2016 - 2017Academic Year

Hematology Course Syllabus

Course #: 526
Year: I
Semester: Fall
Course Dates: 09/26/2016 to 10/30/2016
Credits Hours: 4 credits
Course Director: Nazila Hejazi, MD (Assistant Professor of Pathology)
CNU College of Medicine, Room 147
Office phone: 916-686-7824
nazila.hejazi@cnsu.edu

Coordinator:

Samantha Ka Xiong
916-686-7300 ext 126
Samantha.Xiong@cnsu.edu

Disclaimer about changes in Syllabus and Course Calendar

Every effort will be made to adhere to the contents of this syllabus. However, this
document is subject to changes in the event of unforeseen, extenuating circumstances.
Students will be notified as soon as possible if changes in the syllabus become necessary.

Course Teaching Faculty

Name/Degree

Rank/Title

Michael Bradbury, PhD

Scott Braley, MD
Guy diSibio, MD, PhD
Susan Ely, PhD
Nehad El-Sawi
Xiaodong Feng, PhD, PharmD
Nazila Hejazi, MD
Michael Ibrahim, MD, PhD
For-Shing Lui, MD

Jose Puglisi, PhD

Rajendra Ramsamooj, MD
David Unold, MD

Professor of Biochemistry, Molecular Biology, and Genetics

Associate Professor of Surgery, Oncology, Anatomy and
Clinical Skills
Associate Professor of Pathology, Hematopathology,
Surgical Pathology, Molecular Genetics and Clinical Skills
Professor of Molecular Biology, Immunology and
Microbiology
Professor of Molecular Biology, Immunology and
Microbiology.
Professor of Pharmacology and Oncology
Assistant Professor of Biochemistry, Pharmacology,
Physiology, Radiology/Imaging
Professor of Clinical Neurology and Neurology Clerkship
Director
Vice Chairman of Clinical Sciences
Assistant Professor of Physiology, Biostatistics
Professor of Pathology, Surgical Pathology and Clinical Skills
Assistant Professor of Pathology, Histology, Anatomy, and
Medical Skills

Open Door Policy: Course faculty have an open door policy and encourage contact from
students by e-mail and in person to share impressions, concerns and/or ideas at any time

Volunteer Community Faculty (if applicable)

Name/Degree
Karimireddy Reddy MD
Edward W. Hearn MD
Shiv Sudhakar MD
Jesse Adams MD
Tim Grennan MD

Course Description:
This unit deals with components of the hematopoietic system bone marrow, blood, and lymphoid
tissues emphasizing basic structures (of cells, tissues, organs) and functions (from molecular to tissue
to whole organ level) in health and disease. Four microscopy lab sessions provide students with the
opportunity to practice their skills at blood film cell identification and interpretation. An interactive
classroom session will provide students the opportunity to practice bone marrow cell identification and
interpretation. Clinical presentations within the Hematology unit are focused on common situations
and presentations that a primary care physician is most likely to experience, such as anemia,
polycythemia, abnormal white cells, lymphadenopathy, abnormal bleeding (bleeding diathesis), and

hypercoagulable states. Each week consists of 1 to 2 clinical presentations accompanied by algorithms

and clinical cases with lists of learning objectives. Clinical faculty will introduce students to the
scheme(s) for each clinical presentation, emphasizing critical decision points and setting the framework
for integration of the basic and clinical sciences to each topic. Following the clinical presentation,
faculty will present fundamental principles from the basic sciences (e.g. anatomy, biochemistry, cell
biology, genetics, immunology, microbiology, nutrition, pathology, pharmacology, physiology) which
underlie understanding of the schematic algorithms and provide knowledge and skills required to arrive
at a correct diagnosis. Basic science sessions will highlight normal/homeostatic structure and function,
followed by examination of relevant disease states, including introduction to care and treatment
options. Practice questions will be offered throughout the course, using Turning Point technology.
Two formative exams will be given. These exams will be composed of 25 NBME questions. At the
course conclusion, a summative exam of 100 NBME questions will be given.

Course Objectives:
By the conclusion of this course, the student will demonstrate the ability to:
# Course Learning Objectives (CLOs)

Apply basic knowledge of anatomy (gross and histologic), embryology,

biochemistry, cell biology, physiology, microbiology, nutrition, and pathology
to understand hematolymphoid function in homeostasis and disease,
including expected clinical findings, diagnostic approaches, morphologic
changes, and natural history of disease.

2 Apply knowledge of molecular biology and genetics

Program
Learning
Objectives
(PLOs)
1,2,5,6

1,2,5,6

(molecular/chromosomal/population) to understand etiology and

pathogenesis of hematolymphoid disorders, patterns of their inheritance, and
targeted therapeutic strategies.

3 Apply fundamental knowledge of the immune system to understand: normal

1,2,5,6

hematolymphoid function; disease states involving hematopoiesis and

lymphoid tissues (lymph nodes, spleen, and extranodal lymphoid tissue); and
therapeutic modalities.

4 Apply knowledge of pharmacology (pharmacokinetics, pharmacodynamics,

1,2,5,6

mechanism of action), nutrition, and blood components (transfusion

medicine) to select optimal therapy for effective and safe treatment of
hematopoietic disorders (e.g., treatment of anemias, leukemia, lymphoma,
hypercoagulable states).

5 Apply principles and approaches of biostatistics and epidemiology to

understand the role of ethnic, gender, age, geographic, socioeconomic,

1,2,5,6

behavioral factors, and other significant variables in hematology and

hematolymphoid disorders, such as for interpreting laboratory reference
ranges, patients laboratory results, disease incidence, risk factors, etiology,
staging, therapeutic effectiveness, and clinical prognosis.
6 Demonstrate level-appropriate skills in communication, professionalism and
medical/procedural related abilities in dealing with patients, and includes
environmental, cultural and societal factors in clinical decision making.

3,4,5,6

Please Note: All session objectives listed in the individual sessions (by date and time) are
mapped to the course objectives.
Key: PLO = Program Learning Objective (#1=Patient Care; #2=Medical & Scientific
Knowledge;
#3=Communication and Interpersonal Skills; #4=Professionalism; #5=Health Care Systems;
#6=Reflective
Practice and Personal Development)

Session Locations:
Two large lecture halls, each with a seating capacity of 180 students, will be used for the basic
science sessions. Eight small classrooms/college rooms, each with a capacity for 25 students and
the Simulation Center space are available for small group sessions. Microscopic lab sessions will be
held at Interdisciplinary Laboratory (IDL) with a capacity for 50 students

Lecture/Session Duration: All lectures on the calendar as one hour sessions will be 50 minutes
long with 10 minutes break at the end for questions and preparation for the next session. Any
session/lecture longer than one hour will have 10 minutes break between every two hours.
Teaching/Learning Methodology:
[Select only methods that you are utilizing in the course and delete others]
Case-Based instruction/Learning
Concept Mapping
Conference
Demonstration
Discussion, Large group (>12)
Discussion, Small Group (<12)
Games
Independent Learning
Journal Club
Laboratory
Lecture

Mentorship
Patient Presentation Faculty
Patient Presentation Learner
Peer Teaching
Preceptorship
Problem-Based Learning (PBL)
Reflection
Research
Role Play Dramatization
Self-Directed Learning
Service Learning Activity
Simulation
Team-Based Learning (TBL)
Team-Building
Tutorial
Workshops

Online Materials Canvas: Canvas is California Northstate University's Learning

Management System.). Use your CNU NETID and password.
Turning Point: Every Phase A student was given a Turning Point Clicker during Orientation.
Please bring the Clicker to class at all times.
Library/Learning Resources
The CNUCOM Library and Learning Resource Center is available for students, faculty, and staff.
This program includes an initial 4200 square feet of space and seating for 100 devoted to the
following resources: Library Facility and Collection, Computer resources, CNUCOM Electronic
Library, and Interlibrary Loan Program. CNUCOM Resource Center maintains an Electronic
Learning Resources System to provide information resources to students, faculty, and staff, and
serve as an entry point for all users to meet their academic and research needs.

Required Textbook(s) (available in Vital Source and Access Medicine), Material(s) and
Equipment:
Subject
Anatomy
Atlas

Author
Moore, Dalley and
Augur
Lichtman et al

Title
Clinically Oriented Anatomy 7e

Lichtman's Atlas of Hematology 2016

Biochemistry

Lieberman

Marks' Basic Medical Biochemistry: A Clinical

Approach 4e

Histology
Immunology
Microbiology

Mescher
Perham
Engleberg

Pathology

Kumar, Abbas and

Aster
Klatt
Klatt and Kumar

Pathology Atlas
Pathology Review
Book
Pathophysiology of
Blood Disorders
Pharmacology
Pharmacology
Statistics
Transfusion Medicine

Junquieras Basic Histology Text and Atlas 13e

The Immune System, 4th Edition
Schaechter's Mechanisms of Microbial Disease, 5th
Edition
Robbins and Cotran Pathologic Basis of Disease 9e
Robbins and Cotran Atlas of Pathology 3rd e
Robbins and Cotran Review of Pathology, 4 th e

Bunn and Aster

Pathophysiology of Blood Disorders 2nd e

Katzung and
Trevor
Brunton et al

Basic & Clinical Pharmacology 13e

Dawson and Trapp

Goodman & Gilman's: The Pharmacological Basis

of Therapeutics, 12e
Basic and Clinical Biostatistics, 4th e
The Circular of Information for the Use of Human
Blood and Blood Components
https://www.aabb.org/tm/coi/Documents/coi1113.pdf

Recommended Textbook(s) (available in Vital Source and Access Medicine):

Subject
Anatomy
Embryology
Genetics
Physiology

Author
Gilroy, MacPherson and Ross
Sadler,T.W.
Nussbaum, McInnes and
Willard
Hall

Title
Atlas of Anatomy 2e
Langmans Medical Embryology. 13th e
Thompson and Thompson Genetics in
Medicine 8e
Guyton and Hall Textbook of Medical
Physiology 13e

Exams and Grading/Assessment:

Formative
2 in-class formative USMLE Step 1 format 25 questions multiple-choice examinations.
These will be held on Monday mornings of week 2 and 4. Based on the way this course
is designed and structured, attendance is mandatory in order for the student to get the
most out of the course. The Week 2 examination will cover all material from Week 1;
Week 4 examination will cover all material from Weeks 1 through 3, with emphasis on
Weeks 2 and 3. Formative examinations are compulsory and scored, however they do
not contribute to the final course grade.
Summative

One USMLE Step 1 format 100 multiple-choice questions final examination at the end
of the course
The successful completion of the course is based on passing the different components of
the Summative Examination with a grade of 70% or higher, as well as demonstrating a
high standards of ethical and profession behavior. Failure to reach the passing mark in
the summative examination will result in a remedial examination.

Clinical Cases
4 ~2-h sessions devoted to presentation and discussion of Clinical Cases will be offered;
attendance at these sessions is compulsory. Students will work in group of five and
student presentations will be graded using a rubric. The clinical case grade will
contribute to 25% of the course total grade.

LABORATORY SESSIONS
4 in-lab microscopic sessions will be offered; attendance at these sessions is compulsory, and all
associated laboratory assignments must be completed. Lack of professionalism or participation
will result in special narrative in faculty evaluations of individual students.

Grading percentages
Passing grade requires a total score of 70% or higher
Honors grade requires a total score of 90% or higher
Total Course Score:
The total numeric score for the course will be measured as follows, which translates to
recording a passing grade if 70 or above, and an honors grade if 90 or above.

Components
%
Summative exam: Multiple Choice
75
Questions (MCQs)
Clinical Case Presentations (with 25
rubrics)
Nutrition
Modules
[if
applicable]
Students are expected to
successfully complete assigned
Nutrition in Medicine modules in
order
to
pass
the
course. Students must register
for nutrition in medicine via
nutritioninmedicine.org.
(A
guide to NIM Medical Student
registration will be posted to
CANVAS). Once registered,
enter the access code cnsu_nutr
in order to access all modules
available to CNSU medical
students.

1
2

Notes/Explanation

Refer to description below

For this course, you are expected to complete

the following modules: Nutritional anemias
part 1, and Nutritional anemias part 2. Provide
Course Director with proof of completion.
Note: you need to only successfully
complete the specific modules assigned for
the course. Do not complete the other
modules until told to do so in your other
courses.

Remediation:

Individual exams: failure on formative examinations will be addressed by holding

individual and/or group review sessions
Final summative examination: failure on summative examination will result in repeat
comprehensive USMLE Step-1 format multiple choice examination.

We will use this remediation plan for student with F:

Plan for students who cannot participate in laboratory sessions (pregnancy, allergy, etc.):
Students will cover missed laboratory sessions content by completing assigned
textbook readings and laboratory practical questions (exam will consist of identification
of cell types)
Students who miss lab sessions will be required to submit a short written explanation
of the cause for their absence
Plan for students who cannot participate in other mandatory sessions:
Will be referred to the office of student affairs for further evaluation

Attendance
All exams, medical skills training sessions, laboratory sessions, masters colloquium sessions,
lectures offered by expert volunteer outside faculty (as determined by course director), clinical
case presentations on Fridays and clinical presentation sessions are mandatory
Attendance will be taken for all mandatory sessions
Late arrivals (after 15 minutes = tardy X3 or more) as well as multiple unexcused absences will
be referred to the Office of Student Affairs and are subject to notation in the students academic
record

Description of Clinical Cases

Clinical Cases (CCs) are hypothetical, Power Point-based scenarios compiled by CNU faculty
and community faculty and presented by medical students for evaluation. These cases are designed
to crystallize understanding of the management of patients who present with findings consistent
with those seen during the previously-seen Clinical Presentation (CP) lecture. Oral presentations
of the CC (below) before colleagues and faculty will foster performance and professionalism skills
that will serve the students throughout their education and professional career.
Several aspects of the CC agenda are similar between the first and second years of medical school
curriculum. During a typical week, every predetermined first- (MS1) or second- (MS2) year
approximately five-student group will submit a templated Power Point file to be graded, based on
a standard rubric, by a selected faculty member. For grading consistency, two faculty members
will grade all presentations for the weeks CC. The final grade will be shared among all members
of the group. In addition, based on a previously-distributed roster, one group of five MS1 or MS2
students from every college will present its CC orally for additional evaluation.
Aspects of the academic workflow leading to submission of a completed CC that will differ
between 1st year (MS1) and 2nd year (MS2) students include the format by which that case will be
received by the individual groups, as described below.
During most weeks, the CC will be sent as a Power Point file to MS1 students directly following
the corresponding CP. Based on a previously distributed roster, one group will be selected to
deliver its presentation orally before its College. During academic blocks 1-3, each member of an
MS1 group will select a component from the groups file to present orally from the Power Point
file. During academic blocks 4-6, every MS1 group will present as a ward team, with each
member presenting a component of the case (presentation, physical examination, and
assessment/plan) to the scribe, who transcribes the findings onto the dry-erase board. One team
member will subsequently present the clinically applicable sciences from that section of the Power
Point file. Faculty will grade the presenting group based on factors including clarity, audience
engagement, and professionalism.

For MS2 students, the first half of the weeks Clinical Case (including items such as patient
identification, chief complaint, and history of present illness) will be made available on Tuesday
following the CP lecture and depiction (to the extent possible) of the findings by a Standardized
Patient during Medical Skills. The students will then work within their assigned groups to order
desired laboratory/imaging studies, from a faculty-designed panel, based on their differential
considerations for the portion of the Clinical Case they were sent. The following day, they will
receive a graded, annotated assessment of the appropriateness of the studies they ordered along
with the remaining Power Point slides for the Clinical Case. These final slides will include all
material required for the students to complete their work for presentation on Friday, including
results from labs and studies recommended by the faculty and the remaining Power Point template
slides. As for MS1, one group will be selected via roster to present its case orally. Their
presentation will assume an entirely ward team format as described above. The oral presentation
will be evaluated as described above.

Students will be expected to comply with all CNU and COM policies

Weekly Course Calendars

Hematology
Week 1 - CPs: Anemia
8:00 AM

9:00 AM

10:00 AM

11:00 AM

Monday 9-26-16

Tuesday 9-27-16

Wednesday 9-28 -16

Introduction to Hematology
(Hejazi)

Heme & Hemoglobin

Synthesis, Sructure, and
Function (Bradbury) Part 2

Macrocytic Anemias (diSibio)

Clinical Presentation: Anemia

(Ramsamooj)

Metabolic Pathwayse Essential

for RBC Integrity ( Bradbury)

Origin and Development of

Blood and Blood-Forming
Organs /Stem Cells (Hejazi)

Normal RBC Destruction

(Bradbury)

Minerals & Vitamins Essential

for Hemoglobin Syntheis
(Bradbury)

Microcytic Anemia, Part 1

(Hejazi)

Lunch and activities

Lunch and activities

Heme & Hemoglobin

Synthesis, Sructure, and
Function (Bradbury) Part 1

Microcytic Anemia, Part 2

(Hejazi)

Thursday 9-29-16

Friday 9-30-16

Pharmacologic Management of
Anemia (Feng)

Parasitic Infections of Blood

and their Management
(Sudhakar)

Normocytic Anemia/Hemolytic
Anemia (Hejazi)

Medical Skills:
Self-Study
Group A
Groups B and C

Clinical Case Discussion:

Anemia

Lunch and activities

Lunch and activities

Lunch and activities

Aplastic Anemia (Ramsamooj)

12 noon

1:00 PM

Laboratory Evaluation of RBCs;

Normal and Abnormal RBC
Morphology Laboratory
(Hejazi, Ramsamooj, Unold,
diSibio)

2:00 PM

3:00 PM

Self Study

Medical Skills:
Self-Study
Group B
Groups A and C

Self Study

Self Study
Medical Skills:
Self-Study
Group C
Groups A and B

4:00 PM

Self Study

Hematology
Week 2 - CPs: Polycythemia, Abnormal WBCs
Monday 10-3-16
8:00 AM

Clinical Presentation:
Abnormal WBCs
(disibio)

9:00 AM

Formative Exam

10:00 AM

11:00 AM

Tuesday 10-4-16

Laboratory Evaluation of White

Blood Cells; WBC Differential
(Unold, Hejazi & diSibio, Hearn) Part 1

Bone Marrow Histology and

Cytomorphology
(Hejazi,)
Clinical Presentation and
Lecture Combined:
Polycythemia
(Hejazi)

Fetal Hematopoiesis and vasculogenesis

and Immune Deficiencies in Lymphocyte
Development
(Ely)

Lunch and activities

Lunch and activities

Wednesday 10-5-16

Thursday 10-6-16

Friday 10-7-17

Masters Colloquium Breaking

Bad News

Laboratory Evaluation of White

Blood Cells; WBC Differential
(Hejazi & diSibio)- Part 2

Acute and Chronic Lymphoid

Leukemias
(Reddy)

Introduction to Leukemias:
Acute Myeloid Leukemias;
Chronic Myelogenous
Leukemia, and
Myeloproliferative Disorders
Hejazi

Medical Skills:
Self Study
Group A
Groups B and C

Clinical Case:
Polycythemia and Abnormal
WBCs

Lunch and activities

Lunch and activities

Lunch and activities

12 noon

1:00 PM

2:00 PM

Transport of Oxygen & Carbon

Dioxide by Hemoglobin
(Bradbury)

Non-Neoplastic Disorders of
Granulocytes, Monocytes and
Lymphocytes
(diSibio)

Myelodysplastic Syndromes
and Chronic Myelomonocytic
Leukemia
(Hejazi)
Immunologic Diagnostics and
Flow Cytometry
(Ely)

Medical Skills:
Self Study
Group B
Groups A and C

Self Study
3:00 PM

Self Study
4:00 PM

Self Study

Self Study

Medical Skills:
Self Study
Group C
Groups A and B

Hematology
Week 3
3--CPs;
CPs:Lymphadenopathy
Abnormal WBCs (cont.);
and Splenomegaly,
Lymphadenopathy
Bleeding
andDiatheses
Splenomegaly
Monday 10-10-16

Tuesday 10-11-16

Wednesday 10-12-16

Thursday 10-13-16

Clinical Presentation:
Lymphadenopathy and
Splenomegaly
(diSibio)

Classification of Lymphomas,
non-Hodgkin, Part 2 (diSibio)

Pharmacologic Management
of Leukemia and Lymphoma,
Part 1
(Feng)

Biochemistry of Coagulation
(Bradbury)

9:00 AM

Anatomy/ Embryology of Lymph

Nodes, Thymus and Spleen
(Ramsamooj)

Laboratory Evaluation of
White Blood Cells; WBC
Differential
(Unold, Ramsamooj, Hejazi &
diSibio) - Part 3

Splenomegaly and Other

Disorders of Spleen
(Braley)

Disorders of Primary
Hemostasis
(Ramsamooj)

10:00 AM

Histology Lymph Nodes,

Thymus and Spleen
(Unold)

Hodgkin Lymphoma
(Hejazi)
Introduction to Solid Tissue
and Bone Marrow Transplant
(Ely)

Medical Skills:
Self Study
Group A
Groups B and C

Reactive Lymphadenopathy
(diSibio)

Pharmacologic Management
of Leukemia and Lymphoma,
Part 2
(Feng)

Clinical Case Discussion:

Abnormal WBCs (continued);
Lymphadenopathy and
Splenomegaly

Lunch and activities

Lunch and activities

Lunch and activities

Lunch and activities

Lunch and activities

Introduction to
Transplantation; Graft versus
Host Disease in Bone Marrow
Transplantation Part 2
(Ramsamooj)

Clinical Presentation: Bleeding

Diatheses
( Holquin)

8:00 AM

11:00 AM

Friday 10-14-16

Disorders of Secondary
Hemostasis and Primary
Fibrinolysis
(Ramsamooj)

12 noon

1:00 PM

2:00 PM

Classification of Lymphomas,
Non-Hodgkin Lymphoma;
Plasma Cell Dyscrasias;
Histiocyte Disorders, Part 1
(diSibio)

Platelet Development,
Structure, and Function in
Primary Hemostasis
(Bradbury)

Medical Skills:
Self Study
Group B
Groups A andC

Self Study

3:00 PM

Self Study
Self Study
4:00 PM

Self Study

Medical Skills:
Self Study
Group C
Groups A and B

Hematology
Week 4 - CP: Hypercoagulable States
Monday 10-17-16

Tuesday 10-18-16
Pharmacologic Management
of Hypercoagulable States,
Part 1
(Ibrahim)

8:00 AM

Wednesday 10-19-16

Thursday 10-20-16

Masters Colloquium

Pharmacologic Management of
Hypercoagulable States, Part 2;
Drug Monitoring
(Ibrahim)

9:00 AM

Formative Exam

Introduction to Transfusion
Medicine
(David Unold)

10:00 AM

11:00 AM

Clinical Presentation:
Hypercoagulable States (Lui)

HIV and Other Infections of the

Blood and Reticuloendothelial
Cells
(El-Sawi)

Medical Skills:
Group A

Self Study
Groups B and C

Lunch and activities

Lunch and activities

Hypercoagulable Disorders
(diSibio)

Introduction to Anatomy
(Mason)

Lunch and activities

Pharmacologic Management of
Bleeding Diathesis
(Ibrahim)

Clinical Case Discussion:

Bleeding Diatheses;
Hypercoagulablity

(Faculty/ Course Evaluation

12:00 to 12:30)
Lunch

Self Study
Groups A and C

Self Study

Self Study

3:00 PM

4:00 PM

Lunch and activities

Medical Skills:
Group B

2:00 PM

Self Study

Statistic
(Puglisi)

Self Study

12 noon

1:00 PM

Friday 10-21-16

Self Study
Medical Skills:
Group C

Self Study
Groups A and B

Hematology
Hematology Week 5 - Summative Exam and Tutoring and Review Sessions and others TBD
Monday 10-24-16

Tuesday 10-25-16

Wednesday 10-26-16

Thursday 10-27-16

Friday 10-28-16

Summative Exam

Self Study

Self Study

Medical Skills Practice

Session

Potential Remediation /
Review Time

Lunch and activities

Lunch and activities

Lunch and activities

Lunch and activities

Lunch and activities

Self Study

Self Study

Self Study

Medical Skills Practice

Session

Potential Remediation /
Review Time

8:00 AM

9:00 AM

10:00 AM

11:00 AM

12 noon

1:00 PM

2:00 PM

3:00 PM

4:00 PM