HEMATOLOGY

1. Hematopoiesis 

production of blood cells

2. Blood fx

transportation - carry O2, CO2

regulate body temp, pH, electrolytes

transport waste to kidney - excrete as urine

protection - wbc 

clotting - stop internal & external bleeding 

3. Component - based on density 

55% plasma 

1% wbc & platelet 

45% rbc - Fe heavy, carry O2

4. Site 

yolk sac - 1-3 mth embryo

liver & spleen - fetus 

BM - 6 mth onwards 

tibia 

femur

rib 

sternum

vertebrae 

5. BM environment 

fats & rbc wbc

red BM replace by fats - prone to anemia, aging 

6. HSC

self-renew

multipotentiality

differentiation - myeloid or lymphoid lineage 

7. Surface markers

identification for cells - Ag 

flow cytometry - cell pass laser beam, fluorescence labeled Ab detect

wbc occupy BM, suppress rbc, cause anemia & thrombocytopenia 

8. Cytokines/HGF

regulator - protein/peptide/hormone - myeloid, lymphoid 

9. Cytokines fx

fx stimulation

maturation induction 

differentiation commitment 

proliferation

survival 

10. Erythropoiesis 4-10d

hypoxia - low rbc count, low Hb amount, low O2 availability 

EPO stimulate red BM 

myeloid progenitor cells 

erythroblast 

normoblast eject nucleus - biconcave disc, increase surface: volume & density

reticulocyte 

increase rbc count

increase O2 carrying ability of blood

11. EPO 7q21

site: kidney 

fx:

proliferation

differentiation

survival 

clinical use: 

anemia

reduction of blood transfusion in elective surgery

autologous blood donation

12. Granulopoiesis 6-10d

myeloid progenitor 

myeloblast 

promyelocyte 

myelocyte 

meta myelocyte 

N - bacteria & fungal 

circulating n - free flow in bloodstream

marginating n 6-10h - can exit BV 

E - parasite, allergy 

B - hypersensitivity 

13. 

GM-CSF

G-CSF

M-CSF

IL-3

IL-5

IL-6

14. Thrombopoiesis 

myeloid progenitor 

megakaryoblast 

promegakaryocyte

megakaryocyte 

platelet 

15. TPO 3q27-28 

site: liver

clinical use: 

chemo

platelet transfusion

RBC pathophysio

1. RBC membrane 

vertical interaction: stabilize

horizontal: support sx integrity 

2. membrane ds 

vertical: spherocytosis 

horizontal: elliptocytosis, ovalocytosis 

cholesterol: acanthocytosis - spikes

hydration: stomatocytosis/xerocytosis 

3. met

to survive 120d

supply energy

reduce oxidant 

Hb in reduced state 

release of O2 

4. Embden Meyerhof pathway 

anaerobic glucose met

enzyme: pyruvate kinase

product: 2 pyruvate, 4 ATP, 2 NADH

5. Hexose Monophosphate

prevent oxidative stress

enzyme: G6PD

H2O2 to H2O 

6. MetHb reductase 

Fe3+ to Fe2+ 

Fe2+ as reduced state to able carry O2

7. Leubering Rapoport shunt

enzyme: mutase

product: 2,3 DPG regulate O2 release from Hb 

8. O2 dissociation curve 

left shift 

high O2 affinity 

low H

low PCO2

low temp

CO poison 

9. Hb tetramer

4 polypeptide 

2a chr16 + 2b globin chr11 + 4 heme + 4 Fe + 4 O2

10. why Hb got differ subtype 

gene mutation 

11. Heme 

Fe

site: mitochondria, cytosol 

4 pyrrole rings thro methenyl bridge 

biosynthesis:

12. Porphyrias 

13. Aging & destruction

macrophage eat rbc

deconstruct back to aa & heme 

heme 

billiverdin

billirubin 

excrete in bile

intestine 

urobillinogen 

urobillin 

excrete to kidney as urine 

if stercobillin - feces 

Anemia class

1. define

BM has capacity to increase RBC production 5-10x

inadequate O2

not ds, exp of an underlying ds

2. clinical symptom 

reduction in blood transport of O2 - deficiency in RBC

FBC/CBC parameter:

decrease Hb, RBC count, Hct/PCV 

3. diagnosis 

patient H/O, physical exam, lab, identification of cause

4. rapid develop if

inadequate compensatory mechanism from BM

when RBC loss or destruction exceeds capacity of production

when BM production impair 

5. pathophysio

insufficient Fe, B12, folate

inefficient BM infiltration

hemorrhage, excessive destruction - reduced cell lifespan

pooling - hypersplenism 

6. H/O 

age, sex, geographic location, lung ds

nutritional deficiencies

external/internal blood loss

increase RBC destruct

decrease RBC produce

BM patho

infection

7. FBC

severe Hb <7

8. morphology

microcytic <80fL:

Fe def

thalassemia 

chronic ds

normocytic:

aplasia

protein malnutrition 

chronic renal failure 

post-hemorrhagic

macrocytic >100:

B12 def

folate

myelodysplasia

chemotherapy 

liver ds

increased reticulocytosis

myxedema =hypothyroidism

9. reticulocyte 

immature RBC 

reticulofilamentous materials = RNA 

stains grey-blue with supravital stain - methylene blue or brilliant cresyl blue 

10. reticulocyte count 

% of total no of RBC in blood 

NR adult: 0.5-2.5

infant: 2-6

if low, inadequate BM response

if high, overproduce RBC - may compensate for hemolysis/hemorrhage 

11. high Hb

smoke

live at high altitude

chronic hypoxemic lung ds

right to left intracardiac shunts

low Hb 

African descent 

pregnancy

endurance athlete 

elderly 

12. MCV<80

IDA

thalassemia

chronic inflammation

MCV80-100

chronic kidney ds

acute blood loss

chronic inflammation

hospital acquired anemia

MCV>100

megaloblastic 

non megaloblastic - alcohol, liver ds, hypothyroidism, myelodysplastic syndrome 

13. hypo proliferative 

ret index <2

chronic inflammation

nutrient def

hormone def

BM failure

hospital  

hyper >3

acute blood loss

hemolysis - G6PD