1. Chapter 13
Objectives
Identify terms relating to the composition, formation, & function of blood.
Differentiate among the four major blood types
Identify terms related to blood clotting
Build words & recognize combining forms used in blood system terminology
Identify various pathologic conditions affecting blood
Describe various laboratory tests & clinical procedures used with hematologic disorders, & recognize relevant abbreviations
Apply your new knowledge to understanding medical terms in their proper contexts, such as medical reports & records

2. Blood System
Chapter 13
Pages 503 – 546

3. Vocabulary Page 512 albumin differentiation globulin antibody (Ab)
electrophoresis
granulocyte
antigen
eosinophil
hematopoietic stem cell
basophil
erythroblast
hemoglobin
bilirubin
erythrocyte
hemolysis
coagulation
erythropoietin (EPO)
heparin
colony- stimulating factor (CSF)
fibrin
immune reaction
fibrinogen
immunoglobulin
ALBUMIN (ăl-BŪ-mĭn) Protein in blood; maintains the proper amount of water in the blood.
ANTIBODY (ĂN-tĭ-bŏd-ē) [Ab] Protein [immunoglobulin] made by white blood cells in response to foreign substances [antigens] in the blood – An antibody is specific to an antigen and inactivates it.
ANTIGEN (ĂN-tĭ-jĕn) Substance (usually foreign) that stimulates the production of an antibody.
BASOPHIL (BĀ-sō-fĭl) White blood cell (leukocyte) containing granules that stain with a basic dye; associated with release of histamine and heparin.
BILIRUBIN (bĭl-ĭ-ROO-bĭn) Orange-yellow pigment found in bile; it is released from the breakdown of hemoglobin when red blood cells die.
COAGULATION (kō-ăg-ū-LĀ-shŭn) Process of blood clotting
COLONY-STIMUALTING FACTOR (KŎL-ō-nē STĬM-ū-lā-tĭng FĂK-tŏr) [CSF] Protein that stimulates the growth and proliferation of white blood cells (granulocytes)
DIFFERENTIATION (dĭf-ĕr-ĕn-shē-Ā-shŭn) Change in structure and function of a cell as it matures; Also known as specialization.
ELECTROPHORESIS (ē-lĕk-trō-fō-RĒ-sis) Technique used to separate serum proteins by electrical charge.
EOSINOPHIL (ē-ō-SĬN-ō-fĭl) White blood cell whose granules stain intensely with an acidic eosin (reddish) dye; associated with allergic reactions.
ERYTHROBLAST (ĕ-RĬTH-rō-blăst) Immature, developing red blood cell
ERYTHROCYTE (ĕ-RĬTH-rō-sīt) Red blood cell. . There are about 5 million per microliter (µL) or cubic millimeter (mm3) of blood.
ERYTHROPOIETIN (ĕ-rĭth-rō-POY-ĕ-tĭn) [EPO] Substance [hormone] produced [secreted] by the kidney to stimulate bone marrow to produce erythrocytes
FIBRIN (FĪ-brĭn) Protein threads that form the basis of a blood clot
FIBRINOGEN (fī-BRĬN-ō-jĕn) Plasma protein that is converted to fibrin in the clotting process.
GLOBULIN (GLŎB-ū-lĭn) Major blood protein; EXAMPLE: alpha, beta, and gamma immunoglobulin
GRANULOCYTE (GRĂN-ū-lō-sīt) White blood cell with numerous dark-staining granules; EXAMPLE: neutrophil, eosinophil and basophil
HEMATOPOIETIC STEM CELL (hē-mă-tō-pō-EH-tik stĕm sĕl) Cell in the bone marrow that gives rise to different types of blood cells.
HEMOGLOBIN (HĒ-mō-glō-bĭn) Blood protein containing iron; carries oxygen in red blood cells.
HEMOLYSIS (hē-MŎL-ĭ-sĭs) Destruction or breakdown of blood; specifically red blood cells.
HEPARIN (HĔP-ă-rĭn) Anticoagulant found in blood and tissues.
IMMUNE REACTION (ĭm-MŪN rē-ĂK-shŭn) Response of the immune system to foreign invasion.
IMMUNOGLOBULIN (ĭm-ū-nō-GLŎB-ū-lĭn) Antibody-containing protein in the blood; EXAMPLE: IgG, IgM, IgA, IgE, IgD. Immun/o means protection.

4. Vocabulary (Cont’d) Page 513 leukocyte platelet lymphocyte
polymorphonuclear
macrophage
prothrombin
megakaryocyte
reticulocyte
monocyte
Rh factor
mononuclear
serum
myeloblast
stem cell
neutrophil
thrombin
plasma
thrombocyte
plasmapheresis
LEUKOCYTE (LOO-kō-sīt) White blood cell.
LYMPHOCYTE (LĬM-fō-sīt) Leukocyte (White blood cell) with a single nucleus (mononuclear); capable of producing antibodies.
MACROPHAGE (MĂK-rō-făj) Large phagocytic cell migrating from the blood into tissues – As a phagocyte, it engulfs foreign material and debris. In the liver, spleen, and bone marrow, macrophages destroy worn out red blood cells.
MEGAKARYOCYTE (mĕg-ă-KĀR-ē-ō-sīt) Large, giant cell with a big nucleus; platelet precursor found in the bone marrow.
MONOCYTE (MŎN-ō-sīt) White blood cell (agranulocyte) with one large nucleus; become macrophages as they leave the blood and enter body tissues. It is a cell that engulfs foreign material and debris.
MONONUCLEAR (mŏn-ō-NŪ-klē-ăr) Pertaining to a white blood cell (leukocyte) with a single, round nucleus; EXAMPLE: monocyte or lymphocyte.
MONOBLAST (MŎN-ō-blăst) Immature monocyte; gives rise to granulocytes.
NEUTROPHIL (NOO-trō-fĭl) White blood cell (leukocyte ) with dark granules that stain with a neutral dye; phagocyte formed in the bone marrow and the body's first line of defense against disease. Also called a polymorphonuclear leukocyte.
PLASMA (PLĂZ-mă) Liquid portion of blood containing proteins, water, salts, nutrients, hormones, and vitamins.
PLASMAPHERESIS (plăz-mă-fĕ-RĒ-sĭs) Removal of plasma from withdrawn blood by centrifuge. Collected cells are retransfused back into the donor. Fresh-frozen plasma or salt solution is used to replace withdrawn plasma.
PLATELET (PLĀT-lĕt) Clotting cell [thrombocyte].
POLYMORPHONUCLEAR (pŏl-ē-mŏr-fō-NŪ-klē-ăr) Pertaining to a multi-lobed nucleus (in granulocytic white blood cells); EXAMPLE: neutrophil.
PROTHROMBIN (prō-THRŎM-bĭn) Plasma protein converted to thrombin in the clotting process.
RETICULOCYTE (rĕ-TĬK-ū-lō-sīt) Immature erythrocyte with a network of strands (reticulum); is seen after staining the cell with special dyes.
Rh FACTOR (R-h FĂK-tŏr) Antigen [protein] on RBCs of Rh positive [Rh+] individuals. The factor was first identified in the blood of a rhesus monkey.
SERUM (SĔ-rŭm) Plasma minus clotting proteins [prothrombin and fibrinogen] and clotting cells. Clear, yellowish fluid that separates from blood when it is allowed to clot. It is formed from plasma, but does not contain protein-coagulation factors.
STEM CELLl (STĔM sĕl) Unspecialized cell that gives rise to mature, specialized forms
EXAMPLE: Hematopoietic stem cell = the progenitor for all different types of blood cells.
THROMBIN (THRŎM-bĭn) Enzyme necessary for blood clotting (converts fibrinogen to fibrin in the clotting process).
THROMBOCYTE (THRŎM-bō-sīt) Platelet; clotting cell

5. Page 514
Combining Forms
Meaning Examples
bas/o chrom/o coagul/o cyt/o eosin/o erythr/o granul/o hem/o, hemat/o
base, alkaline
color
clotting
cell
red, dawn, rosy
red
granules
blood
basophil
hypochromic
anticoagulant, coagulopathy
cytology
eosinophil
erythroblast
granulocyte
hemolysis, hematocrit
BASOPHIL (BĀ-sō-fĭl) White blood cell (leukocyte) containing granules that stain with a basic dye; associated with release of histamine and heparin – The suffix -phil means attraction to. Granules in basophils are attracted to a basic dye.
HYPOCHROMIC (hī-pō-KRŌ-mĭk) Pertaining to deficiency in color; decrease in hemoglobin in red blood cells – Hypochromic anemia is marked by a decreased concentration of hemoglobin in red blood cells.
ANTICOAGULANT (ăn-tĭ-cō-ĂG-ū-lănt) Substance that prevents blood clotting COAGULOPATHY (kō-ăg-ū-LŎP-ă-thē) Disease of blood clotting
CYTOLOGY (sī-TŎL-ō-jē) Study of cells
EOSINOPHIL (ē-ō-SĬN-ō-fĭl) White blood cell whose granules stain intensely with an acidic eosin (reddish) dye; associated with allergic reactions.
ERYTHROBLAST (ĕ-RĬTH-rō-blăst) Immature, developing red blood cell – -blast means immature.
GRANULOCYTE (GRĂN-ū-lō-sīt) White blood cell with numerous dark-staining granules; EXAMPLE: neutrophil, eosinophil and basophil
HEMOLYSIS (hē-MŎL-ĭ-sĭs) Destruction or breakdown of blood; specifically red blood cells.
HEMATOCRIT (hē-MĂT-ō-krĭt) Percentage of red blood cells in a given volume of blood – The suffix -crit means to separate.

6. Combining Forms (Cont’d)
Pages 514 – 515
Combining Forms (Cont’d)
Meaning Examples
hemoglobin/o is/o kary/o leuk/o mon/o morph/o myel/o neutr/o
hemoglobin
same, equal
nucleus
white
one, single
shape, form
bone marrow
neutral (not acid or base)
hemoglobinopathy
anisocytosis
megakaryocyte
leukopenia
monocyte
morphology
myeloblast, myelodysplasia
neutropenia, neutrophils
HEMOGLOBINOPATHY (hē-mō-glō-bĭn-ŎP-ă-thē) Disease or defect of hemoglobin production; EXAMPLE: sickle cell anemia
ANISOCYTOSIS (ăn-ī-sō-sī-TŌ-sĭs) Inequality in the size of red blood cells – (anis/o) size; -cytosis means an increase in the number of cells.
MEGAKARYOCYTE (mĕg-ă-KĀR-ē-ō-sīt) Large, giant cell with a big nucleus; platelet precursor found in the bone marrow.
LEUKOPENIA (loo-kō-PĒ-nē-ă) Deficiency of white blood cells
MONOCYTE (MŎN-ō-sīt) White blood cell (agranulocyte) with one large nucleus; become macrophages as they leave the blood and enter body tissues. It is a cell that engulfs foreign material and debris.
MORPHOLOGY (mŏr-FŎL-ō-jē) Study of the shape and form of cells, particularly red blood cells
MYELOBLAST (MĪ-ĕ-lō-blăst) Immature granulocytic white blood cell; a cell normally only found in the bone marrow – The suffix -blast indicates an immature or embryonic cell. MYELODYSPLASIA (MĪ-ĕ-lō-dĭs-PLĀ-zhē-ă) Pre-leukemic condition.
NEUTROPENIA (noo-trō-PĒ-nē-ă) Deficiency of neutrophils

7. Combining Forms (Cont’d)
Page 515
Combining Forms (Cont’d)
Meaning Examples
nucle/o phag/o poikil/o sider/o spher/o thromb/o
nucleus
eat, swallow
varied, irregular
iron
globe, round
clot
ploymorphonuclear
phagocyte
poikilocytosis
sideropenia
spherocytosis
thrombocytopenia
POLYMORPHONUCLEAR (pŏl-ē-mŏr-fō-NŪ-klē-ăr) Pertaining to a multi-lobed nucleus (in granulocytic white blood cells); EXAMPLE: neutrophil.
PHAGOCYTE (FĂG-ō-sīt) Cell that engulfs another cell or foreign organism and destroys it
POIKILOCYTOSIS (poy-kĭ-lō-sī-TŌ-sĭs) Irregularity in the shape of red blood cells; occurs in certain types of anemia.
SIDEROPENIA (sĭd-ĕr-ō-PĒ-nē-ă) Deficiency of iron in the blood.
SPHEROCYTOSIS (sfĕr-ō-sī-TŌ-sĭs) In this condition, the erythrocyte has a round shape, making the cell fragile and easily able to be destroyed; occurs in a type of anemia (hemolytic anemia)
THROMBOCYTOPENIA (thrŏm-bō-sī-tō-PĒ-nē-ă) Deficiency of clotting cells

8. Suffixes Pages 515 – 516 -apheresis -blast -cyte -cytosis -emia -gen
Meaning Examples
-apheresis -blast -cyte -cytosis -emia -gen
removal, a carrying away 
immature or embryonic cell
cell
abnormal condition of cells
blood condition
giving rise to; producing
plasmapheresis, leukapheresis, plateletpheresis monoblast erythrocyte macrocytosis, microcytosis leukemia fibrinogen
PLASMAPHERESIS (plăz-mă-fĕ-RĒ-sĭs) Removal of plasma from withdrawn blood by centrifuge. Collected cells are retransfused back into the donor. Fresh-frozen plasma or salt solution is used to replace withdrawn plasma. LEUKAPHERESIS (loo-kă-fĕ-RĒ-sĭs) Mechanical separation of white blood cells from the rest of the blood PLATELETPHERESIS (plāt-lĕt-fĕ-RĒ-sĭs) Separation of platelets from the rest of the blood – Note that the a of apheresis is dropped in this term.
MONOBLAST (MŎN-ō-blăst) Immature monocyte; gives rise to granulocytes.
ERYTHROCYTE (ĕ-RĬTH-rō-sīt) Red blood cell. . There are about 5 million per microliter (µL) or cubic millimeter (mm3) of blood.
MACROCYTOSIS (măk-rō-sī-TŌ-sĭs) Presence of large [larger than normal] red blood cells in the blood
MICROCYTOSIS (mī-krō-sī-TŌ-sĭs) Increased numbers of smaller than normal red blood cells. Table 13-3 reviews terms related to abnormalities of red blood cell morphology.
LEUKEMIA (loo-KĒ-mē-ă) Increase in cancerous white blood cells
FIBRINOGEN (fī-BRĬN-ō-jĕn) Plasma protein that is converted to fibrin in the clotting process. – Fibrin is a protein that forms the basis of a blood clot.

9. Suffixes (Cont’d) Page 516
Meaning Examples
-globulin, -globin -lytic -oid -osis -penia -phage
protein
pertaining to destruction
derived or originating from
abnormal condition
deficiency
eat, swallow
hemoglobin, immunoglobulin thrombolytic therapy myeloid thrombosis granulocytopenia, pancytopenia macrophage
HEMOGLOBIN (HĒ-mō-glō-bĭn) Blood protein containing iron; carries oxygen in red blood cells.
IMMUNOGLOBULIN (ĭm-ū-nō-GLŎB-ū-lĭn) Antibody-containing protein in the blood; EXAMPLE: IgG, IgM, IgA, IgE, IgD. Immun/o means protection.
THROMBOLYTIC THERAPY (thrŏm-bō-LĬ-tĭk THĔR-ă-pē) Treatment with drugs to break down clots that may abnormally form in blood vessels [Used to dissolve clots]
MYELOID (MĪ-ĕ-loyd) Derived from bone marrow
THROMBOSIS (thrŏm-BŌ-sĭs) Condition of clot formation
GRANULOCYTOPENIA (grăn-ū-lō-sī-tō-PĒ-nē-ă) Deficiency of granulocytes
PANCYTOPENIA (păn-sī-tō-PĒ-nē-ă) Deficiency of all (blood) cells
MACROPHAGE (MĂK-rō-făj) Large phagocytic cell migrating from the blood into tissues – As a phagocyte, it engulfs foreign material and debris. In the liver, spleen, and bone marrow, macrophages destroy worn out red blood cells.

10. Suffixes (Cont’d) Page 516 -philia -phoresis -poiesis -stasis
Meaning Examples
-philia -phoresis -poiesis -stasis
attraction for (an increase in cell numbers)
carrying, transmission
formation
stop, control
eosinophilia, neutrophilia electrophoresis hematopoiesis, erythropoiesis, myelopoiesis hemostasis
EOSINOPHILIA (ē-ō-sĭn-ō-FĬL-ē-ă) Increase in numbers of eosinophils in the bloodstream
NEUTROPHILIA (noo-trō-FĬL-ē-ă) Increased numbers of neutrophils
ELECTROPHORESIS (ē-lĕk-trō-fō-RĒ-sis) Technique used to separate serum proteins by electrical charge. 
HEMATOPOIESIS (hē-mă-tō-poy-Ē-sĭs) Formation of blood cells
ERYTHROPOIESIS (ĕ-rĭth-rō-poy-Ē-sĭs) Formation of red blood cells – Erythropoietin is produced by the kidneys to stimulate erythrocyte formation. MYELOPOIESIS (mī-ĕ-lō-poy-Ē-sĭs) Formation and development of bone marrow or cells that originate from it
HEMOSTASIS (hē-mō-STĀ-sĭs) Stoppage of bleeding or circulation of blood

11. Pathology: Blood Pages 517 – 519 Types of Anemia
iron deficiency anemia
aplastic anemia
hemolytic anemia
pernicious anemia
sickle cell anemia
thalassemia
ANEMIA (ă-NĒ-mē-ă) Deficiency in erythrocytes or hemoglobin
EXAMPLE:
1. Iron deficiency anemia: most common type;
ETIOLOGY: lack of iron, which is required for hemoglobin production
2. APLASTIC ANEMIA (ā-PLĂS-tĭk ă-NĒ-mē-ă) Failure of blood cell production due to aplasia (absence of formation) of bone marrow cells.
ETIOLOGY: unknown (idiopathic), but some have been linked to benzene exposure and rarely to antibiotics such as chloramphenicol. 
Pancytopenia occurs when stem cells fail to produce leukocytes, platelets, and erythrocytes.
TREATMNET: Blood transfusions prolong life, allowing the marrow time to resume its normal functioning, and antibiotics control infections. Bone marrow transplantation and regimens of drugs that inhibit the immune system are successful treatments in cases in which spontaneous recovery is unlikely.
3. HEMOLYTIC ANEMIA (hē-mō-LĬ-tĭk ă-NĒ-mē-ă) Reduction in erythrocytes due to excessive destruction of red blood cells
EXAMPLE: congenital spherocytic anemia (hereditary spherocytosis) = Instead of their normal biconcave shape, erythrocytes become spheroidal. This rounded shape makes them fragile and easily destroyed (hemolysis). Shortened red cell survival results in increased reticulocytes in blood as the bone marrow compensates for hemolysis of mature erythrocytes.
TREATMENT: removal of the spleen usually improves this anemia (Because the spleen destroys red cells)
PICTURE
4. PERNICIOUS ANEMIA (pĕr-NĬSH-ŭs ă-NĒ-mē-ă) Lack of mature erythrocytes; Pernicious means ruinous or hurtful.
ETIOLOGY: inability to absorb vitamin B12 into the body which can be caused by a lack of intrinsic factor (ĭn-TRĬN-sĭk FĂK-tŏr) [necessary for vitamin B12 absorption] which is normally found in gastric juice. The result is unsuccessful maturation of red blood cells, with an excess of large, immature, and poorly functioning cells in the bone marrow and large, often oval red cells (macrocytes) in the circulation.
TREATMENT: injection or oral administration of vitamin B12 for life. 
5. SICKLE CELL ANEMIA (SĬK-l sĕl ă-NĒ-mē-ă) Hereditary condition marked by abnormal sickle shape of erythrocytes and by hemolysis
ETIOLOGY: Genetic defect (presence of the hemoglobin S gene) particularly prevalent among people of African or Hispanic ancestry and appears with different degrees of severity. The distorted, fragile erythrocytes cannot pass through small blood vessels normally.
SYMPTOM: arthralgias, acute attacks of abdominal pain, and ulcerations of the extremities. Persons with the sickle cell trait inherit just one gene for the disorder and usually do not have symptoms.
COMPLICATION: thrombosis and infarction (local tissue death from ischemia)
6. THALASSEMIA (thāl-ă-SĒ-mē-ă) Inherited defect in the ability to produce hemoglobin leading to hypochromia, usually seen in persons of Mediterranean background
ETIOLOGY:A defect in a gene affects production of globin, the protein that is the major component of hemoglobin. Particularly prevalent among people of Mediterranean or Asian background, manifests in varying forms and degrees of severity
COMPLICATION: hypochromic anemia [diminished hemoglobin content in red cells]

12. Pathology (Cont’d) Pages 517 – 519 Dyscrasia Hemochromatosis
polycythemia vera
hemophilia
purpura
DYSCRASIA (dĭs-KRĀ-zē-ă) Any abnormal or pathology condition of the blood
HEMOCHROMATOSIS (hē-mō-krō-mă-TŌ-sĭs) Excessive deposits of iron throughout the body
ETIOLOGY: may be hereditary
SYMPTOM: skin pigmentation, joint pain, and fatigue.
COMPLICATION: cirrhosis, diabetes, and cardiac failure may occur
POLYCYTHEMIA VERA (pŏl-ē-sī-THĒ-mē-ă VĔR-ă) Increase in numbers of erythrocytes [red blood cells]; Blood consistency is viscous (thick) – Also known as erythremia.
The bone marrow is hyperplastic, and leukocytosis and thrombocytosis commonly accompany the increase in red blood cells.
TREATMENT: phlebotomy (removal of blood from a vein) and myelotoxic drugs [suppresses blood cell production]
HEMOPHILIA (hē-mō-FĬL-ē-ă) Hereditary disease of blood clotting failure with abnormal bleeding; affected individuals are lacking a blood clotting factor (factor VIII or factor IX)
Platelet count is normal, deficiency in clotting factors = a prolonged coagulation time.
COMPLICATION: bleed into weight-bearing joints, especially ankles and knees.
TREATMENT: administration of the deficient factors.
PICTURE - Lower limbs of a male with hemophilia showing the effect of recurrent hemorrhage into the left knee.
PURPURA (PŬR-pū-ră) Multiple PETECHIAE (pĕ-TĒ-kē-ā) [Small, pinpoint hemorrhages caused by bleeding under the skin] and ECCHYMOSES (ĕk-kĭ-MŌ-sēs) [Large blue or purplish patches on the skin (bruises)] caused by deficiency of clotting cells (platelets)
ETIOLOGY: thrombocytopenia [too few platelets] or immunologic [antiplatelet factor] in nature.
EXAMPLE: Autoimmune thrombocytopenic purpura → the patient makes an antibody that destroys platelets.
SYMPTOM: Bleeding time is prolonged
TREATMENT: splenectomy (the spleen is the site of platelet destruction) and drug therapy with glucocorticoids are common treatments.
PICTURE
A, Petechiae result from bleeding from capillaries or small arterioles. 
B, Ecchymoses are larger and more extensive than petechiae.

13. Pathology (Cont’d) Pages 517 – 522 Leukemia
Acute myeloid leukemia (AML)
Acute lymphoid leukemia (ALL)
Chronic myeloid leukemia (CML)
Chronic lymphoid leukemia (CLL)
LEUKEMIA (loo-KĒ-mē-ă) Increase in cancerous white blood cells [leukocytes]
Four types of leukemia are:
Two types are acute and these have some common clinical characteristics:
abrupt onset of signs and symptoms—fatigue, fever, bleeding, bone pain, lymphadenopathy, splenomegaly, and hepatomegaly. If the disease has spread to the spinal canal, headache and vomiting also may occur. In addition, because normal blood cells are crowded out, patients have little defense against infection.
1. ACUTE MYELOID [myelocytic] LEUKEMIA (ă-KŪT MĪ-ĕ-lōyd loo-KĒ-mē-ă) [AML] Malignant, immature granulocytes called myeloblasts multiply in the bone marrow and bloodstream
PICTURE
2. ACUTE LYMPHOID LEUKEMIA (ă-KŪT LĬM-fōyd loo-KĒ-mē-ă) [ALL] Malignant, immature lymphocytes called lymphoblasts multiply in the blood, bone marrow, and lymphatic system
This form is seen most often in children and adolescents;
TREATMENT: for acute leukemia → Transplantation of normal bone marrow from donors of similar tissue type is successful in restoring normal bone marrow function. This procedure is performed after high-dose chemotherapy, which is administered to eliminate the leukemic cells.
Two types are chronic:
3. CHRONIC MYELOID [myelocytic] LEUKEMIA (KRŎ-nĭk MĪ-ĕ-lōyd loo-KĒ-mē-ă) [CML] Malignant, but relatively mature granulocytic leukocytes multiply in the bloodstream; progresses slowly → patients (often adults older than 55) may live for many years without encountering life-threatening problems.
TREATMENT: New therapies (such as the drug Gleevec) target abnormal proteins responsible for malignancy and produce long-term control.
4. CHRONIC LYMPHOID [lymphocytic] LEUKEMIA (KRŎ-nĭk LĬM-fōyd loo-KĒ-mē-ă) [CLL] Malignant, but relatively mature lymphocytes, multiply in bone marrow, lymph nodes, and spleen; most common form of leukemia – usually occurs in the elderly and progresses slowly.
TREATMENT: does not require immediate treatment
TREATMENT: All forms of leukemia → chemotherapy [drugs that prevent cell division and selectively injure rapidly dividing cells];
Effective treatment can lead to a remission (rē-MĬSH-ŭn) [disappearance of signs and symptoms of disease]
Relapse (RĒ-lăps) occurs when disease symptoms and signs reappear, necessitating further treatment.

14. Pathology (Cont’d) Pages 517 – 522 granulocytosis mononucleosis
multiple myeloma
GRANULOCYTOSIS (grăn-ū-lō-sī-TŌ-sis) Abnormal increase in numbers of granulocytes in the blood
↑ neutrophils → infection or inflammation of any type
↑ eosinophil → Eosinophilia  → allergic conditions, such as asthma, or in parasitic infections (tapeworm, pinworm). 
↑ basophil → Basophilia  → leukemia.
MONONUCLEOSIS (mŏ-nō-nū-klē-Ō-sĭs) Infectious disease marked by increased numbers of leukocytes and enlarged cervical lymph nodes; transmitted by the Epstein-Barr virus (EBV). Atypical lymphocytes are present in the blood, liver, and spleen; affects primarily young adults.
SYMPTOM: Lymphadenitis, fever, fatigue, asthenia (weakness), and pharyngitis.
COMPLICATION: hepatomegaly and splenomegaly TRANSMITTED: direct oral contact (salivary exchange during kissing)
TREATMENT: No treatment is necessary; Antibiotics are not effective; Rest during the period of acute symptoms and slow return to normal activities are advised.
MULTIPLE MYELOMA (MŬL-tĭ-pl mī-ĕ-LŌ-mă) Malignant tumor of bone marrow; overproduction of immunoglobulins that cause destruction of bone tissue
COMPLICATION: osteolytic lesions, hypercalcemia, anemia, renal damage, and increased susceptibility to infection.
TREATMENT: analgesics, radiotherapy, various doses of chemotherapy, and special orthopedic supports. Drugs such as thalidomide and Velcade (bortezomib) are palliative (PĂL-ē-ă-tĭv) [relieving symptoms] and stop disease progression, which improves the outlook for this disease. Autologous bone marrow transplantation (ABMT), in which the patient serves as his or her own donor for stem cells, may lead to prolonged remission.

15. Laboratory Tests Pages 522 – 523 Antiglobulin test Platelet count
Bleeding time
Prothrombin time
Coagulation time
Red blood count
Complete blood count
Red blood cell morphology
Erythrocyte sedimentation rate
White blood cell count
Hematocrit
White blood cell differential
Hemoglobin test
ANTIGLOBULIN TEST (ăn-tē-GLŎB-ū-lĭn tĕst) Test for the presence of antibodies that coat and damage erythrocytes; Also known as Coombs test. This test determines the presence of antibodies in infants of Rh-negative women or in patients with autoimmune hemolytic anemia.
BLEEDING TIME (BLĒ-dĭng tīm) Time required for blood to stop flowing from a tiny puncture wound. Normal time is 8 minutes or less. Either the Simplate or the Ivy method is used. Platelet disorders and the use of aspirin prolong bleeding time.
COAGULATION TIME (kō-ăg-ū-LĀ-shŭn tīm) Time required for venous blood to clot in a test tube. Normal time is less than 15 minutes.
COMPLETE BLOOD COUNT (kŏm-PLĒT blŭd kount) [CBC] Determination of the number of red and white blood cells, platelets, hemoglobin, hematocrit, and red cell indices (MCH, MCV, MCHC) in a sample of blood
ERYTHROCYTE SEDIMENTATION RATE (ĕ-RĬTH-rō-sīt sĕd-ĭ-mĕn-TĀ-shŭn rāt) [ESR or sed rate] Measurement of the speed at which erythrocytes settle or fall to the bottom of a test tube.
DIAGNOSISES: rate ↑ = infections, joint inflammation, and tumor, which increase the fibrinogen content of the blood.
HEMATOCRIT (hē-MĂT-ō-krĭt) [Hct] Percentage of red blood cells [erythrocytes ] in a given volume of blood.
HEMOGLOBIN TEST (HĒ-mō-glō-bĭn tĕst) [H, Hg, Hgb, HGB] Total amount of hemoglobin in a sample of blood
PLATELET COUNT (PLĀT-lĕt kount) Number of platelets per cubic millimeter (mm³) or microliter (µL) of blood. Normally average between 150, ,000 per mm3 (or µL).
PROTHROMBIN TIME (prō-THRŎM-bĭn tīm) [PT] Test of the ability of blood to clot. Prothrombin is one of the clotting factors (factor II) made by the liver. This test is used to monitor (follow) patients taking anticoagulant drugs. Another blood clotting test, partial thromboplastin time (PTT), measures other clotting factors. Both PT and PTT are often done at the same time to check for bleeding problems.
RED BLOOD CELL COUNT (rĕd blŭd sĕl kount) [RBC] Number of erythrocytes per cubic millimeter (mm3) or microliter (µL) of blood. Normal number is 4 million to 6 million per mm3 (or µL).
RED BLOOD CELL MORPHOLOGY (rĕd blŭd sĕl mŏr-FŎL-ō-jē) Microscopic examination of a stained blood smear to determine the shape of individual red blood cells. Abnormal morphology includes anisocytosis (ăn-ī-sō-sī-TŌ-sĭs), poikilocytosis (poy-kĭ-lō-sī-TŌ-sĭs), and sickle cells.
WHITE BLOOD CELL COUNT (wīt blŭd sĕl kount) [WBC] Number of leukocytes per cubic millimeter (mm3) or microliter (µL) of blood. Normal number averages between 5000 and 10,000 per mm3 (or µL).
WHITE BLOOD CELL DIFFERENTIAL (wīt blŭd sĕl dĭ-fĕr-ĔN-shŭl) [count] Percentage of the total white blood cell count made up by the different types of leukocytes. Percentages of neutrophils, eosinophils, basophils, monocytes, lymphocytes, and immature cells (bands) are determined.

16. Clinical Procedures Page 524 apheresis blood transfusion
bone marrow biopsy
hematopoietic stem cell transplantation
APHERESIS (ă-fĕ-RĒ-sĭs) Withdrawal and separation of blood elements into component parts and removal of a select portion from the blood. This procedure can remove toxic substances or autoantibodies from the blood and can collect blood cells.
EXAMPLE: Leukapheresis, plateletpheresis, and plasmapheresis
PICTURE -  Leukapheresis.
BLOOD TRANSFUSION (blŭd trăns-FŪ-zhŭn) Blood cells or whole blood from a closely matched donor are infused into a patient. Appropriate testing to ensure a match of red blood cell type (A, B, AB, or O) is essential. Tests also are performed to detect the presence of hepatitis and the acquired immunodeficiency syndrome (AIDS) virus (HIV). 
EXAMPLE: AUTOLOGUS TRANSFUSION (ăw-TŎL-ō-gŭs trăns-FŪ-zhŭn) Removal and then reinfusion of a patient's own blood or blood components
BONE MARROW BIOPSY (bōn MĂ-rō BĪ-ŏp-sē) Needle aspiration of a small amount of bone marrow followed by examination under a microscope
EXAMPLE: bone marrow aspiration
DIAGNOSISES: blood disorders such as anemia, pancytopenias, and leukemia.
PICTURE - Bone marrow aspiration and biopsy.
A, Placement of a bone marrow needle into the iliac crest (upper portion of hipbone) and aspiration of liquid bone marrow. 
B,Trephine needle is then inserted and anchored in the bone. 
C, A solid piece of bone marrow (biopsy sample) is then extracted through the needle.
HEMATOPOIETIC STEM CELL TRANSPLANT (hē-mă-tō-poy-Ĕ-tĭk stĕm sĕl TRĂNS-plănt) Peripheral (found in the blood) stem cells from a compatible donor are administered into the vein of a recipient.
TREATMENT FOR: Patients with malignancies, such as AML, ALL, CLL, CML, lymphoma and multiple myeloma.
METHOD: First the donor is treated with a drug that mobilizes stem cells into the blood. Then stem cells are removed from the donor, a process like leukapheresis in the top picture. Meanwhile, the patient (recipient) undergoes a conditioning process in which radiation and chemotherapy drugs are administered to kill malignant marrow cells and inactivate the patient's immune system so that subsequently infused stem cells will not be rejected. A cell suspension containing the donor's stem cells, which will repopulate the bone marrow, is then given through a vein to the recipient. In autologous stem cell transplantation, the patient's own stem cells are collected, stored, and reinfused after potent chemotherapy.
COMPLICATION: serious infection, graft-versus-host disease (GVHD), and relapse of the original disease despite the treatment. In GVHD, the immunocompetent cells in the donor's tissue recognize the recipient's tissues as foreign and attack them.
Because the recipient patient is totally immunosuppressed, his or her immune system cannot defend against the attack. Intensive prophylaxis (prevention) with immunosuppressive drugs is standard for patients undergoing allogeneic transplants.
These drugs include cyclosporine, methotrexate, glucocorticoids, sirolimus (Rapamune), and mycophenolate.
PICTURE - Hematopoietic stem cell and bone marrow transplantation.

17. Abbreviations Page 526 Ab baso eos ABMT BMT EPO ABO CBC ESR ALL CLL Fe
AML
CML
G-CSF
ANC
DIC
GM-CSF
ASCT
diff
g/dL
banda
EBV
Ab = antibody
ABMT = autologous bone marrow transplantation—patient serves as his or her own donor for stem cells
ABO = four main blood types—A, B, AB, and O
ALL = acute lymphoid leukemia
AML = acute myeloid leukemia
ANC = absolute neutrophil count—total WBC times a measure of the number of bands and segs present in the blood; an ANC less than 1500 cells/uL is neutropenia
ASCT = autologous stem cell transplantation
bands = immature white blood cells (granulocytes)
Baso = basophils
BMT = bone marrow transplantation
CBC = complete blood count
CLL = chronic lymphoid leukemia
CML = chronic myeloid leukemia
DIC = disseminated intravascular coagulation—bleeding disorder marked by reduction in blood clotting factors due to their use and depletion for intravascular clotting
diff = differential count (white blood cells)
EBV = Epstein-Barr virus; cause of mononucleosis
eos = eosinophils
EPO = erythropoietin
ESR = erythrocyte sedimentation rate
Fe = iron
G-CSF = granulocyte colony-stimulating factor—promotes neutrophil production
GM-CSF = granulocyte-macrophage colony-stimulating factor—promotes myeloid progenitor cells with differentiation to granulocytes
g/dL = gram per deciliter (1 deciliter = one tenth of a liter; 1 liter = quarts)

18. Abbreviations (Cont’d)
Page 527
Abbreviations (Cont’d)
GVHD
Polys, PMNs, PMNLs
lymphs
HCL
MCH
PT, pro time
Hct
MCHC
PTT
Hgh, HGB
MCV
RBC
H and H µL
sed rate
HLA
MDS
segs
IgS, IgD, IgE, IgG, IgM
Mm3
SMAC
mono
WBC
ITP
WNL
GVHD = graft-versus-host disease—immune reaction of donor's cells to recipient's tissue
HCL = hairy cell leukemia—abnormal lymphocytes accumulate in bone marrow, leading to anemia, thrombocytopenia, neutropenia, and infection
Hct = hematocrit
Hgb, HGB = hemoglobin
H and H = hemoglobin and hematocrit
HLA = human leukocyte antigen
IgA, IgD, IgE, IgG, IgM = immunoglobulins
ITP = idiopathic thrombocytopenic purpura
lymphs = lymphocytes
MCH = mean corpuscular hemoglobin—average amount of hemoglobin per cell
MCHC = mean corpuscular hemoglobin concentration—average concentration of hemoglobin in a single red cell; when MCHC is low, the cell is hypochromic
MCV = mean corpuscular volume—average volume or size of a single red blood cell; when MCV is high, the cells are macrocytic, and when low, the cells are microcytic
µL = microliter—one millionth of a liter; 1 liter = quarts
MDS = myelodysplastic syndrome—preleukemic condition (anemia, cytopenias, and possible transformation to AML)
mm3 = cubic millimeter—one millionth of a liter; 1 liter = quarts
Mono = monocyte
polys, PMNs, PMNLs = polymorphonuclear leukocytes; neutrophils, eosinophils, basophils
PT, pro time = prothrombin time
PTT = partial thromboplastin time
RBC = red blood cell; red blood cell count
sed rate = erythrocyte sedimentation rate
segs = segmented, mature white blood cells (neutrophils)
SMAC = Sequential Multiple Analyzer Computer—an automated chemistry system that determines substances in serum
WBC = white blood cell; white blood cell count
WNL = within normal limits