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Hematology Clinical Medicine - I

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. Hematopoietic Stem cells
Breaking open of the RBC's and release of HgB (spleen)
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
The flat bones: sternum - pelvis - proximal ends of the long bones
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

2. Alpha globin chain genetics
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
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
Male: 14-17 Female: 12-15

3. INR
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Plasma protein that binds to Fe and helps absorb it - 200-400
Standard for reporting the PT
Confluent areas of bleeding right below the skin

4. monocytes are present in....
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Severe infections
Abnormally shaped cells - schiztocyte - tear drop - oval

5. Hemoglobinopathies
HbF: 2 alpha and 2 gamma
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
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.
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

6. Hemolytic Anemia
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Confluent areas of bleeding right below the skin
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

7. IL-1
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
T lymph - stem cell
Sickle cell - G6PD - thalessemia
Fetal Hg - 2 alpha and 2 gamma chains - 1%

8. Reticulocyte count
150 -000-450 -000
In the bone marrow
Acquired or inhereited
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

9. Anisocytosis
Abnormal size of cells and vary in abnormality
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
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

10. Hypercoagulable states are...
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Genetic and rare or acquired
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA

11. Acquired 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
98% - alpha and beta
T and B lymph
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

12. Erythropoietin
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
MCV: 80-100 - sickle cell anemia - G6PD
4.5-10
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

13. Basophils are present in....
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
Parasite infections
GF produced by liver and stimulates production of megakariocytes
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

14. Lymphopenia Causes
N - M - Eo - Meg - B - RBC - stem
XRT (radiation and Chemo - inherited immune disorders
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Type of anemia characterized by smaller paler than usual RBC

15. Blood clot formation
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Sickle cell - G6PD - thalessemia
Plasma protein that binds to Fe and helps absorb it - 200-400
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

16. What is the life span of blood cells?
98% - alpha and beta
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
O2 bearing molecule and carries 02 throughout the body

17. Hgb anatomy
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
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)
XRT (radiation and Chemo - inherited immune disorders
Complete blood count with differential: tells what percentage of cells make up the blood

18. Heme- Heme interction
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
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
Complete blood count with differential: tells what percentage of cells make up the blood
N - M - Eo - Meg - B - RBC - stem

19. Granulocytes
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
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
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

20. GM-CSF
N - M - Meg - RBC
Autoimmnr hypersplensm
T lymph - stem cell
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. Platelets
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
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
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)
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages

22. Thrombopoietin
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
GF produced by liver and stimulates production of megakariocytes
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
150 -000-450 -000

23. WBC
Autoimmnr hypersplensm
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Genetic and rare or acquired
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

24. Normal Hbg Count
Less than 1 persent
Palpable - slightly raised areas of bleeding
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Male: 14-17 Female: 12-15

25. Specific disease of anemia
Sickle cell - G6PD - thalessemia
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

26. WBC Count
4.5-10
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
Sickle cell - G6PD - thalessemia
Acquired or inhereited

27. Hemolysis

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28. Clotting disorders
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

29. Extrinsic hemolytic anemia
Autoimmnr hypersplensm
Plasma protein that binds to Fe and helps absorb it - 200-400
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
M- 75-175 F- 65-165

30. Leukapenia
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
55% of blood plasma - contains all the blood cells
Cellular Immunity: helper - killer cells: affected with HIV

31. von Willebrand Factor
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
low platelet count - skin bleeding - mucosa: especially bleeding of gums
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

32. Variations with HbA
MCV - index for classifying anemia - Norma: 80-100
In the bone marrow
Palpable - slightly raised areas of bleeding
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population

33. Hemoglobin F
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Thalessemia - and sickle cell
Less than 1 persent
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

34. Intrinsic Hemolytic anemia
Vit B 12 and folic acid deficiency
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Process by which all blood cells form - develop - and are replaced in the body - blood production
MCV: 80-100 - sickle cell anemia - G6PD

35. poikilocytosis
Variation in shape
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
Breaking open of the RBC's and release of HgB (spleen)
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

36. Pathology for Thallessemia
Process by which all blood cells form - develop - and are replaced in the body - blood production
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
GF produced by liver and stimulates production of megakariocytes
N - M - Eo - Meg - B - RBC - stem

37. Agranulocytes
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Variation in shape
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
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

38. Hemoglobin
O2 bearing molecule and carries 02 throughout the body
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Acquired or inhereited
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

39. Hemocrit
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Skin - tend to bleed also into the muscles and joints
GF produced by liver and stimulates production of megakariocytes

40. Amount of Hb in Males and Females
Plasma protein that binds to Fe and helps absorb it - 200-400
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Complete blood count with differential: tells what percentage of cells make up the blood
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

41. Poikilocytosis
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
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
Abnormally shaped cells - schiztocyte - tear drop - oval
Genetic and rare or acquired

42. Lab findings for Hemolytic anemia
Asymptomatic until 4 months of life
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
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

43. HgB/ HCT is decreased with....
What is stored in body M: 18-270 W: 18-160
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Complete blood count with differential: tells what percentage of cells make up the blood
N - M - Meg - RBC

44. Bleeding/ Hypercoagulation disorders
Complete blood count with differential: tells what percentage of cells make up the blood
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
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
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

45. HgB/ HCT is increased with....
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
7th month
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Type of anemia characterized by smaller paler than usual RBC

46. Erythrocytes
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
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Palpable - slightly raised areas of bleeding
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

47. bleeding disorders
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
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

48. Decreased MCV
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Humeral immunity: Ab production

49. Thallassemia Syndormes
What is stored in body M: 18-270 W: 18-160
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
Cellular Immunity: helper - killer cells: affected with HIV

50. Reticulocyte
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
Asymptomatic until 4 months of life
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