12 Hematology

q123456's version from 2016-06-01 18:48


Question Answer
Acute myeloblastic leukemiaKA32-38.KA34-10
M5 (monocytic), M7 (megakaryocytic), M3 (Auer rods)
hairy cell leukemiatartrate resistant acid phosphatase
CGDNitroblue tetrazolium; myeloperoxidase stain
Follicular lymphomaLike normal lymph node architecture
T(14,18), Bcl-2
Burkitt lymphomaStarry sky
T(8,14), C-MYC (memorize tip: Burkitt-8)
Hodgkin lymphomareed Sternberg cells
B lymphocytes with somatic hypermutation
CD30(not CD20)
upregulation of NF kB.
EBV is not associated with nodular sclerosis, the most common type of HL

cyclophosphamide-alkylating agent
ABVD chemotherapy
dacarbazine (alkylating agents)

SE: Hemorrhagic cystitis
Acute myelogenous leukemia
"AAA" Acute/Auer/vitamin)
hemorrhage, sore throat (infection), promyelocytes
retinoid acid (vitamin A) receptor
Auer rods(lysosomal granules)(peroxidase)>>>indicate myeloid differentiation
Polycythemia verasensitive to EPO and Thrombopoietin
mutation in Janus kinase 2(JAK2)


Question Answer
Aplastic anemiaelevated circulating erythropoietin
Herediatary spherocytosisRBC membrance defect>>>hemolytic anemia
always show the peripheral smear picture: spherocytes
heme synthesisglycine+succinyl coA>>>aminolevulinic acid (ALA)
pyridoxal phosphate
ALA synthase
heme and glucose inhibit ALA synthase

ALA>>Porphobilinogen (PBG)
ALA dehydratase

Acute intermittent porphyria:
Porphobilinogen deaminase
abdominal pain+ normal peripheral blood smear
Treatment: Glucose and heme (inhibit ALA synthase)

porphyria cutanea tarda

lead: Ferrochelatase and ALA dehydratase
inducstrial laborer+abdominal pain+erythrocyte basophilic stippling
Heme oxygenase Heme>>>Biliverdin
Hemosiderinferritin micelles
only found within cells
mononuclear phagocytes
iron deposited in cells, binds to apoferrintin to form ferritin micelles
Uremic platelet dysfunctionnormal PT, PTT, Platelet and increased BT
Abnormal bleeding in patients with uremia
qualitative platelet disorder
normal platelet/inhibit platelet function
erythrocyte basophilic stipplingthe visualization of ribosomes
sickle cell diseaseThe most common cause of osteomyelitis in kids: Salmonella
Septicemia in the patients with sickle cell disease:S pneumoniae and H influenza
splenic infarction>>>splenic fibrosis (splenic atrophy) and autosplenictomy>>> infection by encepsulated organisms

increase in indirect bilirubin, LDH, decrease in haptoglobin, pain
<1 year old Kids, tender swelling of hands/feet
older kids, pain crises, acute chest syndrome
haptoglobinhemolytic anemia
haptoglobin binds free hemoglobin
In intravascular hemolysis, free hemoglobin will be released into circulation and hence haptoglobin will bind the hemoglobin. This causes a decline in haptoglobin levels.
The most common organism causing bacteriemia S pneumoniae
Hemoglobin A2Beta-thalassemia trait
***Hemoglobin A1c: Diabetes
VIII deficiency (hemophilia A)X-Linked recessive disorder
vWFproduced by Endothelial cells,
binds to GPIb of platelet (platelet glycoproteins) and exposed collagen on injured blood vessle walls
ristocetin aggregation test
increased BT, prolonged PTT, normal platelet
***Prothrombin time 11-14 seconds
***Partial thromboplastin time 25-35 seconds
***International normalized ratio INR 0.8 to 1.2
Androgens stimulate red blood cell productionsteroid abuse>>>high RBC
vitamin k deficiencyA 3 year old boy with cystic fibrosis: nose bleeds and bruises very easily after minor trauma, PT=20 sec, PTT=98 sec, platelets=200,000/mm3, Hb 12g/dl, HCT=36% WBC=6000/mm3

Normal valve
INR 0.8-1.2
Schistocyte(Helmet)A fragmented red blood cell that may assume various shapes,
Bite cells Heinz body is nibbled out of a red cell's cytoplasm by the spleen leaving a bitten apple appearance
Heinz bodyHemoglobin aggregate.
G6PD and Thalassemia
Deep vern thrombosis, cerebral vein thrombosis and recurrent pregnancy lossFactor V Leiden
activated protein C: cleaves and inactivates V/VIII
resistant to activated protein C:mutation in the factor V gene
Arthralgias and low RBC, platelet and WBC
hemolytic anemia+low platelet+leukopenia; low C3/4; Anti-ANA,dsDNA; Proteinuria; elevated creatinine, Heart disease: pericarditis

Migratory arthritis
butterly rash
TransfusionInduced Iron Overload>>>hemosiderosis>>cardiac failure

packed BLOOD cells contain citrate: chelate serum calcium causing hypocacemia after transfusions


Question Answer
rodenticidesbrodifacoum, depleted vitaming K dependent clotting factors,
treatment: fresh frozen plasma
salicylate intoxicationmild intoxication:tinnitus
the levels of salicylate exceed 350 ug/ml: hyperventilation
heparin vs low molecular weight heparin (LMWH)Unfractionated heparin has equal activity against Factor Xa and thrombin, while LMWH has greater activity against factor Xa than thrombin.
heparinmost important cause of thrombocytopenia in hospitalized patients.
HITheparin induced thrombocytopenia
the use of unfractionated heparin compared to LMW heparin

stop all forms of heparin and use Direct thrombin inhibitors (hirudin, lepirudin and argatroban)

patients with unstable angina, develops severe foot pain and right toe paleness. platelet count of 60,000/mm3.

The treatment of bleeding by heparin: protamine sulfate, antagonist of heparin
anti VEGFage related macular degeneration
antibodyinfliximab: TNFa, rheumatoid arthritis
abciximab: GPIIb/IIIa, acute coronary syndrome
imatinib: BCR/ABL fusion gene
rituximab:CD20, lymphoma
trastuzumab: herceptin, breast cancer
Anti coagulation1) aspirin
cox1/2 inhibitor>>>decreased TXA2>>>inhibit platelet aggregation and vasodilation
2) ticlopidine and clopidogrel
block the platelet ADP receptor>>>disallow GPIIb/IIIa to function
ticlopidine's SE:neutropenia
3) alteplase (tPA)
MI, pulmonary embolism and acute ischemic stroke, plasminogen>>>plasmin
4) Abciximab: IIb/IIIa Inhibitors
5) heparin
anticoagulant, antithrombin III
6) warfarin
KA 32-4
necrosis of the skin due to Protein C depletion
Inhibitor of vitamin K epoxide reductase
7) dipyridamole and cilostazol
inhibit platelet phosphodiesterase>>>increase cAMP>>>inhibition of platelet aggregation, direct arterial vasodilator

***aspirin dipyridamole
Dipyridamole is also available in combination with ASA under the brand name Aggrenox and is used to reduce the risk of stroke. Aggrenox is usually administered by mouth twice daily
anti plateletaspirin: COX-1 inhibitor/thrombaxane inhibitor
grel (clopidogrel/prasugrel/ticlopidine): ADP inhitors
Abciximab/Eptifibatide/Tirofiban: GpIIb/IIIa inhbitors
desmopressin (DDAVP)ADH>>>increase vWF release from endothelial cells in 30-60 min