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Hematology Clinical Medicine - I

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1. Lymphocytosis Causes
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
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
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
GF produced by liver and stimulates production of megakariocytes

2. Extrinsic hemolytic anemia
Acquired or inhereited
7th month
Abnormal size of cells and vary in abnormality
Autoimmnr hypersplensm

3. HbA
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Acquired or inhereited
Complete blood count with differential: tells what percentage of cells make up the blood

4. Hematopoeisis in adulthood is limited to....
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
N - M - Eo - Meg - B - RBC - stem
Acquired or inhereited
The flat bones: sternum - pelvis - proximal ends of the long bones

5. Hemoglobin F
Autoimmnr hypersplensm
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Programmed cell death (cyto C. and caspases)
Less than 1 persent

6. Alpha globin chain genetics
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
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)
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
150 -000-450 -000

7. Acquired Disorders
HbF: 2 alpha and 2 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
Less than 1 persent
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

8. Leukocytosis
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

9. Transferrin
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
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Plasma protein that binds to Fe and helps absorb it - 200-400

10. Lymphopenia Causes
XRT (radiation and Chemo - inherited immune disorders
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
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

11. Blood Facts
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
7th month
Thalessemia - and sickle cell
8% of body weight- 5L in women and 5.5L in males

12. petechiae
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Process by which all blood cells form - develop - and are replaced in the body - blood production
T lymph - stem cell
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

13. Amount of Hb in Males and Females
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Thalessemia - and sickle cell
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

14. Hgb anatomy
Parasite infections
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)
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor

15. GM-CSF
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
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
N - M - Meg - RBC
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA

16. microcytic hypochromic anemia
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
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Type of anemia characterized by smaller paler than usual RBC
4.5-10

17. monocytes are present in....
Severe infections
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Autoimmnr hypersplensm
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

18. Liver disease
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
Fetal Hg - 2 alpha and 2 gamma chains - 1%
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:
Most abundant protein in the plasma and helps establish the osmotic gradient

19. IL- 3
N - M - Eo - Meg - B - RBC - stem
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
Genetic and rare or acquired

20. Genetic defects
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
T and B lymph
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
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

21. Progenitor cells
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
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
MCV: 80-100 - sickle cell anemia - G6PD
Most abundant protein in the plasma and helps establish the osmotic gradient

22. Microcytic cells
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
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
T and B lymph

23. Mild forms of thalessemia need to be differentiated from...
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Sickle cell - G6PD - thalessemia
Severe infections
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

24. Inherited Hemoglobinopathy
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
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
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
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. Bleeding/ Hypercoagulation disorders
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
M- 75-175 F- 65-165
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

26. Anisocytosis
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
Abnormal size of cells and vary in abnormality
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%

27. 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
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
MCV: 80-100 - sickle cell anemia - G6PD
The flat bones: sternum - pelvis - proximal ends of the long bones

28. Leukapenia
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Fetal Hg - 2 alpha and 2 gamma chains - 1%
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
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor

29. G-CSF
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
What is stored in body M: 18-270 W: 18-160
Growth factor that causes neutraphils to grow
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

30. Hemolytic Anemia
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
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
8% of body weight- 5L in women and 5.5L in males

31. Iron Serum test
M- 75-175 F- 65-165
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
N - M - Meg - RBC
Breaking open of the RBC's and release of HgB (spleen)

32. HgB/ HCT is increased with....
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
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:
Abnormally shaped cells - schiztocyte - tear drop - oval
Severe infections

33. B Cell
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
Humeral immunity: Ab production
Parasite infections
low platelet count - skin bleeding - mucosa: especially bleeding of gums

34. Thallassemia Syndormes
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
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

35. Hemolytic Anemia
T lymph - stem cell
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
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
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.

36. By what month in the fetus does the development of the RBC move to the bone marrow?
8% of body weight- 5L in women and 5.5L in males
7th month
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

37. Elevated MCV
Vit B 12 and folic acid deficiency
What is stored in body M: 18-270 W: 18-160
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
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:

38. Gestation HgB
Acquired or inhereited
HbF: 2 alpha and 2 gamma
What is stored in body M: 18-270 W: 18-160
Male: 14-17 Female: 12-15

39. Neutropenia
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Breaking open of the RBC's and release of HgB (spleen)

40. Platelets
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
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
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

41. What do growth factors do?
GF produced by liver and stimulates production of megakariocytes
XRT (radiation and Chemo - inherited immune disorders
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
7th month

42. Composition of HgB
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Less than 1 persent
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

43. PE for anemia
55% of blood plasma - contains all the blood cells
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
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 -

44. Neutophilia
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
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
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Palpable - slightly raised areas of bleeding

45. INR
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Severe infections
Standard for reporting the PT
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.

46. Hemobglobin A
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
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
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
98% - alpha and beta

47. Classification of anemia
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
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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

48. Platelet problem
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
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

49. Poikilocytosis
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Abnormal size of cells and vary in abnormality
Abnormally shaped cells - schiztocyte - tear drop - oval
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

50. Lab findings for Hemolytic anemia
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Sickle cell - G6PD - thalessemia
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria