Hematology

"Must know" Coagulation Factor Groupings

•Acc to characteristic:

Contact Group:
Factor XI, XII, PK, HMWK

Prothrombin Group/Vit K dependent

Factor II, VII, IX, X

Fibrinogen Group
Factor I, V, VIII, XIII

•Acc to pathway:
Extrinsic pathway
Factor III, VII

Intrinsic pathway
Factor XII, XI, IX, VIII, PK,HMWK

Common pathway
Factor I, II, V, X

•Acc to different lab tests:

PT: Extrinsic and Common Pathway

aPTT: Intrinsic and Common Pathway

Reptilase and Thrombin Time: Fibrinogen deficiency

Stypven Time: Common pathway only

•Acc to function:

Zymogens/Enzyme precursors:
Factor II, VII, IX, X, XI, XII, PK

Serine Proteases:
Factor IIa, VIIa, IXa, Xa, XIa, XIIa, Kallikrein

Cofactor:
Factor V, VIII, III, HMWK
 Hematology
Thrombocytopenia
Production

Mnemonics: “May’s BF Sebastian E Montreal WAS a Fan of CAT ”

May’s-May Hegglin
B-ernard soulier
F-echtner
Sebastian
E-pstein
Montreal
WAS-Wiskott Aldrich
a
Fan-Fanconi
of
C-ongenital amegakaryo..
A-utosomal dominant...
T-TAR

Thrombocytopenia
Abnormalities of distribution
Mnemonics: “Loss of KaSH”

Loss-of platelet
Of
Ka-sabach meritt
S-splenic sequestration
H-ypothermia

Hematology

Mnemonics: JoNA’s LAb

Job’s Syndrome
Jo- bs syndrome
N- ormal random activity
A- bnormal chemotactic activity
s

Lazy Leukocyte Syndrome

L- azy leukocyte syndrome
Ab- normal random and Abnormal chemotactic activity
 Hematology

Stage where the Neutrophil granules are initially synthesized

•Promyelocyte-Primary/Nonspecific/ azurophilic granules

•Myelocyte-Secondary/Specific Granules

•Metamyelocyte-Tertiary/Gelatinase granules

•Band/Stab cell-Secretory granules/secretory vesicles

Hematology
MEGALOBLASTIC ANEMIA

Due to Vitamin Deficiency:

•Vitamin B12 deficiency
•Folate Deficiency

Other causes:
•C-ongenital dyserythropoietic anemia
•R-everse transcriptase inhibitors
•A-cute erythroid leukemia
•M-yelodysplastic syndrome
To remember:CRAM

If screening tests reveals:

•Oval macrocytes (MCV:100-150fL; commonly:greater than 120fL)

•Pancytopenia
•Reticulocytopenia
•Hypersegmented neutrophils
•Increased total and indirect bilirubin
•Increased lactate dehydrogenase

—>proceed to confirmatory testing

Hematology

” Suckling pig phenomenon ” - a previously believed idea in which the developing RBC's in
erythroid island were provided iron by the macrophages they surrounded

However, the developing RBCs obtain iron via TRANSFERRIN

So what is the role of the macrophages?...

Macrophages...

elaborate cytokines that are vital to the maturation process of the RBCs
are the major cellular anchor for the RBCs

Hematology

INITIAL LAB tests for diagnosis of anemia

CBC
Reticulocyte count
Peripheral blood smear

How to remember? P R C
Yass kunin natin yung PRC LICENSE!!! Go RMTs

Hematology

Types of RBC destruction

•Extravascular Hemolysis/Macrophage mediated hemolysis
-90% of RBC destruction
-associated with “sphErocyte”

•Intravascular/Fragmentation Hemolysis
-10% of RBC destruction
-associated with “schIstocyte”

To remember:
Extravascular:sph(E)rocyte
Intravascular: sch(I)stocyte

Hematology

EDTA
•Mode of action: Chelates Calcium
•MOST PREFERRED AC in HEMATOLOGY
•Dry Form (Na2 and K2 EDTA); Liquid form (K3 EDTA)
•Na2 salt- VERSENE
-how to remember? ver/sene has 2 syllables
•K3 EDTA salt-SEQUESTRENE
-how to remember? sequesTHREEne
 CLIN MIC
CSF ORDER OF COLLECTION AND PRESERVATION

Mnemonics: CoMe Here sa Frozen Room Ref

Tube 1:Co-Chemistry/Serology
Tube 2:Me-Microbiology
Tube 3: Here-Hematology
Sa
Tube 1-Frozen-Frozen
Tube 2:Room-Room Temp
Tube 3:Ref-Refrigerated

Haha sana it will help

Hematology

Disorders with GIANT platelets

mnemonics: “B I G M A”

Bernard Soulier Syndrome

ITP
Gray platelet syndrome
May Hegglin anomaly
Alport Syndrome

Parasitology
how to remember Schistosoma eggs

S haematobium: LARGE TERMINAL spine

“HaLa Te”
Ha-ematobium
La-rge
Te-rminal

S mansoni: LARGE LATERAL spine

“MaLaLa”
Ma-nsoni
La-rge
La-teral
 S japonicum: SMALL LATERAL spine
“JALA sa SM”
Ja-ponicum
La-lateral
Sm-all

Parasitology

LARGEST TAPEWORM OF MAN

D. latum

LONGEST TAPEWORM OF MAN

T. saginata

SMALLEST TAPEWORM OF MAN

H. nana

SHORTEST TAPEWORM OF MAN

E. granulosus

Parasitology

Plasmodium

Most common in the Philippines

P.falciparum
Most common in the world
P.vivax

Helminth
Most common helminth to infect man
Philippines
A.lumbricoides
Worldwide
E.vermicularis

Virology
-some quick notes on virology-
a thread

Largest DNA virus: Poxviridae

Smallest DNA Virus: Parvoviridae

 Largest RNA Virus: Paramyxoviridae

Smallest RNA Virus: Picornaviridae

Herpesviridae

HSV 1: Oral strain

HSV 2: Genital Strain

Human Herpes virus 3:Varicella Zoster Virus

-chickenpox (primary)
-shingles (reinactivation)

Human Herpes Virus 4: EBV

-Infectious mononucleosis aka Kissing Disease
-presence of downey cells and heterophile abs
-infects B lymphocytes

Human Herpes Virus 5: CMV

-40 day fever,salivary gland virus(former name)
-owl’s eye appearance

Human Herpes virus 6

-Roseola
-6th disease
-Exanthem subitum
-infects T lymphocytes

Human Herpes Virus 7:

-Common (90% prevalence in healthy adults)

Human Herpes Virus 8: Kaposi’s sarcoma

Parvovirus B-19
-Erythema infectiosum
-5th disease
-Slapped Cheek Rash
Variola major: smallpox
-severe;fatality rate:30%
Variola minor:
-milder; Less fatal
 Rubella vs Rubeola

Rubella
-Rubivirus
-German measles
-Blueberry muffin baby
-Forchheimer spots on soft palate

Rubeola
-Morbilivirus
-7 day measles
-Koplik’s spots
Poliovirus
-Infantile paralysis
-Salk vaccine: Formalin inactivated
-Sabin vaccine(Oral): Attenuated

Coxsackie A
-Hand foot mouth disease

Coxsackie B
-Devil’s Grip disease
Rabies virus
-Bullet shape
-Negri bodies (virus inclusions inside infected cells)
-from animal bites or contact with bats
-infects muscle tissue but preferentially neurons
-Rabies vax is available
-100% fatal without treatment

Clinical Chemistry

Prefixes Mnemonics: “Da Heck Kill Me Grabe Tired Po sa Exam”

10^1- Da: Deka

10^2- Heck: Hector
10^3- Kill: Kilo
10^6- Me: Mega
10^9- Grabe: Giga
10^12- Tired: Tera
10^15- Po sa: Peta
10^18- Exam: Exa
Prefixes mnemonics: “Dedma Ce MiMi Na Picon Fo Atta”

10^-1: Dedma-Deci
10^-2: Ce-Centi
10^-3: Mi-Milli
10^-6: Mi-Micro
10^-9: Na-Nano
10^-12: Picon-Pico
10^-15: Fo-Femto
10^-18: Atta-Atto

6 Enzyme Classes

Mnemonics: Oh To Have Lyf Is Lit

EC 1: Oh- Oxidoreductases
EC 2: To- Transferases
EC 3: Have- Hydrolases
EC 4: Lyf- Lyases
EC 5: Is- Isomerases
EC 6: Lit- Ligases

Clinical Chemistry

Parameters in the assessment of Acid-Base Balance

1. pH
NV: 7.35-7.45
<7.35: Acidosis
>7.45: Alkalosis

2.pCO2
NV: 35-45mmHg
<35mmHg: Respiratory alkalosis
>45mmHg: Respiratory acidosis

3.HC03
NV: 21-28 meq/L
<21meq/L: Metabolic Acidosis
>28meq/L: Metabolic Alkalosis

4.p02
NV: 81-100mmHg
3 levels of hypoxemia
61-80mmHg: mild
40-60mmHg: moderate
40mmHg or less: severe

Histopath
Post mortem clot vs Antemortem clot

Post mortem clot: “SCCAR”

S-Setting/separation of RBCs from plasma

C-Currant Jelly
C-Chicken fat
A-Assume the shape of vessel
R-Rubbery consistency
 Antemortem clot: “SeNG”

Se-seldom assume the shape of the vessels

N-Not readily detachable from the blood vessels
G-Granular and Friable

Histopath

Formalin
-COLORED TISSUE PHOTOGRAPHY

Mercuric Chloride fixative

-preservation of CELL DETAIL IN TISSUE PHOTOGRAPHY

merCuriC chloride- causes the tissue to shrinC (shrink)

gLaciaL acetic acid-causes the tissue to sweLL

Fixatives for Electron Microscopy:

“KG OT PaMore”

K: Karnovsky
G: Glutaraldehyde
OT: Osmium tetroxide
PaMore: Paraformaldehyde

Gendre’s Fluid: ALCOHOLIC VERSION OF BOUIN’S

FASTEST ACID decalcifying agent: NITRIC ACID

FASTEST NITRIC ACID decalcifying agent:

PHLOROGLUCIN

Incomplete Dehydration: MOST common PROCESSING problem

Nice to know: ACETONE is a raw material in making methamphetamine (“shabu”)

Dioxane and Tetrahydrofuran: both DEHYDRATING and CLEARING agent

Xylene becomes milky when tissue is immersed in it—>

INCOMPLETE DEHYDRATION‼
“3Cs” of Cedarwood oil
Celloidin sections
CNS tissues
Cytological studies

Most IMPORTANT step in EMBEDDING:

ORIENTATION

Of the 3 methods of paraffin wax impregnation_____ gives the fastest result

VACUUM IMPREGNATION

‼ DOUBLE EMBEDDING METHOD‼

“I C E P”

Infiltrated with Celloidin

Embedded in Paraffin

ROUTINE H&E: REGRESSIVE STAINING

FROZEN SECTION H&E: PROGRESSIVE STAINING

Hematoxylin
-Primary stain
-Basic stain
-nuclear stain

Eosin
-secondary stain
-acidic stain
-cytoplasmic stain

Natural Dyes “CHOS”

Cochineal dyes: cochineal bug (Dactylopius coccus costa/Coccus cacti)

Hematoxylin: Mexican tree(Haematoxylon campechianum)

Orcein: from vegetable dye from Lichens

Saffron: Crocus sativus

Rapid ripening agent for PTAH?

Potassium permanganate
Utilized for the study of spermatogenesis?
Copper Hematoxylin

Acridine Orange
Palatandaan: “You Got Dis BRO!”
*Hahaha bor kase yern i bro mo nalang

”You Got Dis”

YELLOW-GREEN: DNA

“BOR”
Brick to Orange Red: RNA

HEMATEIN
-active coloring agent of hematoxylin

HEMATIN
-hemoglobin minus globin

Microbiology (Bacte)

Some quick comparisons in Bacte

-a thread-

Bull’s eye colonies in CIN: Y.enterocolitica

Bull’s eye rash: B.burgdorferi
Bull’s neck- C.diphtheriae

Erythrasma:C minutissimum
Erysipelas:S pyogenes
Erysipeloid:E rhusiopathiae

#1 NTM that cause TB in AIDS px: M.avium

#2 NTM that cause TB in AIDS px: M.kansasii

Amount of H202

3% H202:Staphylococci and Micrococci

15% H202- Anaerobes
30% H202- Neisseria and Mycobacteria
 N.gonorrhoeae:ferments (g)lucose
N.meningitidis: ferments glucose and (m)altose
N.lactamica- ferments glucose,maltose,(l)actose

notice their first letters

C.tetani: spastic paralysis

C.botulinum: flaccid paralysis

Common pili: attachment/adherence

Sex pili: Conjugation

TSI and LIA

•TSI
Slant:Lactose/Sucrose fermentation
Butt: Glucose Fermentation

•LIA
Slant: Deamination
sl(A)nt:de(A)mination
Butt: Decarboxylation
(B)utt:decar(B)oxylation

Microbiology (Bacte)

Cytoplasmic granules/ Inclusion bodies/Metachromatic granules

Much Granules: M.tuberculosis

Babes-Ernst/Metachromatic granules: C.diphtheriae
Bipolar bodies: Y. pestis
Sulfur granules: Actinomyces and Nocardia

Bacte

Antimicrobials and Target sites:

Cell wall synthesis:

“Bet ko sa BGC”

Protein synthesis:
“FACE Te” (mga bisaya for sure di to malilimutan )

Nucleic Acid Synthesis:

“QRST”

Cell membrane inhibitors:

Polymyxins: Colistin

How to remember?

Cell wall synthesis

Bet- Beta Lactams

ko sa
B-Bacitracin
G-Glycopeptides
C-Cycloserine

Protein Synthesis

F-Fusidic acid
A-Aminoglycosides
C-Chloramphenicol
E-Erythromycin
Te-Tetracycline

Nucleic Acid Synthesis:

Q-Quinolones
R-Rifampicin
S-Sulfonamide
T-Trimethoprim

Cell membrane inhibitors:

Polymyxins: Colistin

Bloodbank

Parasites that can be transmitted through BLOOD TRANSFUSION

How to remember: “PLeMa aT TB”

P: Plasmodium
Le: Leishmania spp
Ma: Microfilaria
 aT: T cruzi

T: Toxoplasmosis
B: Babesia microti

Clinical Microscopy

Urinary crystals “resemblances” and how we differentiate them

Cystine and Uric Acid

Cholesterol and Radiographic dyes

Radiographic dyes SG: >1.040

Sulfonamide and Calcium phosphate

Sulfonamide:
(+) Lignin test (urine + 25% HCl)
(+) diazo tests

Calcium phosphagte
soluble in Acetic acid