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IMF-039-01-0001-en	Why is an abnormal blood count not a diagnosis, and what establishes the mechanism?	An abnormal count may reflect altered production, maturation, release, distribution, consumption, destruction, or clonal expansion, so morphology, lineage, tempo, symptoms, organ enlargement, and molecular findings establish mechanism.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0002-en	What distinguishes clonal haematopoiesis from leukaemia, and why is progression not inevitable?	A stem-cell mutation expands without diagnostic malignancy; it can raise future blood-cancer and cardiovascular risk, but additional genetic, epigenetic, and environmental changes shape progression.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0003-en	How can the neutrophil count rise rapidly without any increase in marrow production?	Demargination moves cells already adherent along vessels into the circulating pool, raising the count quickly without new production.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0004-en	What does a left shift mean, and which film features support a reactive rather than neoplastic neutrophilia?	A left shift means increased immature granulocytes; toxic granulation and vacuoles support reactive activation.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0005-en	In lymphocytosis, how does the appearance of the cells help separate reactive from malignant causes?	Atypical reactive lymphocytes, as seen with viral infection, differ from a monomorphic malignant population, which suggests lymphoid neoplasia.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0006-en	Why should a persistent low white count be reviewed as a trend alongside the other lineages?	Trends and coexisting anaemia or thrombocytopenia reveal whether one lineage or the whole marrow is affected, and persistent abnormalities should never be dismissed without trend review.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0007-en	What determines infection risk in neutropenia, and why can a serious infection be missed?	Risk rises with the depth and duration of neutropenia and with skin, mucosal, device, and cellular-immune defects; profound neutropenia can produce serious infection without pus, focal signs, or fever.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0008-en	Why is fever during significant neutropenia handled as an emergency, and what is the first response?	Infection can progress without the usual signs, so cultures are taken, skin, mouth, lungs, abdomen, perineum, devices, and neurological state are assessed, and broad antipseudomonal antibiotics are given promptly.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0009-en	When fever persists in neutropenia despite antibiotics, what should reassessment consider?	Occult bacterial, fungal, viral, drug, or inflammatory causes, rather than simply continuing the initial regimen unchanged.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0010-en	What can granulocyte colony-stimulating factor do in neutropenia, and what can it not replace?	It prevents or shortens selected treatment-related neutropenia, with bone pain and rare splenic or pulmonary complications, but it does not substitute for antimicrobial treatment in established sepsis.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0011-en	What distinguishes aplastic anaemia from pancytopenia caused by malignant infiltration?	Aplastic anaemia is a hypocellular marrow failure, commonly from immune destruction of stem cells, without malignant infiltration and usually without major node or spleen enlargement.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0012-en	Why does transfusion in aplastic anaemia require careful matching and planning?	Alloimmunisation from transfusion can complicate later stem-cell transplantation, which can cure selected patients.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0013-en	What different information do bone-marrow aspirate and trephine biopsy provide?	Aspirate assesses cellular detail and allows flow cytometry, whereas trephine shows architecture, fibrosis, cellularity, granulomas, and infiltration.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0014-en	Why do myelodysplastic neoplasms cause cytopenias, and what must be excluded before diagnosing them?	The clonal stem cells produce ineffective, dysplastic haematopoiesis; reversible nutritional, toxic, drug, and infectious mimics must be excluded.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0015-en	How does the output of myeloproliferative neoplasms differ from that of myelodysplastic neoplasms, as shown by polycythaemia vera?	Myeloproliferative neoplasms overproduce mature myeloid cells; polycythaemia vera expands red cells and often leukocytes and platelets, causing thrombosis, microvascular symptoms, itch, and splenomegaly.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0016-en	Why is treatment of a myeloproliferative neoplasm not decided by the height of the count alone?	Treatment balances thrombosis, bleeding, symptoms, progression, and therapy toxicity, and a high count alone does not determine that risk.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0017-en	Why do patients with acute leukaemia present with fatigue, infection, and bleeding?	Expanding immature blasts suppress normal marrow production and infiltrate tissues, so normal red-cell, leukocyte, and platelet output is lost.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0018-en	Why is differentiation therapy started as soon as acute promyelocytic leukaemia is suspected?	It is a distinct emergency associated with severe coagulopathy, so treatment begins immediately while the diagnosis is being confirmed.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0019-en	In hyperleukocytosis, why does routine red-cell transfusion need careful judgement?	Hyperleukocytosis already impairs microvascular flow, particularly in brain and lungs, and transfusion can further increase blood viscosity.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0020-en	Why are tyrosine-kinase inhibitors effective in chronic myeloid leukaemia, and what still needs monitoring?	The disease is driven by a fusion tyrosine kinase from a chromosome translocation; adherence, interactions, molecular response, resistance, and cardiovascular or metabolic toxicity still require monitoring.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0021-en	What triggers treatment in chronic lymphocytic leukaemia?	Active clinical indications, not the lymphocyte count alone; early asymptomatic disease is observed.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0022-en	Why is excision or adequate core biopsy preferred to fine-needle aspiration for suspected lymphoma?	Tissue biopsy preserves architecture needed for classification, whereas fine-needle aspiration alone often cannot classify lymphoma.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0023-en	What distinguishes monoclonal gammopathy of undetermined significance from multiple myeloma, and why is follow-up still needed?	It lacks defining organ injury, whereas myeloma causes marrow replacement, bone destruction, anaemia, kidney injury, hypercalcaemia, and infection; it can progress, so risk-based follow-up is needed.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending
IMF-039-01-0024-en	How does rapid malignant-cell breakdown cause death in tumour lysis, and what determines risk?	Released potassium, phosphate, and nucleic acids cause hyperkalaemia, hypocalcaemia, and urate kidney injury, leading to arrhythmia and seizure; risk depends on burden, proliferation, treatment sensitivity, kidney function, and hydration.	Integrated Medical Foundations; chapter 39, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f4b761ef37c0a612c95149ac93c7d96488dda894c97778190316b336c5cf25f5; editorial review pending	imf lang::en chapter::039 module::039-01 review::pending