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Intro to Hematology

Clinical Medicine II Spring 2012

The study and tx of diseases of blood and blood forming organs hematology
Malignant hematology leukemia, lymphoma, myeloma
Benign blood dzs anemias, genetic blood dzs: thalassemia, sickle cell, enzyme defects, bleeding and clotting d/o, immune deficiencies
What are the formed elements of blood RBC, WBC, platelets
What are the plasma elements water, dissolved ions, proteins
Where is blood made, and 3 compartments bone marrow, circulation, peripheral tissues
What are leukocytes and thrombocytes l: WBCs T: platelets
Main component of plasma water
Where are proteins in the blood? 3 types? plasma, carrier proteins, immunoproteins, coagulation proteins
What are carrier proteins albumin, lipoproteins, transferrin
What are immunoproteins IgG, IgA, IgM, IgD, IgE complement proteins
Hematopoiesis making or production of blood
When is blood begin to develop in gestation 4-5 weeks
When do blood cells migrate to be produced during gestation liver 5 weeks, bone marrow and thymus 8 weeks, spleen 12 weeks
Why do we look for enlarged liver and spleen during blood diseases liver and spleen help take over RBC production hence enlargement
What does the thymus do maturation of WBC shriveled in adulthood, lg and soft in newborns
At birth what is the primary hematopoietic bone marrow
What happens to bone marrow tissue as we age we don’t need it all, usually at about 20% of what we had in 1st decade of life
Why do medications affect blood counts so much more as we age compared to when we’re young ↓bone marrow tissue
Sinuses lined w/ endothelial cells and fibroblasts support the devellpment of blood cells stroma
What plays and important supportive role in the stroma of bone marrow osteoblasts
What are hematopoietic cells stem cells → mature blood cells
What is the 1st type of cells that many other arise from pluripotent hematopoietic stem cell
Two types of 2nd stem cells myeloid:RBC, platelets, leukocytes or lymphoid stem cells(go into thymus to mature to B and T lymphocytes)
Requirements for hematopoiesis healthy bone marrow, hormones, and nutritional factors
Two most important hormones in hematopoiesis and where are they made erythropoietin: kidney, thrombopoietin: liver
What happens w/ kidney and liver dz k: anemia L: thrombocytopenia
What 3 nutriitional factors are needed for hematopoiesis iron, folate, vit B12
MC anemia deficiency ever iron deficiency anemia
Why are blood dz’s so common manyyyy systemic disease affects the parts of blood production
Process to make RBC erythropoiesis
Where do RBC originate from common myeloid stem cell
What happens to the RBC prior to release from the marrow nucleus is ejected from the cell
What happens to the RBC development w/ folate and VIt B12 def the nuclease doesn’t condense, and looks like an early stage
Why is folate and Vit B12 so important need them for DNA synthesis
5 types WBC neutropohils, eosinophils, basophils, monocytes and lymphocytes (lymphoid path)
Why do we call T and B lymphocytes that? T: mature in thymus B: mature in bone marrow
What is a platelet chunk of cytoplasms from a megakaryocyte
What type of cell has more than one nucleus megakaryocyte, cytoplasms divides, but cell does not, eventually chunks break out→platelets
What are 6 big things can cause anemia 1: nutritional def, 2: marrow toxins, 3: infxs, 4: marrow replacement, 5: autoimmune dzs 6: primary bone marrow dzs
What are examples of marrow replacements infections: fungal, TB, sarcoids, leukemia, lymphoma, myeloma, carcinoma
Three critical ways to evaluate blood and bone marrow CBC, peripheral blood smear, bone marrow
Where do we get a bone marrow biopsy from post, superior, iliac spine, bc no major structures here, lots of bone marrow
Two types of bone marrow biopsies core sample, and aspirate: need two holes in bones
Size and shape of RBC biconcave disk (once they lose their nucleus) , 7mM diameter
What are the 4 compoenets of a RBC membrane, Hb, enzymes, electolytes
What are the enzymes in a RBC doing protecting the Hb from getting oxidized
Fxns of a RBC transports O2 and CO2 to and from tissues
Why do we need to know about enzyme difiencies some like g6phosphate dehydrogenase: can’t use sulfa drugs
Why is iron important w/ RBCs in the center structure of heme w/o iron, no Hb, no RBC no O2 transport
If creatnine is nl, how can there still be anemia need to check EPO level, can be making urine, and not EPO
Three nutrients to make RBC iron, folate, B12
If there is anemia, what should we immediately check reticulocyte count, immature RBCs showing that the bone marrow is making new RBCs, more anemia→↑the retic count
Ave life span of RBC, removed how 120 days, phagocytized by macrophages in spleen, liver, bone marrow d/t different proteins on cell surface
RBC count number per uL blood
Three ways and MC way to measure anemia RBC count, Hct % and Hgb: MC thing to look at
3 types of anemia micrcytic, normocytic, macrocytic
Types of erythrocytosis polycythemia ver, 2nd: hypoxia, abnl EPO production, abnl Hgb w/ ↑O2 affinity: smokers
3 tyeps of hemoglobinopathies abnl hb structures, thalassemia, sickle cell
What is microcytic hypochromic anemia iron deficiency anemia
What should nl RBC be shaped like central pallor 1/3 of the cell, cell size should be the size of a sm. Lymphocyte
With severe iron deficiency, what is the retic count and EPO level low retic count d/t no iron to make RBC and sky high EPO level d/t need for more RBCs
When do you see target cells on the differential thalassemia and liver dz
What do symptoms of anemia depend on rate of blood loss
Sxs of anemia fatigue, dyspnea, palpiations, tachy, dizzy, lightheadness, faintness, HA, angina, claudication
PE of anemia pallor, jaundice, tachy, tachypnea, edema, lymphadenopathy, hepatosplenomegly, ecchymosis, petchiae, stool occult blood
Anemia algorhytima check retic count: nl or low then can’t MAKE it d/t deficiencies 2: Check MCV
Microcytic anemia causes iron deficiency, anemia of chronic dz, thalassemia
Normocytic anemia anemia of chronic dz, renal failure, early/mild iron def, 1 bone marrow failure (aplastic anemia)
Macrocytic anemia B12/folate def, liver dz, hypothyroidism, drugs, myelodysplastic syndrome
What are common drugs causeing macrocytic anemia Mess w/ DNA synthesis MTX, sulfa, trimeterine, phenytoin, chemo, antivirals
4 MC causes of anemia Iron def, renal failure, B12/folate def, liver dz
Created by: becker15
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