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Hematology Clinical Medicine - I

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1. Mild forms of thalessemia need to be differentiated from...
Severe infections
Palpable - slightly raised areas of bleeding
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
55% of blood plasma - contains all the blood cells

2. Hematopoietic Stem cells
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Growth factor that causes neutraphils to grow

3. Blood is produced....
What is stored in body M: 18-270 W: 18-160
In the bone marrow
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

4. Detection of hemoglobinopathy
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
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Process by which all blood cells form - develop - and are replaced in the body - blood production
volume % of RBC in blood - Female: 36-48 - Males: 42-52

5. Extrinsic hemolytic anemia
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
Cellular Immunity: helper - killer cells: affected with HIV
Autoimmnr hypersplensm

6. petechiae
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Most abundant protein in the plasma and helps establish the osmotic gradient
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
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

7. Production of Hemoglobin
Plasma protein that binds to Fe and helps absorb it - 200-400
150 -000-450 -000
Adequate supply of iron - proper synthesis of heme - proper synthesis of 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

8. Transferrin
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Confluent areas of bleeding right below the skin
Plasma protein that binds to Fe and helps absorb it - 200-400

9. 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
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%
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

10. beta globin chain genetic
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
GF produced by liver and stimulates production of megakariocytes
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
Plasma protein that binds to Fe and helps absorb it - 200-400

11. Apoptosis
Programmed cell death (cyto C. and caspases)
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
HbA-2alpha and 2 beta chains

12. Hgb anatomy
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)
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
8% of body weight- 5L in women and 5.5L in males

13. Classification of anemia
Humeral immunity: Ab production
Parasite infections
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
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size

14. purpura
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Palpable - slightly raised areas of bleeding
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
GF produced by liver and stimulates production of megakariocytes

15. What is the life span of blood cells?
150 -000-450 -000
N - M - Eo - Meg - B - RBC - stem
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
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

16. Proper O2 transport depends on...
Less than 1 persent
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
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

17. RBC
Confluent areas of bleeding right below the skin
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Asymptomatic until 4 months of life
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin

18. Iron Serum test
M- 75-175 F- 65-165
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Most abundant protein in the plasma and helps establish the osmotic gradient
98% - alpha and beta

19. Clotting disorders
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
T lymph - stem cell
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
Process by which all blood cells form - develop - and are replaced in the body - blood production

20. Hemolytic Anemia
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
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
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

21. Hemocrit
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
volume % of RBC in blood - Female: 36-48 - Males: 42-52
MCV: 80-100 - sickle cell anemia - G6PD
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

22. Normal Hbg Count
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
Male: 14-17 Female: 12-15
Genetic and rare or acquired
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

23. Thrombopoietin
Thalessemia - and sickle cell
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
GF produced by liver and stimulates production of megakariocytes
150 -000-450 -000

24. INR
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Standard for reporting the PT
8% of body weight- 5L in women and 5.5L in males
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

25. Platelet Count
Confluent areas of bleeding right below the skin
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
150 -000-450 -000
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)

26. Hemoglobin F
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Less than 1 persent
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Variation in size

27. G-CSF
Variation in shape
N - M - Eo - Meg - B - RBC - stem
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Growth factor that causes neutraphils to grow

28. Normocytic
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
MCV: 80-100 - sickle cell anemia - G6PD
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

29. Abnormality in beta chain are present....
Asymptomatic until 4 months of life
Fetal Hg - 2 alpha and 2 gamma chains - 1%
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
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions

30. IL-1
T lymph - stem cell
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
8% of body weight- 5L in women and 5.5L in males

31. Intrinsic Hemolytic anemia
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
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Sickle cell - G6PD - thalessemia

32. Anisocytosis
Growth factor that causes neutraphils to grow
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
Abnormal size of cells and vary in abnormality
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

33. Blood consists of what cellular elements
Confluent areas of bleeding right below the skin
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
Variation in shape
Abnormally shaped cells - schiztocyte - tear drop - oval

34. Megakariocytes/ Thrombocytes
Genetic and rare or acquired
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Erythrocytes - respond to tissue hypoxia and carry O2 to the body

35. Thallassemia Syndormes
N - M - Meg - RBC
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
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
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

36. Granulocytes
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
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
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it

37. Hemoglobin A2
98% - alpha and beta
1-2% - alpha and gamma
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:

38. Bleeding D/O laboratory testing
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
The flat bones: sternum - pelvis - proximal ends of the long bones
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
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

39. Apoptosis
4.5-10
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
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
low platelet count - skin bleeding - mucosa: especially bleeding of gums

40. Lymphopenia Causes
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
XRT (radiation and Chemo - inherited immune disorders
Cellular Immunity: helper - killer cells: affected with HIV

41. Hemoglobinopathies
Breaking open of the RBC's and release of HgB (spleen)
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.
7th month
MCV - index for classifying anemia - Norma: 80-100

42. PE for anemia
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)
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Acquired or inhereited

43. Leukapenia
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
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

44. Erythropoiesis
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Less than 1 persent
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor

45. Inherited Hemoglobinopathy
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
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
Acquired or inhereited
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen

46. Intrinsic hemolytic anemia
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Autoimmnr hypersplensm
Thalessemia - and sickle cell
Variation in size

47. HbA
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%
Type of anemia characterized by smaller paler than usual RBC
T lymph - stem cell

48. HgB/ HCT is decreased with....
HbF: 2 alpha and 2 gamma
Standard for reporting the PT
8% of body weight- 5L in women and 5.5L in males
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

49. Erythropoietin
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
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

50. Fibrin
Acquired or inhereited
Parasite infections
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
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