Be able to recognize the key components of blood. Be able to develop a framework for evaluating hematologic problems.

Mr. Garcia is a 57-year-old retired banker who loves to play golf and garden. Despite chronic hip pain for which he takes aspirin on a regular basis, he plays golf 2-3 times a week in the spring and summer. His wife has encouraged him to see you today because over the past 3-4 months he has felt increasingly tired, and in fact, has not done his usual summer plantings. She also finds him very irritable. With some reluctance, Carmine tells you that he has been short of breath on the green on a couple of occasions over the last week, and that he really feels too fatigued to garden for any length of time. This worries him, as he has some friends with cancer, and they seemed to have the same symptoms prior to their diagnosis.

Maxwell Greenfield is a 32 M was admitted under the general medicine service last night with gastroenteritis. It is your first day on the hematology rotation and you are called to provide a consult for new onset pancytopenia in Maxwell. Maxwell has a history of Crohn’s disease, diagnosed at the age of 28. He is currently on methotrexate 20 mg subcut weekly to control his disease, which he has been on for the last two years. He does not take any other medications at home. He has no other medical problems. Maxwell initially presented to hospital with nausea, vomiting, and diarrhea after eating some old chicken he found at the back of the fridge. He did not have any blood in his bowel movements or mucous. He has note noted any fever.

Billy Elliot, an 18 year old male music store employee was brought into your emergency department after being involved in a motor vehicle accident at about 2:00 a.m. The paramedics that brought him in stated that he was the driver of a vehicle involved in a three car accident. The rescue squad required the "jaws of life" to extricate him from the car. The airbags were deployed, but the car sustained significant damage and the steering wheel was noted to be inches from the front seat after Billy was extricated. The paramedics conveyed that the patient was alert and talking at the scene and an IV was started. However, en route to the hospital, they noted that his pulse rate began to increase and the patient was diaphoretic.

Mr. Garcia is a 57-year-old retired banker who loves to play golf and garden. Despite chronic hip pain for which he takes aspirin on a regular basis, he plays golf 2-3 times a week in the spring and summer. His wife has encouraged him to see you today because over the past 3-4 months he has felt increasingly tired, and in fact, has not done his usual summer plantings. She also finds him very irritable. With some reluctance, Carmine tells you that he has been short of breath on the green on a couple of occasions over the last week, and that he really feels too fatigued to garden for any length of time. This worries him, as he has some friends with cancer, and they seemed to have the same symptoms prior to their diagnosis.

Be able to recognize the key components of blood. Be able to develop a framework for evaluating hematologic problems.

Mr. Garcia is a 57-year-old retired banker who loves to play golf and garden. Despite chronic hip pain for which he takes aspirin on a regular basis, he plays golf 2-3 times a week in the spring and summer. His wife has encouraged him to see you today because over the past 3-4 months he has felt increasingly tired, and in fact, has not done his usual summer plantings. She also finds him very irritable. With some reluctance, Carmine tells you that he has been short of breath on the green on a couple of occasions over the last week, and that he really feels too fatigued to garden for any length of time. This worries him, as he has some friends with cancer, and they seemed to have the same symptoms prior to their diagnosis.

Maxwell Greenfield is a 32 M was admitted under the general medicine service last night with gastroenteritis. It is your first day on the hematology rotation and you are called to provide a consult for new onset pancytopenia in Maxwell. Maxwell has a history of Crohn’s disease, diagnosed at the age of 28. He is currently on methotrexate 20 mg subcut weekly to control his disease, which he has been on for the last two years. He does not take any other medications at home. He has no other medical problems. Maxwell initially presented to hospital with nausea, vomiting, and diarrhea after eating some old chicken he found at the back of the fridge. He did not have any blood in his bowel movements or mucous. He has note noted any fever.

Be able to recognize the key components of blood. Be able to develop a framework for evaluating hematologic problems.

You are on elective at a Health Clinic in downtown Hamilton with a multicultural patient population. Your supervisor asks you to see Alexandria Vardalos. Alexandria is an 8-month-old baby girl who is brought in by her parents. She was healthy at birth, but over the last 2 months, she has not been growing as fast as her sister did at the same age. She is frequently irritable and has difficulty feeding. On physical examination, Alexandria is pale, but in no apparent distress. She is afebrile with HR 125, RR 45, BP 90/60 mmHg and oxygen saturation 98% on room air. She is at the 5th percentile for both weight and height. When you palpate her abdomen, you notice that she has an enlarged liver and spleen. Her peripheral blood smear shows microcytosis, hypochromia and poikilocytosis. Hemoglobin electrophoresis shows Hb F 99.2%, Hb A2 0.8%, Hb A 0%. You inform the parents that their baby appears to be anemic and may have an inherited blood disorder. Her mother states: ‘I’m anemic – I inherited it from my mother and her family back in India. I didn’t think our children would get this because my husband’s family is Greek.”

Part 1: You are working in the Red Blood Cell Disorders Clinic at McMaster. You are asked to see Ms. LW by your preceptor for routine follow up. Ms. LW is a 43-year-old cisgender woman who was diagnosed with sickle cell disease as a child while living in Guyana. Part 2: It is a few months later and you are on a rotation working in the emergency department. You see Ms. LW’s name on the tracker and remember seeing her in the RBC Disorders Clinic. You pull the triage assessment and read that Ms. LW is presenting with a 2-day history of jaundice and pain in her arms and back, which has been unresponsive to oral hydromorphone at home. Vitals in triage reveal HR 110, BP 110/65, T 36°C, RR 16, SpO2 99% on room air.

Mr. Garcia is a 57-year-old retired banker who loves to play golf and garden. Despite chronic hip pain for which he takes aspirin on a regular basis, he plays golf 2-3 times a week in the spring and summer. His wife has encouraged him to see you today because over the past 3-4 months he has felt increasingly tired, and in fact, has not done his usual summer plantings. She also finds him very irritable. With some reluctance, Carmine tells you that he has been short of breath on the green on a couple of occasions over the last week, and that he really feels too fatigued to garden for any length of time. This worries him, as he has some friends with cancer, and they seemed to have the same symptoms prior to their diagnosis.

Maxwell Greenfield is a 32 M was admitted under the general medicine service last night with gastroenteritis. It is your first day on the hematology rotation and you are called to provide a consult for new onset pancytopenia in Maxwell. Maxwell has a history of Crohn’s disease, diagnosed at the age of 28. He is currently on methotrexate 20 mg subcut weekly to control his disease, which he has been on for the last two years. He does not take any other medications at home. He has no other medical problems. Maxwell initially presented to hospital with nausea, vomiting, and diarrhea after eating some old chicken he found at the back of the fridge. He did not have any blood in his bowel movements or mucous. He has note noted any fever.

You are on elective at a Health Clinic in downtown Hamilton with a multicultural patient population. Your supervisor asks you to see Alexandria Vardalos. Alexandria is an 8-month-old baby girl who is brought in by her parents. She was healthy at birth, but over the last 2 months, she has not been growing as fast as her sister did at the same age. She is frequently irritable and has difficulty feeding. On physical examination, Alexandria is pale, but in no apparent distress. She is afebrile with HR 125, RR 45, BP 90/60 mmHg and oxygen saturation 98% on room air. She is at the 5th percentile for both weight and height. When you palpate her abdomen, you notice that she has an enlarged liver and spleen. Her peripheral blood smear shows microcytosis, hypochromia and poikilocytosis. Hemoglobin electrophoresis shows Hb F 99.2%, Hb A2 0.8%, Hb A 0%. You inform the parents that their baby appears to be anemic and may have an inherited blood disorder. Her mother states: ‘I’m anemic – I inherited it from my mother and her family back in India. I didn’t think our children would get this because my husband’s family is Greek.”

Part 1: You are working in the Red Blood Cell Disorders Clinic at McMaster. You are asked to see Ms. LW by your preceptor for routine follow up. Ms. LW is a 43-year-old cisgender woman who was diagnosed with sickle cell disease as a child while living in Guyana. Part 2: It is a few months later and you are on a rotation working in the emergency department. You see Ms. LW’s name on the tracker and remember seeing her in the RBC Disorders Clinic. You pull the triage assessment and read that Ms. LW is presenting with a 2-day history of jaundice and pain in her arms and back, which has been unresponsive to oral hydromorphone at home. Vitals in triage reveal HR 110, BP 110/65, T 36°C, RR 16, SpO2 99% on room air.

You are on elective at a Health Clinic in downtown Hamilton with a multicultural patient population. Your supervisor asks you to see Alexandria Vardalos. Alexandria is an 8-month-old baby girl who is brought in by her parents. She was healthy at birth, but over the last 2 months, she has not been growing as fast as her sister did at the same age. She is frequently irritable and has difficulty feeding. On physical examination, Alexandria is pale, but in no apparent distress. She is afebrile with HR 125, RR 45, BP 90/60 mmHg and oxygen saturation 98% on room air. She is at the 5th percentile for both weight and height. When you palpate her abdomen, you notice that she has an enlarged liver and spleen. Her peripheral blood smear shows microcytosis, hypochromia and poikilocytosis. Hemoglobin electrophoresis shows Hb F 99.2%, Hb A2 0.8%, Hb A 0%. You inform the parents that their baby appears to be anemic and may have an inherited blood disorder. Her mother states: ‘I’m anemic – I inherited it from my mother and her family back in India. I didn’t think our children would get this because my husband’s family is Greek.”

Part 1: You are working in the Red Blood Cell Disorders Clinic at McMaster. You are asked to see Ms. LW by your preceptor for routine follow up. Ms. LW is a 43-year-old cisgender woman who was diagnosed with sickle cell disease as a child while living in Guyana. Part 2: It is a few months later and you are on a rotation working in the emergency department. You see Ms. LW’s name on the tracker and remember seeing her in the RBC Disorders Clinic. You pull the triage assessment and read that Ms. LW is presenting with a 2-day history of jaundice and pain in her arms and back, which has been unresponsive to oral hydromorphone at home. Vitals in triage reveal HR 110, BP 110/65, T 36°C, RR 16, SpO2 99% on room air.

You are on elective at a Health Clinic in downtown Hamilton with a multicultural patient population. Your supervisor asks you to see Alexandria Vardalos. Alexandria is an 8-month-old baby girl who is brought in by her parents. She was healthy at birth, but over the last 2 months, she has not been growing as fast as her sister did at the same age. She is frequently irritable and has difficulty feeding. On physical examination, Alexandria is pale, but in no apparent distress. She is afebrile with HR 125, RR 45, BP 90/60 mmHg and oxygen saturation 98% on room air. She is at the 5th percentile for both weight and height. When you palpate her abdomen, you notice that she has an enlarged liver and spleen. Her peripheral blood smear shows microcytosis, hypochromia and poikilocytosis. Hemoglobin electrophoresis shows Hb F 99.2%, Hb A2 0.8%, Hb A 0%. You inform the parents that their baby appears to be anemic and may have an inherited blood disorder. Her mother states: ‘I’m anemic – I inherited it from my mother and her family back in India. I didn’t think our children would get this because my husband’s family is Greek.”

Part 1: You are working in the Red Blood Cell Disorders Clinic at McMaster. You are asked to see Ms. LW by your preceptor for routine follow up. Ms. LW is a 43-year-old cisgender woman who was diagnosed with sickle cell disease as a child while living in Guyana. Part 2: It is a few months later and you are on a rotation working in the emergency department. You see Ms. LW’s name on the tracker and remember seeing her in the RBC Disorders Clinic. You pull the triage assessment and read that Ms. LW is presenting with a 2-day history of jaundice and pain in her arms and back, which has been unresponsive to oral hydromorphone at home. Vitals in triage reveal HR 110, BP 110/65, T 36°C, RR 16, SpO2 99% on room air.

Describe the major blood group antigens and their role in transfusion of blood products. Summarize the basic principles of antibody screening and cross-matching of blood products. Describe the indications for transfusion of red cells, platelets, plasma and cryoprecipitate. Discuss the pathophysiology of adverse transfusion reactions (AHTR, TACO and TRALI)

Billy Elliot, an 18 year old male music store employee was brought into your emergency department after being involved in a motor vehicle accident at about 2:00 a.m. The paramedics that brought him in stated that he was the driver of a vehicle involved in a three car accident. The rescue squad required the "jaws of life" to extricate him from the car. The airbags were deployed, but the car sustained significant damage and the steering wheel was noted to be inches from the front seat after Billy was extricated. The paramedics conveyed that the patient was alert and talking at the scene and an IV was started. However, en route to the hospital, they noted that his pulse rate began to increase and the patient was diaphoretic.

Be able to recognize the key components of blood. Be able to develop a framework for evaluating hematologic problems.

Be able to describe the process of hemostasis, with emphasis on the coagulation cascade. Be able to explain the common laboratory tests used to assess the coagulation cascade. Be able to describe common clinical conditions that result from abnormalities in the coagulation cascade. Be able to describe the mechanism of action of anticoagulants used to treat venous thrombosis.

Be able to explain the key differences in pathogenesis between venous clots and arterial clots. Be able to describe the role of platelets in hemostasis. Be able to describe mechanisms of thrombocytopenia with a special focus on immune-mediated destruction.

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Terrance Pacheco is a 64 year old gentleman you have been asked to see in the ER with new onset thrombocytopenia and anemia. Terrance was brought into the ER by his family with new onset confusion that started 3 days ago. They have also noted easy bruising and presents with extensive ecchymoses on his lower shins. Terrance’s past medical history includes hypertension and dyslipidemia. He is on amlodipine 10 mg daily and atorvastatin 20 mg daily. He is otherwise well.

Be able to describe the process of hemostasis, with emphasis on the coagulation cascade. Be able to explain the common laboratory tests used to assess the coagulation cascade. Be able to describe common clinical conditions that result from abnormalities in the coagulation cascade. Be able to describe the mechanism of action of anticoagulants used to treat venous thrombosis.

Be able to explain the key differences in pathogenesis between venous clots and arterial clots. Be able to describe the role of platelets in hemostasis. Be able to describe mechanisms of thrombocytopenia with a special focus on immune-mediated destruction.

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Terrance Pacheco is a 64 year old gentleman you have been asked to see in the ER with new onset thrombocytopenia and anemia. Terrance was brought into the ER by his family with new onset confusion that started 3 days ago. They have also noted easy bruising and presents with extensive ecchymoses on his lower shins. Terrance’s past medical history includes hypertension and dyslipidemia. He is on amlodipine 10 mg daily and atorvastatin 20 mg daily. He is otherwise well.

Henrietta Turnbull is a 42 who was admitted to hospital 8 days ago with a bacterial pneumonia. You are on the consultant hematology team and have been asked to assess her for new onset thrombocytopenia, platelets of 33 x 109/L.

Judy Patterson is a 22 year-old university student who presented to the Student Health Clinic with a rash on her lower legs. Her past medical history is unremarkable except for a urinary tract infection diagnosed 6 days ago for which she is taking trimethoprim-sulfamethoxazole. The only other medication she takes is the occasional dose of ibuprofen for headaches. She has never had any dental extractions or surgeries. On examination, she has no lymphadenopathy or splenomegaly, but she does have petechiae on her lower legs. You ask to look inside her mouth and there you see a blood blister on the inside of her cheek. She says she must have bitten it by accident.

Terrance Pacheco is a 64 year old gentleman you have been asked to see in the ER with new onset thrombocytopenia and anemia. Terrance was brought into the ER by his family with new onset confusion that started 3 days ago. They have also noted easy bruising and presents with extensive ecchymoses on his lower shins. Terrance’s past medical history includes hypertension and dyslipidemia. He is on amlodipine 10 mg daily and atorvastatin 20 mg daily. He is otherwise well.

Be able to describe the process of hemostasis, with emphasis on the coagulation cascade. Be able to explain the common laboratory tests used to assess the coagulation cascade. Be able to describe common clinical conditions that result from abnormalities in the coagulation cascade. Be able to describe the mechanism of action of anticoagulants used to treat venous thrombosis.

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Sana is an 18-year-old female who presents to the emergency room with prolonged bleeding following extraction of a wisdom tooth. The extraction was performed earlier that day and she was sent home with packing to be removed 1 hour later. She bled through the packing by the time she got home and has continued to bleed for the past 2 hours. This is her first tooth extraction and she has no previous history of surgical procedures. On questioning, she describes her periods as “heavy”, but her mother and grandmother reported a similar experience so she assumed that was normal. Physical examination reveals constant oozing from the site of extraction, severe edema of her cheek and a large ecchymosis along her jaw line.

Shane Mosley an 18-month-old boy was brought to the emergency room by the baby sitter for treatment of a swollen and tender right knee that had developed suddenly within the previous three hours. The knee began to swell soon after Shane tripped on the family room carpet. Physical examination reveals an apparently healthy child who is crying and favouring his right leg. The knee is swollen and held in partial flexion. Shane has a few old, superficial bruises over shins, chest wall and his back. The physician in the ER concludes that there is fluid in the knee and because of the sudden onset and absence of fever, thinks this is most likely due to a joint bleed. The physician wonders about an underlying systemic bleeding disorder as the cause of Shane's joint bleed. A complete blood count, "hemostasis screen" and an x-ray of the knee are ordered.

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Henrietta Turnbull is a 42 who was admitted to hospital 8 days ago with a bacterial pneumonia. You are on the consultant hematology team and have been asked to assess her for new onset thrombocytopenia, platelets of 33 x 109/L.

Judy Patterson is a 22 year-old university student who presented to the Student Health Clinic with a rash on her lower legs. Her past medical history is unremarkable except for a urinary tract infection diagnosed 6 days ago for which she is taking trimethoprim-sulfamethoxazole. The only other medication she takes is the occasional dose of ibuprofen for headaches. She has never had any dental extractions or surgeries. On examination, she has no lymphadenopathy or splenomegaly, but she does have petechiae on her lower legs. You ask to look inside her mouth and there you see a blood blister on the inside of her cheek. She says she must have bitten it by accident.

Terrance Pacheco is a 64 year old gentleman you have been asked to see in the ER with new onset thrombocytopenia and anemia. Terrance was brought into the ER by his family with new onset confusion that started 3 days ago. They have also noted easy bruising and presents with extensive ecchymoses on his lower shins. Terrance’s past medical history includes hypertension and dyslipidemia. He is on amlodipine 10 mg daily and atorvastatin 20 mg daily. He is otherwise well.

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Sana is an 18-year-old female who presents to the emergency room with prolonged bleeding following extraction of a wisdom tooth. The extraction was performed earlier that day and she was sent home with packing to be removed 1 hour later. She bled through the packing by the time she got home and has continued to bleed for the past 2 hours. This is her first tooth extraction and she has no previous history of surgical procedures. On questioning, she describes her periods as “heavy”, but her mother and grandmother reported a similar experience so she assumed that was normal. Physical examination reveals constant oozing from the site of extraction, severe edema of her cheek and a large ecchymosis along her jaw line.

Terrance Pacheco is a 64 year old gentleman you have been asked to see in the ER with new onset thrombocytopenia and anemia. Terrance was brought into the ER by his family with new onset confusion that started 3 days ago. They have also noted easy bruising and presents with extensive ecchymoses on his lower shins. Terrance’s past medical history includes hypertension and dyslipidemia. He is on amlodipine 10 mg daily and atorvastatin 20 mg daily. He is otherwise well.

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Be able to describe the process of hemostasis, with emphasis on the coagulation cascade. Be able to explain the common laboratory tests used to assess the coagulation cascade. Be able to describe common clinical conditions that result from abnormalities in the coagulation cascade. Be able to describe the mechanism of action of anticoagulants used to treat venous thrombosis.

Mrs. Foster is a 50-year-old female who comes to the ER complaining about some chest discomfort that seems worse when she takes a breath in and shortness of breath. She also feels like her heart is racing. Her past medical history is unremarkable except for mild hypertension. She usually takes an aspirin a day because she heard it was a good idea to take it, but she stopped taking it one week ago when she noticed some blood in her stool. She thinks her mother may have had a blood clot in her leg during one of her pregnancies. Mrs. Foster is married with no children. On physical examination in the emergency room, her HR is 110/min, RR 28/min, BP 122/70, oxygen saturation 86% on room air. Her chest and precordial exam are normal. Her left leg is normal in colour, slightly warm and edematous. The circumference of her left calf is 3 cm larger the circumference of her right calf. She complains of pain when you palpate behind her knee. Her pedal pulses are palpable. The ER staff person calculates her Wells Score and based on the result, orders a D-dimer blood test.

Henrietta Turnbull is a 42 who was admitted to hospital 8 days ago with a bacterial pneumonia. You are on the consultant hematology team and have been asked to assess her for new onset thrombocytopenia, platelets of 33 x 109/L.

Judy Patterson is a 22 year-old university student who presented to the Student Health Clinic with a rash on her lower legs. Her past medical history is unremarkable except for a urinary tract infection diagnosed 6 days ago for which she is taking trimethoprim-sulfamethoxazole. The only other medication she takes is the occasional dose of ibuprofen for headaches. She has never had any dental extractions or surgeries. On examination, she has no lymphadenopathy or splenomegaly, but she does have petechiae on her lower legs. You ask to look inside her mouth and there you see a blood blister on the inside of her cheek. She says she must have bitten it by accident.

Sana is an 18-year-old female who presents to the emergency room with prolonged bleeding following extraction of a wisdom tooth. The extraction was performed earlier that day and she was sent home with packing to be removed 1 hour later. She bled through the packing by the time she got home and has continued to bleed for the past 2 hours. This is her first tooth extraction and she has no previous history of surgical procedures. On questioning, she describes her periods as “heavy”, but her mother and grandmother reported a similar experience so she assumed that was normal. Physical examination reveals constant oozing from the site of extraction, severe edema of her cheek and a large ecchymosis along her jaw line.

Terrance Pacheco is a 64 year old gentleman you have been asked to see in the ER with new onset thrombocytopenia and anemia. Terrance was brought into the ER by his family with new onset confusion that started 3 days ago. They have also noted easy bruising and presents with extensive ecchymoses on his lower shins. Terrance’s past medical history includes hypertension and dyslipidemia. He is on amlodipine 10 mg daily and atorvastatin 20 mg daily. He is otherwise well.

Be able to describe the process of hemostasis, with emphasis on the coagulation cascade. Be able to explain the common laboratory tests used to assess the coagulation cascade. Be able to describe common clinical conditions that result from abnormalities in the coagulation cascade. Be able to describe the mechanism of action of anticoagulants used to treat venous thrombosis.

Sana is an 18-year-old female who presents to the emergency room with prolonged bleeding following extraction of a wisdom tooth. The extraction was performed earlier that day and she was sent home with packing to be removed 1 hour later. She bled through the packing by the time she got home and has continued to bleed for the past 2 hours. This is her first tooth extraction and she has no previous history of surgical procedures. On questioning, she describes her periods as “heavy”, but her mother and grandmother reported a similar experience so she assumed that was normal. Physical examination reveals constant oozing from the site of extraction, severe edema of her cheek and a large ecchymosis along her jaw line.

Shane Mosley an 18-month-old boy was brought to the emergency room by the baby sitter for treatment of a swollen and tender right knee that had developed suddenly within the previous three hours. The knee began to swell soon after Shane tripped on the family room carpet. Physical examination reveals an apparently healthy child who is crying and favouring his right leg. The knee is swollen and held in partial flexion. Shane has a few old, superficial bruises over shins, chest wall and his back. The physician in the ER concludes that there is fluid in the knee and because of the sudden onset and absence of fever, thinks this is most likely due to a joint bleed. The physician wonders about an underlying systemic bleeding disorder as the cause of Shane's joint bleed. A complete blood count, "hemostasis screen" and an x-ray of the knee are ordered.

Judy Patterson is a 22 year-old university student who presented to the Student Health Clinic with a rash on her lower legs. Her past medical history is unremarkable except for a urinary tract infection diagnosed 6 days ago for which she is taking trimethoprim-sulfamethoxazole. The only other medication she takes is the occasional dose of ibuprofen for headaches. She has never had any dental extractions or surgeries. On examination, she has no lymphadenopathy or splenomegaly, but she does have petechiae on her lower legs. You ask to look inside her mouth and there you see a blood blister on the inside of her cheek. She says she must have bitten it by accident.

Sana is an 18-year-old female who presents to the emergency room with prolonged bleeding following extraction of a wisdom tooth. The extraction was performed earlier that day and she was sent home with packing to be removed 1 hour later. She bled through the packing by the time she got home and has continued to bleed for the past 2 hours. This is her first tooth extraction and she has no previous history of surgical procedures. On questioning, she describes her periods as “heavy”, but her mother and grandmother reported a similar experience so she assumed that was normal. Physical examination reveals constant oozing from the site of extraction, severe edema of her cheek and a large ecchymosis along her jaw line.

Shane Mosley an 18-month-old boy was brought to the emergency room by the baby sitter for treatment of a swollen and tender right knee that had developed suddenly within the previous three hours. The knee began to swell soon after Shane tripped on the family room carpet. Physical examination reveals an apparently healthy child who is crying and favouring his right leg. The knee is swollen and held in partial flexion. Shane has a few old, superficial bruises over shins, chest wall and his back. The physician in the ER concludes that there is fluid in the knee and because of the sudden onset and absence of fever, thinks this is most likely due to a joint bleed. The physician wonders about an underlying systemic bleeding disorder as the cause of Shane's joint bleed. A complete blood count, "hemostasis screen" and an x-ray of the knee are ordered.

Billy Elliot, an 18 year old male music store employee was brought into your emergency department after being involved in a motor vehicle accident at about 2:00 a.m. The paramedics that brought him in stated that he was the driver of a vehicle involved in a three car accident. The rescue squad required the "jaws of life" to extricate him from the car. The airbags were deployed, but the car sustained significant damage and the steering wheel was noted to be inches from the front seat after Billy was extricated. The paramedics conveyed that the patient was alert and talking at the scene and an IV was started. However, en route to the hospital, they noted that his pulse rate began to increase and the patient was diaphoretic.

Be able to recognize the key components of blood. Be able to develop a framework for evaluating hematologic problems.

Charlotte Bouchard is a 31 year old female who has presented to the ER with new onset shortness of breath. She is previously healthy with no history of medical problems and is not on any medications. She tells you her chest pain and shortness of breath started roughly six weeks prior and have gotten worse to the point she can barely take a few steps without having to stop. She’s also lost about 15 lbs in this time and has noted night sweats such that she has had to change her pajamas during the night. On exam, her pulse is 105, BP 115/87, SpO2 97% on R/A, Temp 37.2. She is not visibly distressed. Respiratory exam reveals decreased air entry on the left and you are able to palpate lymph nodes along her bilateral cervical chains and supraclavicular regions. You also appreciate enlarged lymph nodes in her bilateral axillae and inguinal regions. Her spleen is palpable 5 cm below the costal margin. Chest x-ray performed in the ER reveals a left-sided pleural effusion and is suspicious for a mediastinal mass. You order a follow up CT and this confirms a 15.3 cm mediastinal mass as well as diffuse hilar and axillary adenopathy.

Mr. Knox is a 22-year-old male undergoing chemotherapy treatment for Acute Myeloid Leukemia. He was seen in clinic last week for chemotherapy, and he was relieved to see that his neutrophil count was back up above 1 (ANC 1000). He had no evidence of bleeding, and his platelet count was 110. He tolerated his intravenous chemotherapy and anti-emetics well, and went home to recover for the weekend. Eight days later, Jesse is feeling unwell and checks his temperature as he has been taught to do – it reads 38.5 deg C orally, so he presents to the ER as instructed. Apart from the fever, his only complaint is a sore mouth. He denies cough, shortness of breath, dysuria or change in bowel movements. Physical exam reveals a tired and pale-looking young man. His blood pressure is 105/60, heart rate 125 bpm, respiratory rate 18 and a temperature of 38.9 deg C. His tongue has a white coating and his gums look sore. His central line catheter site appears clean.

The lymphatic system consists of lymphatic tissues (Thymus, Lymph nodes, Spleen) and lymphatic vessels (vessels which assist in returning tissue fluid to the blood). Thymus Gland. Type of cells in a lymph node. Lymph node and lymphatic vessel. Popliteal lymph nodes and vessels. Femoral and external iliac lymph nodes and vessels. Female and male pelvic lymph nodes.

Be able to recognize the key components of blood. Be able to develop a framework for evaluating hematologic problems.

Charlotte Bouchard is a 31 year old female who has presented to the ER with new onset shortness of breath. She is previously healthy with no history of medical problems and is not on any medications. She tells you her chest pain and shortness of breath started roughly six weeks prior and have gotten worse to the point she can barely take a few steps without having to stop. She’s also lost about 15 lbs in this time and has noted night sweats such that she has had to change her pajamas during the night. On exam, her pulse is 105, BP 115/87, SpO2 97% on R/A, Temp 37.2. She is not visibly distressed. Respiratory exam reveals decreased air entry on the left and you are able to palpate lymph nodes along her bilateral cervical chains and supraclavicular regions. You also appreciate enlarged lymph nodes in her bilateral axillae and inguinal regions. Her spleen is palpable 5 cm below the costal margin. Chest x-ray performed in the ER reveals a left-sided pleural effusion and is suspicious for a mediastinal mass. You order a follow up CT and this confirms a 15.3 cm mediastinal mass as well as diffuse hilar and axillary adenopathy.

The lymphatic system consists of lymphatic tissues (Thymus, Lymph nodes, Spleen) and lymphatic vessels (vessels which assist in returning tissue fluid to the blood). Thymus Gland. Type of cells in a lymph node. Lymph node and lymphatic vessel. Popliteal lymph nodes and vessels. Femoral and external iliac lymph nodes and vessels. Female and male pelvic lymph nodes.

Be able to recognize the key components of blood. Be able to develop a framework for evaluating hematologic problems.

Charlotte Bouchard is a 31 year old female who has presented to the ER with new onset shortness of breath. She is previously healthy with no history of medical problems and is not on any medications. She tells you her chest pain and shortness of breath started roughly six weeks prior and have gotten worse to the point she can barely take a few steps without having to stop. She’s also lost about 15 lbs in this time and has noted night sweats such that she has had to change her pajamas during the night. On exam, her pulse is 105, BP 115/87, SpO2 97% on R/A, Temp 37.2. She is not visibly distressed. Respiratory exam reveals decreased air entry on the left and you are able to palpate lymph nodes along her bilateral cervical chains and supraclavicular regions. You also appreciate enlarged lymph nodes in her bilateral axillae and inguinal regions. Her spleen is palpable 5 cm below the costal margin. Chest x-ray performed in the ER reveals a left-sided pleural effusion and is suspicious for a mediastinal mass. You order a follow up CT and this confirms a 15.3 cm mediastinal mass as well as diffuse hilar and axillary adenopathy.

The lymphatic system consists of lymphatic tissues (Thymus, Lymph nodes, Spleen) and lymphatic vessels (vessels which assist in returning tissue fluid to the blood). Thymus Gland. Type of cells in a lymph node. Lymph node and lymphatic vessel. Popliteal lymph nodes and vessels. Femoral and external iliac lymph nodes and vessels. Female and male pelvic lymph nodes.

Charlotte Bouchard is a 31 year old female who has presented to the ER with new onset shortness of breath. She is previously healthy with no history of medical problems and is not on any medications. She tells you her chest pain and shortness of breath started roughly six weeks prior and have gotten worse to the point she can barely take a few steps without having to stop. She’s also lost about 15 lbs in this time and has noted night sweats such that she has had to change her pajamas during the night. On exam, her pulse is 105, BP 115/87, SpO2 97% on R/A, Temp 37.2. She is not visibly distressed. Respiratory exam reveals decreased air entry on the left and you are able to palpate lymph nodes along her bilateral cervical chains and supraclavicular regions. You also appreciate enlarged lymph nodes in her bilateral axillae and inguinal regions. Her spleen is palpable 5 cm below the costal margin. Chest x-ray performed in the ER reveals a left-sided pleural effusion and is suspicious for a mediastinal mass. You order a follow up CT and this confirms a 15.3 cm mediastinal mass as well as diffuse hilar and axillary adenopathy.

Charlotte Bouchard is a 31 year old female who has presented to the ER with new onset shortness of breath. She is previously healthy with no history of medical problems and is not on any medications. She tells you her chest pain and shortness of breath started roughly six weeks prior and have gotten worse to the point she can barely take a few steps without having to stop. She’s also lost about 15 lbs in this time and has noted night sweats such that she has had to change her pajamas during the night. On exam, her pulse is 105, BP 115/87, SpO2 97% on R/A, Temp 37.2. She is not visibly distressed. Respiratory exam reveals decreased air entry on the left and you are able to palpate lymph nodes along her bilateral cervical chains and supraclavicular regions. You also appreciate enlarged lymph nodes in her bilateral axillae and inguinal regions. Her spleen is palpable 5 cm below the costal margin. Chest x-ray performed in the ER reveals a left-sided pleural effusion and is suspicious for a mediastinal mass. You order a follow up CT and this confirms a 15.3 cm mediastinal mass as well as diffuse hilar and axillary adenopathy.

Mr. Knox is a 22-year-old male undergoing chemotherapy treatment for Acute Myeloid Leukemia. He was seen in clinic last week for chemotherapy, and he was relieved to see that his neutrophil count was back up above 1 (ANC 1000). He had no evidence of bleeding, and his platelet count was 110. He tolerated his intravenous chemotherapy and anti-emetics well, and went home to recover for the weekend. Eight days later, Jesse is feeling unwell and checks his temperature as he has been taught to do – it reads 38.5 deg C orally, so he presents to the ER as instructed. Apart from the fever, his only complaint is a sore mouth. He denies cough, shortness of breath, dysuria or change in bowel movements. Physical exam reveals a tired and pale-looking young man. His blood pressure is 105/60, heart rate 125 bpm, respiratory rate 18 and a temperature of 38.9 deg C. His tongue has a white coating and his gums look sore. His central line catheter site appears clean.

The lymphatic system consists of lymphatic tissues (Thymus, Lymph nodes, Spleen) and lymphatic vessels (vessels which assist in returning tissue fluid to the blood). Thymus Gland. Type of cells in a lymph node. Lymph node and lymphatic vessel. Popliteal lymph nodes and vessels. Femoral and external iliac lymph nodes and vessels. Female and male pelvic lymph nodes.

Mr. Knox is a 22-year-old male undergoing chemotherapy treatment for Acute Myeloid Leukemia. He was seen in clinic last week for chemotherapy, and he was relieved to see that his neutrophil count was back up above 1 (ANC 1000). He had no evidence of bleeding, and his platelet count was 110. He tolerated his intravenous chemotherapy and anti-emetics well, and went home to recover for the weekend. Eight days later, Jesse is feeling unwell and checks his temperature as he has been taught to do – it reads 38.5 deg C orally, so he presents to the ER as instructed. Apart from the fever, his only complaint is a sore mouth. He denies cough, shortness of breath, dysuria or change in bowel movements. Physical exam reveals a tired and pale-looking young man. His blood pressure is 105/60, heart rate 125 bpm, respiratory rate 18 and a temperature of 38.9 deg C. His tongue has a white coating and his gums look sore. His central line catheter site appears clean.

Part 1: You are working in the Red Blood Cell Disorders Clinic at McMaster. You are asked to see Ms. LW by your preceptor for routine follow up. Ms. LW is a 43-year-old cisgender woman who was diagnosed with sickle cell disease as a child while living in Guyana. Part 2: It is a few months later and you are on a rotation working in the emergency department. You see Ms. LW’s name on the tracker and remember seeing her in the RBC Disorders Clinic. You pull the triage assessment and read that Ms. LW is presenting with a 2-day history of jaundice and pain in her arms and back, which has been unresponsive to oral hydromorphone at home. Vitals in triage reveal HR 110, BP 110/65, T 36°C, RR 16, SpO2 99% on room air.

Part 1: You are working in the Red Blood Cell Disorders Clinic at McMaster. You are asked to see Ms. LW by your preceptor for routine follow up. Ms. LW is a 43-year-old cisgender woman who was diagnosed with sickle cell disease as a child while living in Guyana. Part 2: It is a few months later and you are on a rotation working in the emergency department. You see Ms. LW’s name on the tracker and remember seeing her in the RBC Disorders Clinic. You pull the triage assessment and read that Ms. LW is presenting with a 2-day history of jaundice and pain in her arms and back, which has been unresponsive to oral hydromorphone at home. Vitals in triage reveal HR 110, BP 110/65, T 36°C, RR 16, SpO2 99% on room air.

Vasculogenesis. The capillaries. Capillary permeability. Arteries. Veins. Muscular arteries. Aortic branches of the Thorax. Arteries to the head and neck. Subclavian Artery Stenosis. Branches of the Abdominal Aorta. Abdominal Aortic Aneurysm. Atherosclerosis of the abdominal aorta. Abomidable arteries. Venous System. Caval system. Hepatic portal system. Vertebral Venous System. Arterial and Venous circulation of the legs. Deep vein thrombosis (DVT). Varicose Veins.

Vasculogenesis. The capillaries. Capillary permeability. Arteries. Veins. Muscular arteries. Aortic branches of the Thorax. Arteries to the head and neck. Subclavian Artery Stenosis. Branches of the Abdominal Aorta. Abdominal Aortic Aneurysm. Atherosclerosis of the abdominal aorta. Abomidable arteries. Venous System. Caval system. Hepatic portal system. Vertebral Venous System. Arterial and Venous circulation of the legs. Deep vein thrombosis (DVT). Varicose Veins.

Vasculogenesis. The capillaries. Capillary permeability. Arteries. Veins. Muscular arteries. Aortic branches of the Thorax. Arteries to the head and neck. Subclavian Artery Stenosis. Branches of the Abdominal Aorta. Abdominal Aortic Aneurysm. Atherosclerosis of the abdominal aorta. Abomidable arteries. Venous System. Caval system. Hepatic portal system. Vertebral Venous System. Arterial and Venous circulation of the legs. Deep vein thrombosis (DVT). Varicose Veins.