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Hematology Clinical Medicine - I

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1. microcytic hypochromic anemia
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Type of anemia characterized by smaller paler than usual RBC

2. Decreased Platelets
Confluent areas of bleeding right below the skin
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
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
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets

3. Gestation HgB
T lymph - stem cell
low platelet count - skin bleeding - mucosa: especially bleeding of gums
HbF: 2 alpha and 2 gamma
Male: 14-17 Female: 12-15

4. Elevated MCV
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
N - M - Eo - Meg - B - RBC - stem
Autoimmnr hypersplensm
Vit B 12 and folic acid deficiency

5. Bone Marrow Cellularity
Palpable - slightly raised areas of bleeding
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
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
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

6. Patient with Anemia c/o
7th month
Thalessemia - and sickle cell
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

7. von Willebrand Factor
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:
Thalessemia - and sickle cell
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

8. Amount of Hb in Males and Females
In the bone marrow
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
HbF: 2 alpha and 2 gamma
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

9. CBC with differential
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
Breaking open of the RBC's and release of HgB (spleen)
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
Complete blood count with differential: tells what percentage of cells make up the blood

10. Serum Ferritin
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Abnormally shaped cells - schiztocyte - tear drop - oval
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.
What is stored in body M: 18-270 W: 18-160

11. Mean Corpuscular Volume
MCV - index for classifying anemia - Norma: 80-100
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
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:

12. WBC Count
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
XRT (radiation and Chemo - inherited immune disorders
4.5-10
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

13. Hematopoeisis in adulthood is limited to....
Abnormal size of cells and vary in abnormality
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)
In the bone marrow
The flat bones: sternum - pelvis - proximal ends of the long bones

14. Neutropenia
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
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
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)

15. Alpha globin chain genetics
Abnormal size of cells and vary in abnormality
Confluent areas of bleeding right below the skin
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

16. Fibrin
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Most abundant protein in the plasma and helps establish the osmotic gradient
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
8% of body weight- 5L in women and 5.5L in males

17. anisocytosis
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Variation in size
GF produced by liver and stimulates production of megakariocytes

18. Hemolytic Anemia
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Severe infections

19. monocytes are present in....
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Severe infections
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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

20. Mild forms of thalessemia need to be differentiated from...
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
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Genetic and rare or acquired

21. B Cell
Most abundant protein in the plasma and helps establish the osmotic gradient
HbF: 2 alpha and 2 gamma
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Humeral immunity: Ab production

22. Hgb anatomy
Thalessemia - and sickle cell
MCV - index for classifying anemia - Norma: 80-100
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)
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances

23. Anemia developes because
Breaking open of the RBC's and release of HgB (spleen)
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Sickle cell - G6PD - thalessemia

24. Platelets
Standard for reporting the PT
Growth factor that causes neutraphils to grow
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages

25. petechiae
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Vit B 12 and folic acid deficiency

26. Reticulocyte count
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
What is stored in body M: 18-270 W: 18-160
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Cellular Immunity: helper - killer cells: affected with HIV

27. Granulocytes
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Type of anemia characterized by smaller paler than usual RBC
Abnormally shaped cells - schiztocyte - tear drop - oval
Confluent areas of bleeding right below the skin

28. Microcytic cells
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

29. Decreased 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
HbF: 2 alpha and 2 gamma
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation

30. Blood cells transport mechanism
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
Severe infections
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
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

31. Hemolysis

32. G-CSF
150 -000-450 -000
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
T lymph - stem cell
Growth factor that causes neutraphils to grow

33. beta globin chain genetic
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Complete blood count with differential: tells what percentage of cells make up the blood
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
What is stored in body M: 18-270 W: 18-160

34. HbF
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

35. Lab findings for Hemolytic anemia
Variation in size
Abnormal size of cells and vary in abnormality
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

36. Clotting disorders
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)
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
O2 bearing molecule and carries 02 throughout the body
Lymphoid Leukemia - Mono - acute infections a/w viral diseases

37. Blood Facts
8% of body weight- 5L in women and 5.5L in males
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
Severe infections
Sickle cell - G6PD - thalessemia

38. Composition of HgB
N - M - Meg - RBC
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

39. Progenitor cells
GF produced by liver and stimulates production of megakariocytes
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
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
Breaking open of the RBC's and release of HgB (spleen)

40. 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
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
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
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)

41. Albumin
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
Most abundant protein in the plasma and helps establish the osmotic gradient
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)
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

42. Megakariocytes/ Thrombocytes
55% of blood plasma - contains all the blood cells
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
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

43. Iron Serum test
M- 75-175 F- 65-165
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Abnormally shaped cells - schiztocyte - tear drop - oval
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)

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
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
In the bone marrow

45. INR
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)
Standard for reporting the PT
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Fetal Hg - 2 alpha and 2 gamma chains - 1%

46. Apoptosis
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Variation in size
Abnormal size of cells and vary in abnormality

47. Lymphopenia Causes
XRT (radiation and Chemo - inherited immune disorders
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
N - M - Meg - RBC
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:

48. Hemoglobinopathies
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
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
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs

49. Leukocytosis
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
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
Autoimmnr hypersplensm
Abnormally shaped cells - schiztocyte - tear drop - oval

50. Bleeding/ Hypercoagulation disorders
Asymptomatic until 4 months of life
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Process by which all blood cells form - develop - and are replaced in the body - blood production
98% - alpha and beta