Hematology / Oncology - M2

gloved hands hold tube of blood attached to person's arm

Image adapted from wiccked under a Creative Commons license: BY-NC-SA.

Term:
Winter 2009
Published:
July 6, 2010
Revised:
June 5, 2015

In the hematology sequence, students learn to recognize and diagnose anemias, bleeding and clotting disorders, and abnormal white blood cell and lymphocyte disorders. Students learn the clinical approach to a patient with a red blood cell, hemostatic or thrombotic, and white blood cell disorder.

Sequence Directors:
Paula Bockenstedt, M.D.
Lloyd Stoolman, M.D

dScribe: Cathy Mummert

Syllabus

Educational Objectives

The following are the educational objectives of the Hematology Sequence.

I. Management of a Presenting Problem
Given a real or simulated patient with one of the following presenting problems, the student will be able to list the steps to be taken in appropriate sequence to determine the diagnosis:

Anemia—macrocytic, normocytic, or microcytic - Leukocytosis

Bleeding (including petechiae and purpura) - Leukopenia

Lymphadenopathy - Thrombocytopenia

II. Diagnosis of a Specific Disease
Given a real or simulated patient with one of the following diagnoses, the student will be able to gather the appropriate data, arrive at a diagnosis, and give the evidence (historical, physical, laboratory, radiologic, and special procedural data) to support the diagnosis:

Iron deficiency anemia - Hemolytic disease of the newborn

Anemia due to Vit B12 deficiency - Lymphoma (any type)

Anemia due to folic acid deficiency - Chronic lymphocytic leukemia

Thalassemia, Sickle cell Disease - Chronic myelocytic leukemia

Hereditary spherocytosis - Acute leukemia

Hemolytic Anemias - Multiple Myeloma

Thrombosis - Hemophilia A and B and von Willebrands disease

Platelet Receptors - Disseminated Intravascular Coagulation

III. Therapy of Patients
Given a real or simulated patient with one of the following diagnoses, the student will be able to describe the etiologic and/or pathophysiologic process present in the patient, how these relate to abnormal findings, and outline the principles of the therapeutic program:

Iron deficiency anemia - G-6-PD deficiency

Anemia due to Vit B12 deficiency - Hereditary spherocytosis

Anemia due to folic acid deficiency - Lymphoma/Hodgkin’s Disease

Venous Thrombosis - Immune thrombocytopenia

Disseminated Intravascular Coagulation

IV. Procedural/Interpretive Skills
A. The student will be able to list the indications for:

Bone marrow aspiration and/or biopsy. Lymph node biopsy.

B. The student will be able to examine a peripheral blood smear to:

  1. Identify polymorphonuclear neutrophils, mature mononuclear cells (lymphocytes and monocytes), and granulocyte precursors as a group (not individual stages).
  2. Perform a WBC differential composed of cells in the line above sufficiently accurately to extract the clinical information relevant to the patient being examined.
  3. Estimate platelets being able to recognize moderate to extreme thrombocytopenia, normal platelet status, and moderate to extreme thrombocytosis.
  4. Accurately describe the RBC morphology of any condition using standard nomenclature.

V. Enabling Objectives
The student shall be able to:

  1. Describe the general origin, function, and component parts of the hematopoietic system.
  2. Describe the basic kinetics of red cell, white cell, and platelet formation and life span.
  3. Be able to classify red blood cell disorders based upon the size of the red blood cells.
  4. List the indications for, hazards of, and methods of whole blood, packed red cell, platelet, and plasma component transfusions.
  5. Provide a diagnostic approach to the bleeding patient by completely knowing the differential diagnosis of a long APTT, PT, both APTT and PT, and bleeding time.
  6. List the indications for and be able to interpret the following tests: serum iron and iron binding capacity, ferritin level, reticulocyte count, Schilling test, Coombs' test, stool guaiac, platelet count, prothrombin time, activated partial thromboplastin time, thrombin clotting time, and bleeding time.
  7. Describe the mode of action of standard heparin, low molecular weight heparin, warfarin (Coumadin™), platelet glycoprotein IIb/IIIa antongists, and clopidogrel (PlavixTM).
  8. Be able to provide a differential diagnosis of clinical, protein, and molecular defects associated with thrombosis.

Attendance Requirements

  1. All students must review the Powerpoint Presentation “Laboratory Evaluation of the Peripheral Blood Smear”.
  2. All students must attend their assigned Small Group Sessions.
  3. All students must attend the final two lectures of the Heme Sequence called MDC I and II on Autologous Bone Marrow Trasnplantation and Allo Bone Marrow Transplantation.
  4. All students must attend the Hematopathology Labs I and II the second week of the course (see Dr. Stoolman for details).

Dr. Bockenstedt will discuss remediation for required events at the start of the course.

Grading Criteria

The Hematology sequence grade will be based on the final examination that will include a laboratory component. The final examination of about 100 questions will be open at 5 PM on Friday January 16, 2009. Each question on the final exam (80-90) will be worth one to five points. The remaining 10 points will come from the laboratory practical exam, which will also be administered beginning 5 PM on Friday, January 16, 2009 through 11:59 PM Monday, January 19, 2009.

Medical School criteria will be used to assign grades. Grading will comply with M2 grading policies. A pass/fail system will be used, and a cumulative grade of 75% or higher will be required for a passing score. Cumulative grades of 74.99% or lower will be assigned a failing grade. Make-up examinations for failures is a combination multiple choice and essay examination.

gloved hands hold tube of blood attached to person's arm

Image adapted from wiccked under a Creative Commons license: BY-NC-SA.

Term:
Winter 2009
Published:
July 6, 2010
Revised:
June 5, 2015

Lectures

Document Title Creator Downloads License

01.03.11: Hematopoieses

Ivan Maillard

01.07.09(a): Introduction to Radiation Oncology, Pre-Clinical

Theodore Lawrence

01.07.09(b): Introduction to Radiation Oncology, Clinical

Theodore Lawrence

01.08.09: Acquired Bleeding Disorders

Steven Pipe

01.09.09(a): Blood Banking Theory and Component Therapy

Robertson Davenport

01.09.09(b): Complications of Transfusion

Robertson Davenport

01.12.09: Myeloid Cell Disorders

John Levine

01.13.09: Chronic Myeloid Leukemia and other Myeloproliferative Neoplasms (MPNs)

Dale Bixby

Schedules

Document Title Creator Downloads License

2007 Daily Schedule: M2 Hematology / Oncology

Dept. Staff

2008 Daily Schedule: M2 Hematology / Oncology

Dept. Staff

2009 Daily Schedule: M2 Hematology / Oncology

Dept. Staff

2010 Daily Schedule: M2 Hematology / Oncology

Dept. Staff

Student Notes

Document Title Creator Downloads License

01.05.09(a): Hematopoiesis

Aken Desai
Michael Mathis

01.05.09(b): Red Blood Cells

Aken Desai
Michael Mathis

01.05.09(c): Anemia

Aken Desai
Michael Mathis

01.05.09(d): Nutritional Anemias

Aken Desai
Michael Mathis

01.05.09(e): Congenital Hemolytic Anemias

Aken Desai
Michael Mathis

01.05.09(f): Peripheral Blood Smear Self-Review

Aken Desai
Michael Mathis

01.05.09(g): Coagulation Self-Review

Aken Desai
Michael Mathis

01.06.09(a): Acquired Hemolytic Anemias

Aken Desai
Michael Mathis

01.07.09(a): Hemostasis

Aken Desai
Michael Mathis

01.07.09(b): Bleeding Disorders

Aken Desai
Michael Mathis

01.07.09(c): Congenital Coagulation Factor Deficiencies

Aken Desai
Michael Mathis

01.07.09(d): Introduction to Radiation Oncology

Aken Desai
Michael Mathis

01.08.09(a): Acquired Bleeding Disorders

Aken Desai
Michael Mathis

01.08.09(b): Platelet Disorders

Aken Desai
Michael Mathis

01.08.09(c): Thrombosis

Aken Desai
Michael Mathis

01.08.09(d): Anticoagulants and Antiplatelet Drugs

Aken Desai
Michael Mathis

01.09.09(a): Blood Banking and Component Therapy

Aken Desai
Michael Mathis

01.09.09(b): Pediatric Hematology

Aken Desai
Michael Mathis

01.09.09(c): Blood Transfusion Complications

Aken Desai
Michael Mathis

01.12.09(a): Myeloid Cell Disorders

Aken Desai
Michael Mathis

01.12.09(b): Leukocytes and Malignancies

Aken Desai
Michael Mathis

01.12.09(c): Bone Marrow Stem Cell Disorder Pathology

Aken Desai
Michael Mathis

01.13.09(a): Aplastic Anemia and Myelodysplastic Syndromes

Aken Desai
Michael Mathis

01.13.09(b): Chronic Myeloid Leukemia and Myeloproliferative Disorders

Aken Desai
Michael Mathis

01.13.09(c): Acute Leukemia

Aken Desai
Michael Mathis

01.14.09(a): Lymphoma Pathology

Aken Desai
Michael Mathis

01.14.09(b): Lymphoma

Aken Desai
Michael Mathis

01.14.09(c): Multiple Myeloma and other Plasma Cell Disorders

Aken Desai
Michael Mathis

01.15.09(a): Cancer Pharmacology

Aken Desai
Michael Mathis

01.16.09(a): Blood and Marrow Stem Cell Transplantation

Aken Desai
Michael Mathis