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Hematology Clinical Medicine - I

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Answer 50 questions in 15 minutes.
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1. Production of Hemoglobin
Complete blood count with differential: tells what percentage of cells make up the blood
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Autoimmnr hypersplensm
Variation in size

2. Classification of anemia
T lymph - stem cell
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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
Abnormal size of cells and vary in abnormality

3. Specific disease of anemia
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Sickle cell - G6PD - thalessemia
Encapsulated bacteria: Strep pneumonia and H. Influenza
T and B lymph

4. Function of Hgb
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
Vit B 12 and folic acid deficiency
Acquired or inhereited
GF produced by liver and stimulates production of megakariocytes

5. 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
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
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
Standard for reporting the PT

6. Hemolytic Anemia
Complete blood count with differential: tells what percentage of cells make up the blood
Growth factor that causes neutraphils to grow
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
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

7. IL-2
T and B lymph
8% of body weight- 5L in women and 5.5L in males
Male: 14-17 Female: 12-15
98% - alpha and beta

8. Mean Corpuscular Volume
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
MCV - index for classifying anemia - Norma: 80-100
The flat bones: sternum - pelvis - proximal ends of the long bones
Humeral immunity: Ab production

9. Agranulocytes
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
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
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

10. Decreased MCV
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
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 platelet count - skin bleeding - mucosa: especially bleeding of gums

11. Blood is produced....
In the bone marrow
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
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Parasite infections

12. Hemoglobin A2
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
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
1-2% - alpha and gamma

13. bleeding disorders
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Thalessemia - and sickle cell
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Fetal Hg - 2 alpha and 2 gamma chains - 1%

14. GM-CSF
Skin - tend to bleed also into the muscles and joints
Male: 14-17 Female: 12-15
N - M - Meg - RBC
4.5-10

15. Abnormality in beta chain are present....
Programmed cell death (cyto C. and caspases)
Asymptomatic until 4 months of 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
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates

16. When is a CBC with difference ordered?
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
55% of blood plasma - contains all the blood cells
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma

17. Genetic defects
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Growth factor that causes neutraphils to grow
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
T and B lymph

18. poikilocytosis
98% - alpha and beta
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
Variation in shape
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation

19. Anemia developes because
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
MCV: 80-100 - sickle cell anemia - G6PD
MCV - index for classifying anemia - Norma: 80-100
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

20. Basophils are present in....
Parasite infections
HbA-2alpha and 2 beta chains
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

21. Platelet Count
Palpable - slightly raised areas of bleeding
M- 75-175 F- 65-165
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
150 -000-450 -000

22. Bacteria that patients with sickle cell anemia are at risk for
Encapsulated bacteria: Strep pneumonia and H. Influenza
7th month
Vit B 12 and folic acid deficiency
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

23. 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
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
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
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

24. Alpha globin chain genetics
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
The flat bones: sternum - pelvis - proximal ends of the long bones
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
Confluent areas of bleeding right below the skin

25. Lymphocytosis Causes
Process by which all blood cells form - develop - and are replaced in the body - blood production
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
GF produced by liver and stimulates production of megakariocytes
Humeral immunity: Ab production

26. Hemostasis
T lymph - stem cell
Abnormal size of cells and vary in abnormality
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)

27. Amount of Hb in Males and Females
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
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
Process by which all blood cells form - develop - and are replaced in the body - blood production

28. Albumin
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Most abundant protein in the plasma and helps establish the osmotic gradient
Complete blood count with differential: tells what percentage of cells make up the blood
Standard for reporting the PT

29. Hemoglobin F
Most abundant protein in the plasma and helps establish the osmotic gradient
Male: 14-17 Female: 12-15
Less than 1 persent
XRT (radiation and Chemo - inherited immune disorders

30. Eosinophilia Causes
MCV - index for classifying anemia - Norma: 80-100
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
T and B lymph
Allergies - drug reactions (pCH) - parasitic diseases and tape worms

31. Erythropoietin
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
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
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
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets

32. Heme- Heme interction
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
Vit B 12 and folic acid deficiency
98% - alpha and beta

33. Hemoglobinopathies
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
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.
Abnormally shaped cells - schiztocyte - tear drop - oval

34. Liver disease
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:
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Fetal Hg - 2 alpha and 2 gamma chains - 1%

35. Proper O2 transport depends on...
Type of anemia characterized by smaller paler than usual RBC
Acquired or inhereited
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances

36. purpura
The flat bones: sternum - pelvis - proximal ends of the long bones
Palpable - slightly raised areas of bleeding
M- 75-175 F- 65-165
98% - alpha and beta

37. Poikilocytosis
Abnormally shaped cells - schiztocyte - tear drop - oval
Palpable - slightly raised areas of bleeding
The flat bones: sternum - pelvis - proximal ends of the long bones
low platelet count - skin bleeding - mucosa: especially bleeding of gums

38. Transferrin
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Plasma protein that binds to Fe and helps absorb it - 200-400
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

39. Blood Facts
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
8% of body weight- 5L in women and 5.5L in males
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:

40. Composition of HgB
Sickle cell - G6PD - thalessemia
Acquired or inhereited
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning

41. Bleeding disoders can be....
Acquired or inhereited
The flat bones: sternum - pelvis - proximal ends of the long bones
Skin - tend to bleed also into the muscles and joints
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

42. Normocytic
MCV: 80-100 - sickle cell anemia - G6PD
150 -000-450 -000
Standard for reporting the PT
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. Plasma
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
55% of blood plasma - contains all the blood cells
N - M - Eo - Meg - B - RBC - stem
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

44. G-CSF
Growth factor that causes neutraphils to grow
In the bone marrow
Type of anemia characterized by smaller paler than usual RBC
Male: 14-17 Female: 12-15

45. Lymphopenia Causes
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
XRT (radiation and Chemo - inherited immune disorders
98% - alpha and beta
Type of anemia characterized by smaller paler than usual RBC

46. Lab findings for Hemolytic anemia
In the bone marrow
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
Most abundant protein in the plasma and helps establish the osmotic gradient

47. Clotting disorders
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
4.5-10
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

48. Reticulocyte count
N - M - Eo - Meg - B - RBC - stem
Cellular Immunity: helper - killer cells: affected with HIV
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

49. HbF
Confluent areas of bleeding right below the skin
Most abundant protein in the plasma and helps establish the osmotic gradient
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

50. Anisocytosis
Abnormal size of cells and vary in abnormality
Autoimmnr hypersplensm
4.5-10
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)