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Hematology Clinical Medicine - I

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1. Hemoglobin
In the bone marrow
Severe infections
O2 bearing molecule and carries 02 throughout the body
Sickle cell - G6PD - thalessemia

2. Alpha globin chain genetics
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
XRT (radiation and Chemo - inherited immune disorders
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
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

3. Hemostasis
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
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
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Male: 14-17 Female: 12-15

4. Anemia developes because
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
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
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)

5. Hemolysis

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6. HgB/ HCT is increased with....
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
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
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

7. PE of bleeding patient
Plasma protein that binds to Fe and helps absorb it - 200-400
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
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)

8. WBC Count
4.5-10
8% of body weight- 5L in women and 5.5L in males
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
MCV - index for classifying anemia - Norma: 80-100

9. Blood cells transport mechanism
Asymptomatic until 4 months of life
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:
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
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

10. Granulocytes
55% of blood plasma - contains all the blood cells
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
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

11. Function of Hgb
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
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
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
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

12. Normocytic
MCV: 80-100 - sickle cell anemia - G6PD
GF produced by liver and stimulates production of megakariocytes
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

13. When is a CBC with difference ordered?
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)
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
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Variation in size

14. B Cell
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
150 -000-450 -000
Humeral immunity: Ab production
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions

15. Composition of HgB
Acquired or inhereited
Variation in size
T lymph - stem cell
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron

16. What is the life span of blood cells?
Abnormally shaped cells - schiztocyte - tear drop - oval
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:
The flat bones: sternum - pelvis - proximal ends of the long bones
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

17. Bleeding D/O laboratory testing
Parasite infections
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
What is stored in body M: 18-270 W: 18-160
The flat bones: sternum - pelvis - proximal ends of the long bones

18. bleeding disorders
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
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. Lymphocytosis Causes
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

20. Intrinsic Hemolytic anemia
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA

21. Extrinsic hemolytic anemia
Plasma protein that binds to Fe and helps absorb it - 200-400
Autoimmnr hypersplensm
Most abundant protein in the plasma and helps establish the osmotic gradient
The flat bones: sternum - pelvis - proximal ends of the long bones

22. Clotting disorders
Growth factor that causes neutraphils to grow
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
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
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

23. Classification of anemia
Programmed cell death (cyto C. and caspases)
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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin

24. Heme- Heme interction
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Severe infections
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

25. Blood is produced....
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-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)
In the bone marrow

26. Detection of hemoglobinopathy
T lymph - stem cell
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

27. Anisocytosis
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
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
Abnormal size of cells and vary in abnormality

28. Neutropenia
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
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
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
7th month

29. Hematopoiesis
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Process by which all blood cells form - develop - and are replaced in the body - blood production

30. Erythrocytes
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
Type of anemia characterized by smaller paler than usual RBC
Growth factor that causes neutraphils to grow
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

31. Agranulocytes
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Most abundant protein in the plasma and helps establish the osmotic gradient
Cellular Immunity: helper - killer cells: affected with HIV
T lymph - stem cell

32. Acquired Disorders
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
1-2% - alpha and gamma
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

33. Poikilocytosis
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
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Abnormally shaped cells - schiztocyte - tear drop - oval
Asymptomatic until 4 months of life

34. Blood Facts
Abnormally shaped cells - schiztocyte - tear drop - oval
150 -000-450 -000
Skin - tend to bleed also into the muscles and joints
8% of body weight- 5L in women and 5.5L in males

35. petechiae
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
T and B lymph
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs

36. Plasma
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
55% of blood plasma - contains all the blood cells
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:
Cellular Immunity: helper - killer cells: affected with HIV

37. Hematopoeisis in adulthood is limited to....
The flat bones: sternum - pelvis - proximal ends of the long bones
4.5-10
Asymptomatic until 4 months of life
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets

38. 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
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
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
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

39. Blood consists of what cellular elements
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
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
Standard for reporting the PT
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma

40. Leukocytosis
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
In the bone marrow
Lymphoid Leukemia - Mono - acute infections a/w viral diseases

41. Abnormality in beta chain are present....
Asymptomatic until 4 months of life
N - M - Eo - Meg - B - RBC - stem
Vit B 12 and folic acid deficiency
In the bone marrow

42. Hemoglobinopathies
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
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:
7th month
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.

43. Hemocrit
volume % of RBC in blood - Female: 36-48 - Males: 42-52
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
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

44. Lab findings for Hemolytic anemia
The flat bones: sternum - pelvis - proximal ends of the long bones
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Acquired or inhereited

45. Normal Hbg Count
Encapsulated bacteria: Strep pneumonia and H. Influenza
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
Male: 14-17 Female: 12-15
Sickle cell - G6PD - thalessemia

46. Macrocytic cells
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
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
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Sickle cell - G6PD - thalessemia

47. Microcytic cells
MCV - index for classifying anemia - Norma: 80-100
Thalessemia - and sickle cell
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
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

48. Albumin
Most abundant protein in the plasma and helps establish the osmotic gradient
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.
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

49. Mean Corpuscular Volume
MCV - index for classifying anemia - Norma: 80-100
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
HbF: 2 alpha and 2 gamma
Growth factor that causes neutraphils to grow

50. Approach to a bleeding patient
8% of body weight- 5L in women and 5.5L in males
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
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
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates