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57 Cards in this Set
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Elderly Patient with Anemia and negative Fecal Occult Blood
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Probably B12 deficiency 2° aging → gastric atrophy → [relative] achlorhydria → poor B12 release from eaten foods
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#biochemistry #nutrition #gastrointestinal #hematology
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Haptoglobin Levels
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Haptoglobin Binds Free Hemoglobin within Blood Vessels
Complexed Hemoglobin-Haptoglobin is phagocytized by Spenic M∅ ↓ serum haptoglobin levels ≈ intravascular hemolysis normal serum haptoglobin levels rules out intravascular hemolysis (ie extravascular = direct splenic phagocytosis) |
#hematology #diagnostics #molecules
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Differentiating Intravascular from Extravascular Hemolysis
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Haptoglobin Levels
Haptoglobin Binds Free Hemoglobin within Blood Vessels Complexed Hemoglobin-Haptoglobin is phagocytized by Spenic M∅ ↓ serum haptoglobin levels ≈ intravascular hemolysis normal serum haptoglobin levels rules out intravascular hemolysis (ie extravascular = direct splenic phagocytosis) NB: Extravascular includes Splenic Phagocytosis |
#hematology #diagnostics #molecules
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Diathesis Panel
Laboratory Abnormality of HUS |
↑ Bleeding Time from Platelet consuming thrombi
oddly no ↑ PT, or PTT Shiga toxin producing Shigella or E Coli O157H7 |
#microbiology #pathology #hematology
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Warfarin Necrosis
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Proteins C & S are natural anticoagulants
Protien C is vitamin K dependent and has much shorter λ than factors 2, 7, 9 and X. Rare complication: in pts w/ already defective Protein C, warfarin creates a transient hypercoagulable state Tx: Vitamin K + FFP |
#hematology #pharmacology #toxicity
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Hemosiderin
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aggregation of ferritin micelles
maker of iron accumulation golden yellow brown pigment indicative of chronic iron overload/hemolytic anemia |
#pathology #molecules #diagnostics #hematology
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Pigment found in chronic iron overload
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Hemosiderin
aggregation of ferritin micelles golden yellow brown pigment indicative of chronic iron overload/hemolytic anemia |
#pathology #molecules #diagnostics #hematology
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electrolyte abnormality following massive packed RBC transfusion
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Hypocalcemia
Packed RBC's contain citrate anticoagulant citrate chelates calcium |
#pathology #electrolytes #hematology
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Heparin vs LMWH
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enoxapren = LMWH
both activate AT3 to bind Factors 9 X & 2 Only require pentasaccharide to bind AT3 & ↑ affinity Heparin has >18 sacchardies, allowing it to wrap around AT3 and form a stable bond with factor 2 (ie thrombin) LMWH cannot and thus has higher affinity for X than 2 |
#pharmacology #hematology
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"Hotdog" looking inclusions in eosinophils
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Major Basic Protein
Kills helminths damages epithlium |
#immunology
#hematology |
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Timeline for correcting B12 deficiency
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Immediate ↑ Reticulocyte Count, drops off again
slow ↑ hemoglobin |
#nutrition #hematology
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Loss of FAS → SLE
pathogenesis? |
impaired "Clonal deletion" of activated T's by CTL's in peripheral ts
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#pathology #hematology #immunology
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DOC: AML
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t(15:17) RAR-PML
DOC: all-trans-retinoic acid induces remission in 90% of pts |
#hematology #pharmacology #chemotheraputic #neoplasia #pathology
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many immature myelogenous cells on blood smear
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Not AML: would be "blast cells" rather than immature cells (bands, metamyelocytes, myelocytes)
either CML t(9:22) or leukemoid rxn (ie infx) depends on AP low AP: CML normal or high: leukemoid rxn |
#pathology #diagnostics #hematology #neoplasia
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Desmopressin
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aka DDAVP
ADH analogue used for central diabetes insipidus and also coagulopathies → induces release of vWF & Factor 8 from endothelial cells (where they are produced and stored) |
#pharmacology #drugs #hematology #nephrology
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DDAVP
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aka Desmopressin
ADH analogue used for central diabetes insipidus and also coagulopathies → induces release of vWF & Factor 8 from endothelial cells (where they are produced and stored) |
#pharmacology #drugs #hematology #nephrology
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DIC vs TTP vs HUS
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DIC:
Pts bleed Activated Coagulation Cascade ↑ PT & ↑ PTT ↓ fibrinogen, ↑ FDP (D-dimer) TTP-HUS usually do not bleed Only Platelets activated normal PT, PTT, fibrinogen, ∅ FDP |
#hematology #pathology
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Px of ITP
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Ideopathic thrombocytopenic purprua
Bleeding from platelet destrx Chidlren: acute and self-limited Adults: insidious and chronic |
#pathology #hematology #rheumatology
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Nails which bow in and bend out
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Spoon nails aka Koilonychia
specific for iron deficiency anemia ___________________ Plummer Vincent Sro: Triad of Iron Deficiency Anemia Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology
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Plummer Vincent Sro
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Triad of
Iron Deficiency Anemia (Spoon Nails aka Koilonychia) Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology #gastrointestinal
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Anemia + Dysphagia
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Plummer Vincent Sro
Triad of Iron Deficiency Anemia (Spoon Nails aka Koilonychia) Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology #gastrointestinal
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Spoon Nails + Dysphagia
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Plummer Vincent Sro
Triad of Iron Deficiency Anemia (Spoon Nails aka Koilonychia) Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology #gastrointestinal
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Spoon Nails
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aka Koilonychia
Specific for Iron Deficiency Anemia ___________________ Plummer Vincent Sro: Triad of Iron Deficiency Anemia Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology
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Koilonychia
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aka spoon nails
Specific for Iron Deficiency Anemia ___________________ Plummer Vincent Sro: Triad of Iron Deficiency Anemia Glossitis Esophageal Webbing (Dysphagia) |
#pathology #hematology
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B6 deficiency anemia
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required for first step of heme synthesis
microcytic hypochromatic B6 responsive anemia same morphology as X linked Sideroblastic Anemia, but B6 responsive |
#pathology #nutrition #hematology
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Pure Red Cell Aplasia
Pathogenesis |
Parvovirus B19
or Thymoma |
#pathology #hematology #microbiology #noplasia
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Vitamin E deficiency
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anti-oxidant which preserves cell membranes
most affected: neurons (large surface area) RBC's (poor antioxidant fnx) manifestation: Friederick's ataxia-like neuropathy w/ ataxi a & loss of proprioception and vibration + hemolytic anemia |
#pathology #nutrition #neurology #hematology
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Teardrop RBC's
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indicative of myelofibrosis or metastatic cancer
RBC's which had had to squeeze through fibrous strands (not sliced like schistocytes) |
#hematology #pathology #diagnostics
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Acanthrocytosis
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indicative of abetalipoproteinemia
or liver dz no fat absorption (no vitamin E absorption) |
#hematology #pathology #diagnostics
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Spur cells
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extreme form of acanthrocytosis
or liver dz indicative of abetalipoproteinemia |
#hematology #pathology #diagnostics
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Helmet Cell
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Schistocyte
ie mechanical trauma |
#hematology #pathology #diagnostics
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bisphosphoglycerate mutase
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bisphosphoglycerate mutase
present only in RBC's & Placenta alternative glycolytic pathway which produces no ATP BPG mutase: 1,3 BPG → 2,3 BPG Phosphatase: 2,3 BPG → 3 Phosphoglycerate Bypasses one step by Phosphoglycerate kinase which would have produced ATP 2,3 BPG allosterically induces a right shift → O2 dumping [I guess BPG mutase fnx is upregulated by hypoxia] |
#biochemistry #hemoglobin #molecules #energymetzm
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1,3 BPG → 2,3 BPG
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bisphosphoglycerate mutase
present only in RBC's & Placenta alternative glycolytic pathway which produces no ATP BPG mutase: 1,3 BPG → 2,3 BPG Phosphatase: 2,3 BPG → 3 Phosphoglycerate Bypasses one step by Phosphoglycerate kinase which would have produced ATP 2,3 BPG allosterically induces a right shift → O2 dumping |
#biochemistry #hemoglobin #molecules #energymetzm
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2,3-bisphosphoglycerate
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bisphosphoglycerate mutase
present only in RBC's & Placenta alternative glycolytic pathway which produces no ATP BPG mutase: 1,3 BPG → 2,3 BPG Phosphatase: 2,3 BPG → 3 Phosphoglycerate Bypasses one step by Phosphoglycerate kinase which would have produced ATP 2,3 BPG allosterically induces a right shift → O2 dumping |
#biochemistry #hemoglobin #molecules #energymetzm
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CD55
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Paroxysmal Nocturnal Hemoglobinuria
Neither Paroxysmal nor Nocturnal Constant w/ ↑ visualization in first urine of day mutation in PIG-A gene which codes for glycosylphosphatidylcholine (GPI) anchor necessary for CD55 and CD59 attachment CD55 & 59 important to inactivate complement a disorder of the stem cells → pancytopenia chronic hemolysis → recurrent venous thromboses >>deficiency of CD55 and CD59 diagnostic of PNH<< |
#pathology #hematology
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Paroxysmal Nocturnal Hemoglobinuria
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Paroxysmal Nocturnal Hemoglobinuria
Neither Paroxysmal nor Nocturnal Constant w/ ↑ visualization in first urine of day mutation in PIG-A gene which codes for glycosylphosphatidylcholine (GPI) anchor necessary for CD55 and CD59 attachment CD55 & 59 important to inactivate complement a disorder of the stem cells → pancytopenia chronic hemolysis → recurrent venous thromboses >>deficiency of CD55 and CD59 diagnostic of PNH<< |
#pathology #hematology
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CD59
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Paroxysmal Nocturnal Hemoglobinuria
Neither Paroxysmal nor Nocturnal Constant w/ ↑ visualization in first urine of day mutation in PIG-A gene which codes for glycosylphosphatidylcholine (GPI) anchor necessary for CD55 and CD59 attachment CD55 & 59 important to inactivate complement a disorder of the stem cells → pancytopenia chronic hemolysis → recurrent venous thromboses >>deficiency of CD55 and CD59 diagnostic of PNH<< |
#pathology #hematology
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"Starry Sky" Lymphoma
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Burkitt's Lymphoma
appearance from M∅ &apoptotic bodies almost all assoc. w/ c-MYC translocations on chrom 8 usually w/ Ig on 14 t(18;14) |
#pathology #neoplasia #hematology
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Accute Intermittent Porphyria
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Deficiency of HMB synthase (Uroporphyrinogen I Synthase)
responsible for condensing 2 PBG's → HMB aka uroporphyrinogen 1 1. Abodminal Pain, Neurologic Sx w/o Photosensitivity 2. Urine Darkens on standing 3. ALA & PBG-uria precipitated by EtOH, Barbituates, Hypoglycemia, Phenytoin & Griseofulvin relieved by: heme, glucose |
#pathology #biochemistry #hematology
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HMB synthase
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responsible for condensing 2 PBG's → HMB aka uroporphyrinogen 1
Deficiency: Acute Intermittent Porphyria 1. Abodminal Pain, Neurologic Sx w/o Photosensitivity 2. Urine Darkens on standing 3. ALA & PBG-uria precipitated by EtOH, Barbituates, Hypoglycemia, Phenytoin & Griseofulvin relieved by: heme, glucose |
#pathology #biochemistry #hematology
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Sequence of Ig Isotype Switching
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Requires interaction of B cell CD40 and T cell CD40L (CD154)
Once you go on to the next you cannot come back M D G E A |
#hematology #immunology
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Mitotane
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adrenocorticolytic used for adrenocortical carcinoma
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#pharmacology #endocrine
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Tryptase
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Indicative of Mast Cell Degranulation
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#physiology #hematology
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Blood Product indicative of Mast Cell Degranulation
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Tryptase
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#physiology #hematology
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Sickler with Macrocellular Anemia
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Folic Acid Deficiency 2° to ↑ Bone Marrow Turnover
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#pathology #hematology
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HFE mutation
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"High Fe" = hematochromatosis
protein on basolateral membrane of SI intestinal crypt cells compelxes with β2 microglobulin and binds transferrin receptor to regulat endocytosis of transferrin/iron intracellular [iron] ≈ systemic iron → suppresses iron uptke mutation = hematochromatosis Liver cirrhosis and hepatocellular carcinoma are the end stage |
#pathology #hematology
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Hematochromatosis
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HFE "High Fe" Mutation
protein on basolateral membrane of SI intestinal crypt cells compelxes with β2 microglobulin and binds transferrin receptor to regulat endocytosis of transferrin/iron intracellular [iron] ≈ systemic iron → suppresses iron uptke mutation = hematochromatosis Liver cirrhosis and hepatocellular carcinoma are the end stage |
#pathology #hematology
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Systemic Mastocytosis
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↑ Histamine Secretion leads to manifestations
↑ Gastric secretion inactivates pancreatic and intestinal enzymes → diarrhea & malabosprtion ↑ vasodilation → flushing, hypotension, tachycardia, syncope urticaria/, pruritis, dematographism |
#pathology #hematology
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Ristocetin
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activates GP Ib-IX receptors on platelets which bind vWF
good test to see if vWF deficient |
#pathology #diagnostics #hematology
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prolonged PTT c prolonged bleeding time, same pathology
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vWF deficiency
vWF binds Factor8 and marketly ↑↑ λ |
#pathology #hematology
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pancytopenia s hepatosplenomegaly
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aplastic anemia
--severe B12 or folic deficiency --aleukemic leukemia --myelodysplastic sro "dry tap" hypocellular marrow filled with fat & fibrotic stroma |
#pathology #hematology
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Factor V Leiden mutation
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glutamine for arginine substrition near protein C cleavage site → not degraded
hypercoagulative [activated protein C (APC) responsible for inactivating factors V & 7] |
#pathology #hematology
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glutamine for arginine substrition near protein C cleavage site on Factor V
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Factor V Leiden mutation → not degraded
hypercoagulative [activated protein C (APC) responsible for inactivating factors V & 7] |
#pathology #hematology
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Reed Sternberg Cells
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ample cytoplasm
double/bi-lobed nuclei indicative of Hodgkin's Lymphoma |
#pathology #neoplasia #hematology
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Cell with double/bi-lobed nuclei and ample cytoplasm
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Reed Sternburg Cells
pathognomic for Hodgkin's Lymphoma |
#pathology #neoplasia #hematology
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Hematologic/poietic Effects of Glucocorticoids
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lyses lymphocytes, eosinophils and basophils, ↓ monocyte differentiation into M∅ (thus decreasing antigen presentation)
"↑" PMN's on CBC via demargination, does not actually ↑ # PMN |
#pharmacology #physiology #hematology
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Severe hypothermia and oxygen dyssociation curve
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left shift (does not release O2 into ts as well)
this is because the lungs are normally cooler than the tissues, helpful in normal physiologic state to load with more o2 |
#biochemistry #hemoglobin
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