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Hematology Clinical Medicine - I

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Answer 50 questions in 15 minutes.
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1. ecchymosis
Confluent areas of bleeding right below the skin
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Standard for reporting the PT
Palpable - slightly raised areas of bleeding

2. Hemostasis
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
1-2% - alpha and gamma
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

3. IL-1
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)
T lymph - stem cell
7th month
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

4. Thrombopoietin
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
GF produced by liver and stimulates production of megakariocytes

5. Extrinsic hemolytic anemia
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
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
Autoimmnr hypersplensm
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages

6. anisocytosis
Variation in size
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
HbA-2alpha and 2 beta chains
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets

7. Mild forms of thalessemia need to be differentiated from...
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
M- 75-175 F- 65-165

8. Hemoglobinopathies
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.
O2 bearing molecule and carries 02 throughout the body
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
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

9. Elevated MCV
Abnormally shaped cells - schiztocyte - tear drop - oval
Vit B 12 and folic acid deficiency
In the bone marrow
98% - alpha and beta

10. Coagulation factor deficiency
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Skin - tend to bleed also into the muscles and joints
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Type of anemia characterized by smaller paler than usual RBC

11. IL-2
150 -000-450 -000
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
T and B lymph
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

12. 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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Type of anemia characterized by smaller paler than usual RBC
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

13. PE of bleeding patient
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
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)
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases

14. Progenitor cells
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
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
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
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

15. Intrinsic Hemolytic anemia
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Thalessemia - and sickle cell
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Variation in size

16. purpura
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
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
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Palpable - slightly raised areas of bleeding

17. Thallassemia Syndormes
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
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
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)
Skin - tend to bleed also into the muscles and joints

18. What is the life span of blood cells?
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
O2 bearing molecule and carries 02 throughout the body
150 -000-450 -000
Variation in size

19. Anemia developes because
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Thalessemia - and sickle cell
In the bone marrow

20. Approach to a bleeding patient
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Acquired or inhereited
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
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

21. Transferrin
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Plasma protein that binds to Fe and helps absorb it - 200-400
Palpable - slightly raised areas of bleeding
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

22. Macrocytic cells
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
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
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population

23. Hemolytic Anemia
In the bone marrow
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Lymphoid Leukemia - Mono - acute infections a/w viral diseases

24. Reticulocyte count
Encapsulated bacteria: Strep pneumonia and H. Influenza
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

25. WBC
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
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
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
N - M - Eo - Meg - B - RBC - stem

26. Erythropoiesis
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin

27. Serum Ferritin
What is stored in body M: 18-270 W: 18-160
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
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
MCV: 80-100 - sickle cell anemia - G6PD

28. Decreased MCV
Autoimmnr hypersplensm
8% of body weight- 5L in women and 5.5L in males
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
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

29. Specific disease of anemia
1-2% - alpha and gamma
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Sickle cell - G6PD - thalessemia

30. Coombs Antiglobulin Test
Growth factor that causes neutraphils to grow
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
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
8% of body weight- 5L in women and 5.5L in males

31. Eosinophilia Causes
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)
O2 bearing molecule and carries 02 throughout the body
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
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. By what month in the fetus does the development of the RBC move to the bone marrow?
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
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
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
7th month

33. Bleeding D/O laboratory testing
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
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
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)

34. Gestation HgB
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
HbF: 2 alpha and 2 gamma
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease

35. Albumin
Most abundant protein in the plasma and helps establish the osmotic gradient
Severe infections
Abnormal size of cells and vary in abnormality
XRT (radiation and Chemo - inherited immune disorders

36. Plasma
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
N - M - Eo - Meg - B - RBC - stem
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
55% of blood plasma - contains all the blood cells

37. B Cell
Humeral immunity: Ab production
Encapsulated bacteria: Strep pneumonia and H. Influenza
O2 bearing molecule and carries 02 throughout the body
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

38. Hemobglobin A
XRT (radiation and Chemo - inherited immune disorders
Fetal Hg - 2 alpha and 2 gamma chains - 1%
98% - alpha and beta
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

39. HgB/ HCT is increased with....
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
150 -000-450 -000
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

40. WBC Count
4.5-10
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
MCV: 80-100 - sickle cell anemia - G6PD
Less than 1 persent

41. Normal Hbg Count
Parasite infections
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
GF produced by liver and stimulates production of megakariocytes
Male: 14-17 Female: 12-15

42. Acquired Disorders
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:
Type of anemia characterized by smaller paler than usual RBC
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
O2 bearing molecule and carries 02 throughout the body

43. GM-CSF
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
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
N - M - Meg - RBC

44. Intrinsic hemolytic anemia
Sickle cell - G6PD - thalessemia
M- 75-175 F- 65-165
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)
Thalessemia - and sickle cell

45. Alpha globin chain genetics
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
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:
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
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

46. beta globin chain genetic
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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Thalessemia - and sickle cell
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

47. Granulocytes
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

48. Blood is produced....
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Genetic and rare or acquired
In the bone marrow

49. HgB/ HCT is decreased with....
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
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)
The flat bones: sternum - pelvis - proximal ends of the long bones
7th month

50. Bone Marrow Cellularity
150 -000-450 -000
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Parasite infections
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