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Hematology Clinical Medicine - I

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1. Plasma
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
55% of blood plasma - contains all the blood cells
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

2. Specific disease of anemia
Sickle cell - G6PD - thalessemia
Variation in shape
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
1-2% - alpha and gamma

3. Hemoglobin F
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Less than 1 persent
Male: 14-17 Female: 12-15

4. Approach to a bleeding patient
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
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
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Sickle cell - G6PD - thalessemia

5. Acquired Disorders
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
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

6. Transferrin
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Plasma protein that binds to Fe and helps absorb it - 200-400
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

7. Lab findings for Hemolytic anemia
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
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
Process by which all blood cells form - develop - and are replaced in the body - blood production
O2 bearing molecule and carries 02 throughout the body

8. Elevated MCV
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
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
Vit B 12 and folic acid deficiency

9. Agranulocytes
The flat bones: sternum - pelvis - proximal ends of the long bones
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
Plasma protein that binds to Fe and helps absorb it - 200-400
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)

10. Hemoglobinopathies
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:
98% - alpha and beta
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.
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

11. Hemostasis
Abnormal size of cells and vary in abnormality
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
volume % of RBC in blood - Female: 36-48 - Males: 42-52
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

12. Basophils are present in....
Parasite infections
Plasma protein that binds to Fe and helps absorb it - 200-400
Variation in shape
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

13. Megakariocytes/ Thrombocytes
Vit B 12 and folic acid deficiency
Acquired or inhereited
Autoimmnr hypersplensm
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

14. PE of bleeding patient
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)
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
Acquired or inhereited
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

15. Hematopoeisis in adulthood is limited to....
The flat bones: sternum - pelvis - proximal ends of the long bones
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
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Abnormally shaped cells - schiztocyte - tear drop - oval

16. Gestation HgB
Palpable - slightly raised areas of bleeding
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
HbF: 2 alpha and 2 gamma
4.5-10

17. Thallassemia Syndormes
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
M- 75-175 F- 65-165
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
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

18. Hematopoiesis
Process by which all blood cells form - develop - and are replaced in the body - blood production
Standard for reporting the PT
Encapsulated bacteria: Strep pneumonia and H. Influenza
Variation in shape

19. poikilocytosis
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
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)
Variation in shape

20. Poikilocytosis
Abnormally shaped cells - schiztocyte - tear drop - oval
T lymph - stem cell
Growth factor that causes neutraphils to grow
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)

21. Platelet problem
Autoimmnr hypersplensm
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Confluent areas of bleeding right below the skin
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

22. Alpha globin chain genetics
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
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
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma

23. monocytes are present in....
150 -000-450 -000
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
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:
Severe infections

24. Hypercoagulable states are...
Genetic and rare or acquired
Plasma protein that binds to Fe and helps absorb it - 200-400
Humeral immunity: Ab production
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

25. Erythrocytes
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
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)
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

26. Normocytic
98% - alpha and beta
MCV: 80-100 - sickle cell anemia - G6PD
Variation in shape
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

27. Blood clot formation
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Most abundant protein in the plasma and helps establish the osmotic gradient

28. petechiae
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
HbA-2alpha and 2 beta chains

29. Intrinsic hemolytic anemia
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Thalessemia - and sickle cell
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%

30. Pathology for Thallessemia
Standard for reporting the PT
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
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
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule

31. Reticulocyte count
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 -
M- 75-175 F- 65-165
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

32. Reticulocyte
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
Type of anemia characterized by smaller paler than usual RBC
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
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

33. Variations with HbA
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
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
Thalessemia - and sickle cell
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population

34. Eosinophilia Causes
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
MCV: 80-100 - sickle cell anemia - G6PD
Allergies - drug reactions (pCH) - parasitic diseases and tape worms
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis

35. Coagulation factor deficiency
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Skin - tend to bleed also into the muscles and joints
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Genetic and rare or acquired

36. Leukocytosis
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Process by which all blood cells form - develop - and are replaced in the body - blood production
N - M - Eo - Meg - B - RBC - stem
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

37. Neutropenia
150 -000-450 -000
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
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 neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)

38. B Cell
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
Humeral immunity: Ab production
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

39. WBC Count
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
volume % of RBC in blood - Female: 36-48 - Males: 42-52
4.5-10
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

40. anisocytosis
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Variation in size
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
Growth factor that causes neutraphils to grow

41. Platelets
In the bone marrow
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Humeral immunity: Ab production
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

42. Hgb anatomy
MCV - index for classifying anemia - Norma: 80-100
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Abnormally shaped cells - schiztocyte - tear drop - oval
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)

43. Serum Ferritin
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
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
What is stored in body M: 18-270 W: 18-160
Type of anemia characterized by smaller paler than usual RBC

44. Erythropoiesis
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Programmed cell death (cyto C. and caspases)
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets

45. Mild forms of thalessemia need to be differentiated from...
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
7th month
In the bone marrow

46. What is the life span of blood cells?
In the bone marrow
N - M - Eo - Meg - B - RBC - stem
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

47. Genetic defects
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
MCV: 80-100 - sickle cell anemia - G6PD
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

48. Leukapenia
Thalessemia - and sickle cell
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Cellular Immunity: helper - killer cells: affected with HIV
low platelet count - skin bleeding - mucosa: especially bleeding of gums

49. Albumin
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
Growth factor that causes neutraphils to grow
Most abundant protein in the plasma and helps establish the osmotic gradient
Breaking open of the RBC's and release of HgB (spleen)

50. IL-1
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
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
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