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Hematology Clinical Medicine - I

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1. Lymphocytosis Causes
Male: 14-17 Female: 12-15
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
FE deficiency - have normal FE iron studies because cannot attach to Hb molecule
Lymphoid Leukemia - Mono - acute infections a/w viral diseases

2. Leukapenia
55% of blood plasma - contains all the blood cells
Confluent areas of bleeding right below the skin
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
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)

3. PE for anemia
HbA-2alpha and 2 beta chains
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)
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
Platelet problems - factor 10 and vwf deficiency - vitamin K deficiency - anti-thrombin III deficiency - protein C deficiency - acquired disorder or coagulation

4. Production of Hemoglobin
HbA-2alpha and 2 beta chains
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
Programmed cell death (cyto C. and caspases)
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

5. microcytic hypochromic anemia
MCV: 80-100 - sickle cell anemia - G6PD
Fetal Hg - 2 alpha and 2 gamma chains - 1%
Lymphoid Leukemia - Mono - acute infections a/w viral diseases
Type of anemia characterized by smaller paler than usual RBC

6. Composition of HgB
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
Skin - tend to bleed also into the muscles and joints
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size

7. Poikilocytosis
Acquired or inhereited
Abnormally shaped cells - schiztocyte - tear drop - oval
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection

8. Lymphopenia Causes
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
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Hemoglobulinopathy - inherited or acquired - Problem: RBC membrane defects so will get episodic or continuous RBC destruction - varies from mild to severe
XRT (radiation and Chemo - inherited immune disorders

9. Extrinsic hemolytic anemia
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
Starts with vasoconstriction and this causes platelets to come to the site of damage and adhere to damaged collagen
Autoimmnr hypersplensm
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

10. PE of bleeding patient
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
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)
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Have granules in the cytoplasm - neutrophil: 50-60%** most prominent - eosinophil: 1-4% - basophil: 0.5-1%

11. Classification of anemia
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
Sickle cell - G6PD - thalessemia
Pathophysiologic basis: diminished product of increase destruction - Morphologic basis: measure of average RBC size
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)

12. GM-CSF
Breaking open of the RBC's and release of HgB (spleen)
N - M - Meg - RBC
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

13. IL- 3
N - M - Eo - Meg - B - RBC - stem
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs
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
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production

14. Fibrin
4 globin chaines: globin (each bines to 1 O2 molecule Heme: binds to iron
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
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
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets

15. Hemolytic Anemia
7th month
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
Type of anemia characterized by smaller paler than usual RBC
What is stored in body M: 18-270 W: 18-160

16. Hemoglobin F
Abnormal size of cells and vary in abnormality
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Less than 1 persent

17. petechiae
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
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
Less than 80 MCV - iron deficiency - thalessemia - siderblastic

18. Bleeding disoders can be....
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
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
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
Acquired or inhereited

19. Transferrin
Plasma protein that binds to Fe and helps absorb it - 200-400
What is stored in body M: 18-270 W: 18-160
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs
Confluent areas of bleeding right below the skin

20. Plasma
High neutrophil count - due to acute - localized/ general bacterial infections - inflammation - myeloproliferative diseases
55% of blood plasma - contains all the blood cells
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
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:

21. Leukocytosis
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)
Confluent areas of bleeding right below the skin
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
Temporary infections - trauma/ tissue injury - Acute Infections: WBC count increases - Other causes:Leukemia - Malignant Neoplasms - Drugs -

22. Hematopoeisis in adulthood is limited to....
The flat bones: sternum - pelvis - proximal ends of the long bones
Differentiate into whatever cell the body needs - self renewing - uncommitted cells - can differentiate into specialized cells such as progenitor cells
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Type of anemia characterized by smaller paler than usual RBC

23. Hemoglobin A2
1-2% - alpha and gamma
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
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Plasma protein that binds to Fe and helps absorb it - 200-400

24. Hemoglobinopathies
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.
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
1-2% - alpha and gamma
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria

25. T cell
XRT (radiation and Chemo - inherited immune disorders
Less than 1 persent
Cellular Immunity: helper - killer cells: affected with HIV
Autoimmnr hypersplensm

26. Normal Hbg Count
Holds platelets together - factor VIII activated it and has to tighten - trapping more platelets
Arrest of bleeding - depends on vessel wall - platelets - and coagulation factors (fibrolytic factors)
Platelets - In BM: very large - In blood: small irregular shaped cell fragments - involved in hemostasis
Male: 14-17 Female: 12-15

27. Abnormality in beta chain are present....
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)
Asymptomatic until 4 months of life
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

28. Microcytic cells
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
Variation in size
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

29. Amount of Hb in Males and Females
Baseline test - wellness screening - diagnosing certain condition - response to treatment and recovery - monitor certain health conditions
N - M - Eo - Meg - B - RBC - stem
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Severe infections

30. Bone Marrow Cellularity
XRT (radiation and Chemo - inherited immune disorders
Vit B 12 and folic acid deficiency
Usually 40-45% - fat cells make up 50-55Q% - Rest are RBC precursor
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

31. Anisocytosis
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
Abnormal size of cells and vary in abnormality
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
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)

32. Iron Serum test
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
M- 75-175 F- 65-165
Most abundant protein in the plasma and helps establish the osmotic gradient
Mild: tired - pale - often assymptomatic - pallor - jaudnice - tachycardia - palpitation - spleen enlargement - glossitis - cheilosis (sore in the mouth) - neurologic sxs

33. By what month in the fetus does the development of the RBC move to the bone marrow?
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Type of anemia characterized by smaller paler than usual RBC
7th month
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

34. Specific disease of anemia
Hb analysis and electrophoresis with functional assays for sickling - solubility - and O2 affinity are used for routine clinical evaluations
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages
Sickle cell - G6PD - thalessemia
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease

35. HgB/ HCT is decreased with....
Excessive loss of RBC - inadequate production of RBC (problem with bone marrow) - increased destruction of RBC - secondary to chronic disease
Tetramer structure of proteins - proper arrangement of charged amino acids - interaction with low molecular weight substances
N - M - Eo - Meg - B - RBC - stem
Anemia - hemodilution (over hydration) - leukemia - hemolytic reactions - drugs

36. RBC
Erythrocytes - respond to tissue hypoxia and carry O2 to the body
low platelet count - skin bleeding - mucosa: especially bleeding of gums
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
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

37. Platelets
Humeral immunity: Ab production
FE deficiency - Hemoglobinopathies - sideroblastic anemia - lead poisoning
Lymphocytes: 20-40% - Monocytes: 2- 6% (circulate in the blood 1-3 days and mature in tissues)
Megakaryocytes (growth stimulated by thrombopoieten) - help prevent hemorrhages

38. Macrocytic cells
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
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
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
Greater than 100 MCV - B12 deficiency - folic acid deficiency - pernicious anemia (form of B12)

39. HgB/ HCT is increased with....
Polycythemia vera - CHF/COPD - Drugs - Living at high altitudes
XRT (radiation and Chemo - inherited immune disorders
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
Asymptomatic until 4 months of life

40. Intrinsic Hemolytic anemia
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
MCV - index for classifying anemia - Norma: 80-100
Hereditary spherocytosis - G6PD deficiency - sickle cell syndrome
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains

41. purpura
Palpable - slightly raised areas of bleeding
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
Abnormally shaped cells - schiztocyte - tear drop - oval
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

42. bleeding disorders
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Skin - tend to bleed also into the muscles and joints
Thrombocytopenia - Henoch- Scholein Purpura - Scurvy - ITP - TTP - DIC - Hemophilia A and B - Von Willebrands disease - Vit. K deficiency - Liver disease
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

43. Erythropoiesis
If platelets are below 40 -000 will spontaneously bleed and occurs where pressure it
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Confluent areas of bleeding right below the skin
Production of RBC - stimulated by decrease in O2 -kidneys produce hormone erythropoietin

44. Bleeding D/O laboratory testing
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
Increased retic with falling/ stable HgB - increase serum LDH - increase total bilirubin - transient hemoglobinuria
Type of anemia characterized by smaller paler than usual RBC
7th month

45. ecchymosis
Low WBC count - Bone marrow depression: drug related (H2 blockers) - primary bone marrow disorder - immune associated neutropenia (chemo) - fungal infection of bone marrow (HIV)
Erythrocytes: 120 days - Platelets: 8-10 days - WBC: hours to few weeks - increase during infection
Female: 12-16 gm/dl ***menopausal women have more Male: 14-17 gm/dl
Confluent areas of bleeding right below the skin

46. Normocytic
MCV: 80-100 - sickle cell anemia - G6PD
Adequate supply of iron - proper synthesis of heme - proper synthesis of globin chains
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

47. Coagulation factor deficiency
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)
Programmed cell death - eliminates old - unnecessary - or unhealthy/ abnormal cells - defects in the pathway are important in causing CA
Skin - tend to bleed also into the muscles and joints
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

48. Reticulocyte count
Autoimmnr hypersplensm
Immature red blood cells - normal: 0.5-1.5%: elevated in people with anemic anemia - low retic: anemia from decreased RBC production
Growth factor that causes neutraphils to grow
volume % of RBC in blood - Female: 36-48 - Males: 42-52

49. B Cell
T lymph - stem cell
volume % of RBC in blood - Female: 36-48 - Males: 42-52
Less than 80 MCV - iron deficiency - thalessemia - siderblastic
Humeral immunity: Ab production

50. monocytes are present in....
8% of body weight- 5L in women and 5.5L in males
Tiredness - easily fatigued - DOE - palpitation - dizziness - bleeding - sores on mouth and tongue
HbA2: 2 alpha and 2 delta globin chains - in 2% of the population
Severe infections