cells and vary in abnormality
Growth factor that causes neutraphils to grow
Complete blood count with differential: tells what percentage of cells make up the blood
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

33. When is a CBC with difference ordered?
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Encapsulated bacteria: Strep pneumonia and H. Influenza
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

34. Decreased Platelets
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Abnormally shaped cells - schiztocyte - tear drop - oval
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

35. ecchymosis
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Standard for reporting the PT
Confluent areas of bleeding right below the skin
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. Mild forms of thalessemia need to be differentiated from...
What is stored in body M: 18-270 W: 18-160
In the bone marrow
7th month
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

37. Macrocytic cells
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
55% of blood plasma - contains all the blood cells
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

38. Neutropenia
O2 bearing molecule and carries 02 throughout the body
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
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
7th month

39. bleeding disorders
Palpable - slightly raised areas of bleeding
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

40. microcytic hypochromic anemia
Variation in size
Process by which all blood cells form - develop - and are replaced in the body - blood production
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Type of anemia characterized by smaller paler than usual RBC

41. petechiae
Confluent areas of bleeding right below the skin
Autoimmnr hypersplensm
150 -000-450 -000
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it

42. Hemostasis
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
HbA-2alpha and 2 beta chains
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

43. Elevated MCV
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Vit B 12 and folic acid deficiency
N - M - Eo - Meg - B - RBC - stem

44. Hemolytic Anemia
N - M - Eo - Meg - B - RBC - stem
Cellular Immunity: helper - killer cells: affected with HIV
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe

45. Blood Facts
XRT (radiation and Chemo - inherited immune disorders
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
1-2% - alpha and gamma
8% of body weight- 5L in women and 5.5L in males

46. beta globin chain genetic
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
GF produced by liver and stimulates production of megakariocytes
In the bone marrow
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

47. Platelet Count
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
150 -000-450 -000
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
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)

48. Erythropoiesis
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
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
XRT (radiation and Chemo - inherited immune disorders

49. Platelet problem
low platelet count - skin bleeding - mucosa: especially bleeding of gums
1-2% - alpha and 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
Asymptomatic until 4 months of life

50. Blood cells transport mechanism
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
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
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
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases