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Hematology Clinical Medicine - I

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1. petechiae
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
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
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.

2. INR
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)
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
Standard for reporting the PT
Programmed cell death (cyto C. and caspases)

3. HbA
7th month
Plasma protein that binds to Fe and helps absorb it - 200-400
4.5-10
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%

4. beta globin chain genetic
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Plasma protein that binds to Fe and helps absorb it - 200-400
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
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

5. T cell
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Variation in shape
Cellular Immunity: helper - killer cells: affected with HIV

6. Acquired Disorders
Autoimmnr hypersplensm
Confluent areas of bleeding right below the skin
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
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. Bone Marrow Cellularity
Complete blood count with differential: tells what percentage of cells make up the blood
Less than 1 persent
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
O2 bearing molecule and carries 02 throughout the body

8. Microcytic cells
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
HbA-2alpha and 2 beta chains
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Acquired or inhereited

9. Platelet Count
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
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
150 -000-450 -000
T and B lymph

10. Apoptosis
GF produced by liver and stimulates production of megakariocytes
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Programmed cell death (cyto C. and caspases)
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets

11. Alpha globin chain genetics
Vit B 12 and folic acid deficiency
4.5-10
Growth factor that causes neutraphils to grow
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

12. Megakariocytes/ Thrombocytes
M- 75-175 F- 65-165
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
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
Thalessemia - and sickle cell

13. Bleeding disoders can be....
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
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
Acquired or inhereited
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor

14. Function of Hgb
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
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
volume % of RBC in blood - Female: 36-48 - Males: 42-52
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

15. Elevated MCV
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
Vit B 12 and folic acid deficiency
Palpable - slightly raised areas of bleeding
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

16. Proper O2 transport depends on...
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Genetic and rare or acquired
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

17. 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
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
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
Process by which all blood cells form - develop - and are replaced in the body - blood production

18. Fibrin
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
4.5-10

19. IL-2
What is stored in body M: 18-270 W: 18-160
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
T and B lymph

20. Hemoglobinopathies
150 -000-450 -000
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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
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.

21. bleeding disorders
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
Process by which all blood cells form - develop - and are replaced in the body - blood production
Sickle cell - G6PD - thalessemia

22. Blood consists of what cellular elements
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
MCV: 80-100 - sickle cell anemia - G6PD
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma

23. poikilocytosis
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
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)
Variation in shape
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

24. Extrinsic hemolytic anemia
8% of body weight- 5L in women and 5.5L in males
Autoimmnr hypersplensm
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
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

25. Apoptosis
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
T lymph - stem cell

26. Intrinsic Hemolytic anemia
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
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

27. Hemocrit
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Less than 1 persent

28. What is the life span of blood cells?
M- 75-175 F- 65-165
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Most abundant protein in the plasma and helps establish the osmotic gradient

29. Erythropoiesis
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Cellular Immunity: helper - killer cells: affected with HIV
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
7th month

30. Intrinsic hemolytic anemia
Fetal Hg - 2 alpha and 2 gamma chains - 1%
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
Thalessemia - and sickle cell
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

31. Hemoglobin
Acquired or inhereited
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
N - M - Eo - Meg - B - RBC - stem
O2 bearing molecule and carries 02 throughout the body

32. Drug Inducted Thrombocytopenia
Cellular Immunity: helper - killer cells: affected with HIV
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
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

33. Anisocytosis
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Abnormal size of cells and vary in abnormality
Programmed cell death (cyto C. and caspases)

34. Inherited Hemoglobinopathy
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
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
Asymptomatic until 4 months of life

35. 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
Sickle cell - G6PD - thalessemia
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

36. Genetic defects
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

37. What do growth factors do?
Genetic and rare or acquired
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
8% of body weight- 5L in women and 5.5L in males
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

38. IL-1
Variation in shape
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Standard for reporting the PT
T lymph - stem cell

39. Lymphopenia Causes
Variation in shape
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
XRT (radiation and Chemo - inherited immune disorders

40. Classification of anemia
55% of blood plasma - contains all the blood cells
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
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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size

41. Anemia developes because
Type of anemia characterized by smaller paler than usual RBC
T and B lymph
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

42. Platelet problem
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up 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.
XRT (radiation and Chemo - inherited immune disorders
low platelet count - skin bleeding - mucosa: especially bleeding of gums

43. Hemolytic Anemia
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
N - M - Eo - Meg - B - RBC - stem
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

44. Neutropenia
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
The flat bones: sternum - pelvis - proximal ends of the long bones
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets

45. Variations with HbA
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
MCV - index for classifying anemia - Norma: 80-100
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size

46. Gestation HgB
Genetic and rare or acquired
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
HbF: 2 alpha and 2 gamma
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

47. Hypercoagulable states are...
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
GF produced by liver and stimulates production of megakariocytes
N - M - Eo - Meg - B - RBC - stem
Genetic and rare or acquired

48. Lab findings for Hemolytic anemia
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
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
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
Plasma protein that binds to Fe and helps absorb it - 200-400

49. Blood clot formation
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
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
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

50. By what month in the fetus does the development of the RBC move to the bone marrow?
7th month
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Breaking open of the RBC's and release of HgB (spleen)