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Hematology Clinical Medicine - I

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. T cell
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)
Cellular Immunity: helper - killer cells: affected with HIV
Thalessemia - and sickle cell
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

2. Amount of Hb in Males and Females
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
M- 75-175 F- 65-165
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

3. Intrinsic Hemolytic anemia
4.5-10
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells

4. GM-CSF
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
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)
Most abundant protein in the plasma and helps establish the osmotic gradient
N - M - Meg - RBC

5. purpura
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
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
Palpable - slightly raised areas of bleeding
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

6. Progenitor cells
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Male: 14-17 Female: 12-15
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
N - M - Meg - RBC

7. Neutophilia
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
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Severe infections

8. RBC
T lymph - stem cell
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
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
Asymptomatic until 4 months of life

9. PE of bleeding patient
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Severe infections
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)

10. Erythropoietin
Male: 14-17 Female: 12-15
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
Palpable - slightly raised areas of bleeding

11. Platelet Count
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Parasite infections
150 -000-450 -000
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

12. Reticulocyte
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
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
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

13. Pathology for Thallessemia
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
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
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Standard for reporting the PT

14. Microcytic cells
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
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

15. Thallassemia Syndormes
Abnormally shaped cells - schiztocyte - tear drop - oval
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation
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
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

16. IL-2
T and B lymph
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
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
XRT (radiation and Chemo - inherited immune disorders

17. Extrinsic hemolytic anemia
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
Confluent areas of bleeding right below the skin
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Autoimmnr hypersplensm

18. von Willebrand Factor
HbA-2alpha and 2 beta chains
7th month
Process by which all blood cells form - develop - and are replaced in the body - blood production
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life

19. IL- 3
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
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
N - M - Eo - Meg - B - RBC - stem
98% - alpha and beta

20. Specific disease of anemia
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Sickle cell - G6PD - thalessemia
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations

21. Blood clot formation
Normal adult Hg - 2 alpha and 2 beta globin chains - attached to each chain is heme - 95-98%
Severe infections
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
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen

22. Blood is produced....
Most abundant protein in the plasma and helps establish the osmotic gradient
Parasite infections
Variation in size
In the bone marrow

23. Erythrocytes
Abnormal size of cells and vary in abnormality
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
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
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

24. Bleeding disoders can be....
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)
Acquired or inhereited
GF produced by liver and stimulates production of megakariocytes
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets

25. Hgb anatomy
ITP/TTP: platelets destroyed - bone marrow suppression - drugs - prosthetic heart valve: chew up platelets
Plasma protein that binds to Fe and helps absorb it - 200-400
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)
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

26. Hemolysis

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27. Granulocytes
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
HbF: 2 alpha and 2 gamma
Acquired or inhereited
Anti-thrombin III deficiency - Lupus anticoagulant - other conditions for hyper-coagulation

28. Genetic defects
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
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
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites

29. Mean Corpuscular Volume
large gylcoprotein - major adhesion molecule which allows platelets to stick - binding factor in factor VIII and prolongs its half life
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
MCV - index for classifying anemia - Norma: 80-100
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)

30. Approach to a bleeding patient
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
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Abnormal size of cells and vary in abnormality

31. Bleeding D/O laboratory testing
XRT (radiation and Chemo - inherited immune disorders
Skin - tend to bleed also into the muscles and joints
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
Abnormally shaped cells - schiztocyte - tear drop - oval

32. monocytes are present in....
Severe infections
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
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Vit B 12 and folic acid deficiency

33. INR
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Standard for reporting the PT
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen

34. Transferrin
Plasma protein that binds to Fe and helps absorb it - 200-400
RBC (erythrocytes) - WBC (leukocytes) - Platelet (thrombocytes) - blood cells are surrounded in Plasma
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
Variation in shape

35. Bacteria that patients with sickle cell anemia are at risk for
M- 75-175 F- 65-165
Encapsulated bacteria: Strep pneumonia and H. Influenza
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

36. Coagulation factor deficiency
Acyclovir - Phenytoin - Quinin - Amphotericin B - Levamisole - Digoxin - Ibuprofin - Amiodarone - Rifampin - ASA
Plasma protein that binds to Fe and helps absorb it - 200-400
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Skin - tend to bleed also into the muscles and joints

37. Bleeding/ Hypercoagulation disorders
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation
MCV - index for classifying anemia - Norma: 80-100
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
HbA-2alpha and 2 beta chains

38. Hemolytic Anemia
Autoimmnr hypersplensm
Genetic and rare or acquired
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
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

39. Poikilocytosis
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Parasite infections
Abnormally shaped cells - schiztocyte - tear drop - oval
Skin - tend to bleed also into the muscles and joints

40. Proper O2 transport depends on...
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Variation in size
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
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances

41. Leukapenia
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
55% of blood plasma - contains all the blood cells
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)

42. Inherited Hemoglobinopathy
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
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
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Variation in size

43. Neutropenia
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
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Low neutrophil count - seen in bone marrow/ blood diseases - drugs - chemicals (benzene) - radiation (affects bone marrow)
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

44. Hemobglobin A
M- 75-175 F- 65-165
Abnormally shaped cells - schiztocyte - tear drop - oval
98% - alpha and beta
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

45. Apoptosis
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Genetic and rare or acquired

46. Hypercoagulable states are...
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
GF produced by liver and stimulates production of megakariocytes
Genetic and rare or acquired

47. Intrinsic hemolytic anemia
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -
Plasma protein that binds to Fe and helps absorb it - 200-400
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Thalessemia - and sickle cell

48. ecchymosis
Bind to receptors on cells and initiate carrying of signals that generate transcription factors and the cell proliferates
Confluent areas of bleeding right below the skin
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
Abnormal size of cells and vary in abnormality

49. Hemoglobin A2
1-2% - alpha and gamma
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.
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl

50. HgB/ HCT is increased with....
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Bleeding usually begins in infancy or childhood - recurrent bleeding - bleeding from multiple sites
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
M- 75-175 F- 65-165