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Hematology Clinical Medicine - I

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1. Erythropoiesis
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
Acquired or inhereited
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs

2. Bone Marrow Cellularity
T and B lymph
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
MCV - index for classifying anemia - Norma: 80-100
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

3. Albumin
Most abundant protein in the plasma and helps establish the osmotic gradient
MCV: 80-100 - sickle cell anemia - G6PD
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA

4. Mean Corpuscular Volume
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
T and B lymph
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
MCV - index for classifying anemia - Norma: 80-100

5. Decreased MCV
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Breaking open of the RBC's and release of HgB (spleen)
Acquired or inhereited
Severe infections

6. G-CSF
Abnormal size of cells and vary in abnormality
Palpable - slightly raised areas of bleeding
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)
Growth factor that causes neutraphils to grow

7. Production of Hemoglobin
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Breaking open of the RBC's and release of HgB (spleen)
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

8. Megakariocytes/ Thrombocytes
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Vit B 12 and folic acid deficiency
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:
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

9. When is a CBC with difference ordered?
low platelet count - skin bleeding - mucosa: especially bleeding of gums
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
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)
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions

10. Blood Facts
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
150 -000-450 -000
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
8% of body weight- 5L in women and 5.5L in males

11. Blood is produced....
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
In the bone marrow
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome

12. Intrinsic hemolytic anemia
Growth factor that causes neutraphils to grow
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Thalessemia - and sickle cell

13. WBC
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
55% of blood plasma - contains all the blood 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
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation

14. What is the life span of blood cells?
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
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)
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 spherocytosis - G6PD deficiency - sickle cell syndrome

15. Anemia
Type of anemia characterized by smaller paler than usual RBC
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
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)
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

16. Clotting disorders
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
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

17. Hemoglobin
O2 bearing molecule and carries 02 throughout the body
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
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
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

18. Abnormality in beta chain are present....
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Asymptomatic until 4 months of life
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

19. IL- 3
Thalessemia - and sickle cell
N - M - Eo - Meg - B - RBC - stem
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

20. IL-2
8% of body weight- 5L in women and 5.5L in males
T and B lymph
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions

21. Platelet Count
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Severe infections
150 -000-450 -000

22. T cell
Cellular Immunity: helper - killer cells: affected with HIV
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
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
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

23. Composition of HgB
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Less than 1 persent
Humeral immunity: Ab production
Thalessemia - and sickle cell

24. Poikilocytosis
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
Abnormally shaped cells - schiztocyte - tear drop - oval
Vit B 12 and folic acid deficiency

25. What do growth factors do?
Cellular Immunity: helper - killer cells: affected with HIV
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
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
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

26. Normocytic
4.5-10
N - M - Meg - RBC
MCV: 80-100 - sickle cell anemia - G6PD
Confluent areas of bleeding right below the skin

27. Hemocrit
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
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
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
volume % of RBC in blood - Female: 36-48 - Males: 42-52

28. Inherited Hemoglobinopathy
Standard for reporting the PT
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
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
MCV - index for classifying anemia - Norma: 80-100

29. Transferrin
Plasma protein that binds to Fe and helps absorb it - 200-400
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Asymptomatic until 4 months of life

30. microcytic hypochromic anemia
Type of anemia characterized by smaller paler than usual RBC
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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
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

31. RBC
Programmed cell death (cyto C. and caspases)
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Plasma protein that binds to Fe and helps absorb it - 200-400

32. Major Adult Hgb
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)
Autoimmnr hypersplensm
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
HbA-2alpha and 2 beta chains

33. Classification of anemia
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
MCV - index for classifying anemia - Norma: 80-100
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets

34. 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
Male: 14-17 Female: 12-15
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Thalessemia - and sickle cell

35. Blood cells transport mechanism
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
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Palpable - slightly raised areas of bleeding
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

36. Basophils are present in....
Thalessemia - and sickle cell
Most abundant protein in the plasma and helps establish the osmotic gradient
Parasite infections
T lymph - stem cell

37. Apoptosis
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
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
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
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

38. bleeding disorders
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Lymphoid Leukemia - Mono - acute infections a/w viral diseases

39. Neutophilia
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
MCV: 80-100 - sickle cell anemia - G6PD
8% of body weight- 5L in women and 5.5L in males

40. Agranulocytes
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
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Genetic and rare or acquired

41. Proper O2 transport depends on...
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
4.5-10
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin

42. Neutropenia
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes

43. 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)
Less than 1 persent
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:
Standard for reporting the PT

44. Granulocytes
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
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
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

45. Reticulocyte count
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 red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Severe infections
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs

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

47. Decreased Platelets
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Abnormally shaped cells - schiztocyte - tear drop - oval

48. Hemolytic Anemia
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
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
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue

49. Genetic defects
Palpable - slightly raised areas of bleeding
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
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
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

50. Hemobglobin A
The flat bones: sternum - pelvis - proximal ends of the long bones
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
98% - alpha and beta
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA