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  <head>
    <title>011-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Red cells, anaemia, haemostasis, thrombosis, and transfusion">
      <outline text="Red-cell production and turnover">
        <outline text="Stem cells generate red cells, white cells, platelets"/>
        <outline text="Erythropoietin from renal interstitial cells">
          <outline text="Released when oxygen delivery is inadequate"/>
          <outline text="Supports erythroid precursor survival and maturation"/>
        </outline>
        <outline text="Erythropoiesis needs iron, vitamins, healthy marrow"/>
        <outline text="Reticulocytes are recently released red cells">
          <outline text="Raised corrected response suggests marrow compensation"/>
          <outline text="Poor response suggests impaired production"/>
          <outline text="Marrow response is not immediate"/>
        </outline>
        <outline text="Haemoglobin: globin chains and iron-bearing haem"/>
        <outline text="No nucleus or mitochondria, glycolysis only"/>
        <outline text="Splenic and hepatic macrophages clear old cells">
          <outline text="Iron recycled, globin reused, haem to bilirubin"/>
        </outline>
      </outline>
      <outline text="Anaemia by mechanism">
        <outline text="Reduced haemoglobin lowers arterial oxygen content"/>
        <outline text="Microcytosis: impaired haemoglobin synthesis">
          <outline text="Iron deficiency demands a search for cause"/>
          <outline text="Ferritin also rises with inflammation"/>
          <outline text="Thalassaemia preserves the red-cell count"/>
        </outline>
        <outline text="Macrocytosis: vitamin B twelve, folate, alcohol, liver">
          <outline text="Folate alone risks neurological injury"/>
        </outline>
        <outline text="Normocytic: bleeding, inflammation, kidney, marrow failure">
          <outline text="Kidney disease: less erythropoietin, shorter survival"/>
        </outline>
        <outline text="Haemolysis intrinsic or extrinsic">
          <outline text="Membrane, enzyme, or haemoglobin defects"/>
          <outline text="Antibodies, mechanical injury, infection, hypersplenism"/>
          <outline text="Bilirubin and lactate dehydrogenase up, haptoglobin down"/>
        </outline>
      </outline>
      <outline text="Iron from store to marrow">
        <outline text="Ferroportin exports iron from cells"/>
        <outline text="Hepcidin removes ferroportin from the surface"/>
        <outline text="Iron stays in stores while marrow supply falls"/>
        <outline text="Deficiency empties reserve, restriction blocks access"/>
        <outline text="Circulating iron alone cannot separate them"/>
      </outline>
      <outline text="Platelets and primary haemostasis">
        <outline text="Injury constricts vessels and exposes matrix"/>
        <outline text="Von Willebrand factor binds platelets to collagen"/>
        <outline text="Activation: shape change, granules, thromboxane"/>
        <outline text="Fibrinogen bridges glycoprotein two b three a"/>
        <outline text="Count does not measure platelet function">
          <outline text="Drugs, uraemia, bypass, inherited defects"/>
        </outline>
        <outline text="Petechiae and mucosal bleeding versus deep bleeding"/>
      </outline>
      <outline text="Coagulation and fibrinolysis">
        <outline text="Tissue factor starts coagulation and makes thrombin"/>
        <outline text="Thrombin forms fibrin and amplifies itself"/>
        <outline text="Factor thirteen cross-links fibrin"/>
        <outline text="Natural anticoagulants restrain the reaction">
          <outline text="Antithrombin, protein C and S, pathway inhibitor"/>
        </outline>
        <outline text="Prothrombin time monitors vitamin K antagonists"/>
        <outline text="Activated partial thromboplastin time and heparin"/>
        <outline text="Normal screens do not exclude bleeding disorders"/>
        <outline text="Plasmin degrades fibrin and releases D-dimer"/>
        <outline text="D-dimer excludes thromboembolism in selected patients"/>
      </outline>
      <outline text="Thrombosis">
        <outline text="Virchow&#x27;s triad: injury, flow, hypercoagulability"/>
        <outline text="Arterial thrombi are platelet-rich at high flow"/>
        <outline text="Venous thrombi are rich in fibrin and red cells"/>
        <outline text="Venous risk: surgery, immobility, cancer, oestrogen"/>
        <outline text="Deep-vein thrombosis may be silent"/>
        <outline text="Pulmonary embolism: dyspnoea, pleuritic pain, shock"/>
        <outline text="Disseminated coagulation consumes platelets and factors"/>
      </outline>
      <outline text="Antithrombotic drugs">
        <outline text="Antiplatelet drugs dominate arterial syndromes"/>
        <outline text="Anticoagulants prevent extension and recurrence"/>
        <outline text="Fibrinolytics dissolve clot at high bleeding cost"/>
        <outline text="Reversal needs time, antidotes, or factor concentrates"/>
        <outline text="Stopping treatment can also be dangerous"/>
      </outline>
      <outline text="Transfusion">
        <outline text="Red cells add capacity, not a diagnosis"/>
        <outline text="No single universal haemoglobin threshold"/>
        <outline text="One unit, then reassess"/>
        <outline text="Compatibility testing reduces haemolytic reactions"/>
        <outline text="Acute reactions: haemolysis, fever, allergy, overload"/>
        <outline text="Suspected reaction: stop, assess, check identity, notify"/>
        <outline text="Plasma is not a volume expander"/>
        <outline text="Patient blood management limits avoidable loss"/>
      </outline>
      <outline text="Blood film and marrow logic">
        <outline text="Film shows shape, fragments, inclusions, parasites"/>
        <outline text="Schistocytes still need clinical correlation"/>
        <outline text="Spherocytes: immune haemolysis or membrane disease"/>
        <outline text="Pancytopenia raises marrow failure or infiltration"/>
        <outline text="Marrow examination when peripheral evidence falls short"/>
        <outline text="Splenomegaly sequesters and destroys blood cells"/>
      </outline>
    </outline>
  </body>
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