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Hematology Clinical Medicine - I

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1. G-CSF
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
N - M - Meg - RBC
Growth factor that causes neutraphils to grow
Encapsulated bacteria: Strep pneumonia and H. Influenza

2. Progenitor cells
GF produced by liver and stimulates production of megakariocytes
Most abundant protein in the plasma and helps establish the osmotic gradient
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
HbF: 2 alpha and 2 gamma

3. HbA
Autoimmnr hypersplensm
Severe infections
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
7th month

4. IL-2
T and B lymph
Asymptomatic until 4 months of life
Autoimmnr hypersplensm
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

5. Agranulocytes
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
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
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
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

6. Granulocytes
The flat bones: sternum - pelvis - proximal ends of the long bones
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
150 -000-450 -000
N - M - Eo - Meg - B - RBC - stem

7. petechiae
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
What is stored in body M: 18-270 W: 18-160
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
Skin - tend to bleed also into the muscles and joints

8. B Cell
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Most abundant protein in the plasma and helps establish the osmotic gradient
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Humeral immunity: Ab production

9. Liver disease
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
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
Humeral immunity: Ab production
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:

10. Leukapenia
7th month
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Standard for reporting the PT
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets

11. Gestation HgB
7th month
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
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)

12. Eosinophilia Causes
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Standard for reporting the PT
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

13. Bacteria that patients with sickle cell anemia are at risk for
Encapsulated bacteria: Strep pneumonia and H. Influenza
XRT (radiation and Chemo - inherited immune disorders
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

14. PE for anemia
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
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
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)
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs

15. Plasma
55% of blood plasma - contains all the blood cells
Type of anemia characterized by smaller paler than usual RBC
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

16. Hematopoietic Stem cells
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

17. Anemia developes because
Standard for reporting the PT
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
7th month
98% - alpha and beta

18. Acquired Disorders
MCV - index for classifying anemia - Norma: 80-100
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
low platelet count - skin bleeding - mucosa: especially bleeding of gums
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

19. Specific disease of anemia
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Sickle cell - G6PD - thalessemia
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%

20. INR
Standard for reporting the PT
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
Process by which all blood cells form - develop - and are replaced in the body - blood production
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

21. Composition of HgB
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
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
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

22. Bone Marrow Cellularity
The flat bones: sternum - pelvis - proximal ends of the long bones
What is stored in body M: 18-270 W: 18-160
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor

23. Lymphocytosis Causes
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
Cellular Immunity: helper - killer cells: affected with HIV
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Lymphoid Leukemia - Mono - acute infections a/w viral diseases

24. Inherited Hemoglobinopathy
MCV: 80-100 - sickle cell anemia - G6PD
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
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Parasite infections

25. Hypercoagulable states are...
N - M - Meg - 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
MCV - index for classifying anemia - Norma: 80-100
Genetic and rare or acquired

26. T cell
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Breaking open of the RBC's and release of HgB (spleen)
Cellular Immunity: helper - killer cells: affected with HIV
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)

27. Drug Inducted Thrombocytopenia
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
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:
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

28. Albumin
Most abundant protein in the plasma and helps establish the osmotic gradient
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Thalessemia - and sickle cell

29. von Willebrand Factor
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.
Genetic and rare or acquired
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

30. Blood cells transport mechanism
Programmed cell death (cyto C. and caspases)
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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
volume % of RBC in blood - Female: 36-48 - Males: 42-52

31. Hemocrit
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)
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
volume % of RBC in blood - Female: 36-48 - Males: 42-52
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

32. Microcytic cells
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
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
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

33. HbF
Fetal Hg - 2 alpha and 2 gamma chains - 1%
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
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

34. Neutophilia
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)
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it

35. Blood clot formation
1-2% - alpha and gamma
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Cellular Immunity: helper - killer cells: affected with HIV
MCV: 80-100 - sickle cell anemia - G6PD

36. Lab findings for Hemolytic anemia
Fetal Hg - 2 alpha and 2 gamma chains - 1%
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
GF produced by liver and stimulates production of megakariocytes
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

37. Hemostasis
Humeral immunity: Ab production
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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

38. Amount of Hb in Males and Females
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
M- 75-175 F- 65-165
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Less than 1 persent

39. Patient with Anemia c/o
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
volume % of RBC in blood - Female: 36-48 - Males: 42-52
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

40. What do growth factors do?
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
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
XRT (radiation and Chemo - inherited immune disorders
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

41. Extrinsic hemolytic anemia
Variation in size
Autoimmnr hypersplensm
7th month
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

42. 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
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
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Skin - tend to bleed also into the muscles and joints

43. Proper O2 transport depends on...
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
N - M - Eo - Meg - B - RBC - stem
Vit B 12 and folic acid deficiency

44. Approach to a bleeding patient
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
Plasma protein that binds to Fe and helps absorb it - 200-400
Encapsulated bacteria: Strep pneumonia and H. Influenza
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)

45. Coagulation factor deficiency
Skin - tend to bleed also into the muscles and joints
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)
Acquired or inhereited
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease

46. Neutropenia
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
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
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)

47. beta globin chain genetic
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
8% of body weight- 5L in women and 5.5L in males
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
Plasma protein that binds to Fe and helps absorb it - 200-400

48. Function of Hgb
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Autoimmnr hypersplensm

49. Classification of anemia
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Humeral immunity: Ab production
Abnormal size of cells and vary in abnormality
Growth factor that causes neutraphils to grow

50. Thrombopoietin
Process by which all blood cells form - develop - and are replaced in the body - blood production
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
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
GF produced by liver and stimulates production of megakariocytes