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Hematology-First-Aid-For-The-Usmle-Step-1
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First Aid for the USMLE Step 1 2020, Thirtieth
FA 2019.pdf
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42 pages (109.99 MB)
1/5/20, 12:57:57 PM
1/5/20, 12:52:18 PM
BY u/verified-idiot
To the only girl i've ever loved, to soufia.
BLUE new in FA 2020
YELLOW text of FA 2019 was edited; the note box next to the yellow highlight will
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,HIGH-YIELD SYSTEMS
Hematology
and Oncology
“You’re always somebody’s type! (blood type, that is)” ` Embryology 404
—BloodLink
` Anatomy 406
“All the soarings of my mind begin in my blood.”
—Rainer Maria Rilke ` Physiology 410
“The best blood will at some time get into a fool or a mosquito.” ` Pathology 414
—Austin O’Malley
` Pharmacology 435
When studying hematology, pay close attention to the many cross
connections to immunology. Make sure you master the different types
of anemias. Be comfortable interpreting blood smears. When reviewing
oncologic drugs, focus on mechanisms and adverse effects rather than
details of clinical uses, which may be lower yield.
Please note that solid tumors are covered in their respective organ
system chapters.
403
,404 SEC TION III HEMATOLOGY AND ONCOLOGY `H̀EMATOLOGY AND ONCOLOGY—EMBRYOLOGY
``
HEMATOLOGY AND ONCOLOGY—EMBRYOLOGY
Fetal erythropoiesis Fetal erythropoiesis occurs in: Young Liver Synthesizes Blood.
Yolk sac (3–8 weeks)
Liver (6 weeks–birth)
Spleen (10–28 weeks)
Bone marrow (18 weeks to adult)
Hemoglobin Embryonic globins: ζ and ε.
development Fetal hemoglobin (HbF) = α2γ2. From fetal to adult hemoglobin:
Adult hemoglobin (HbA1) = α2β2. Alpha Always; Gamma Goes, Becomes Beta.
HbF has higher affinity for O2 due to less avid
binding of 2,3-BPG, allowing HbF to extract
O2 from maternal hemoglobin (HbA1 and
HbA2) across the placenta. HbA2 (α2δ2) is a
form of adult hemoglobin present in small
amounts.
BIRTH
Site of Yolk Liver Bone marrow
erythropoiesis sac
Spleen
50 α
40
Fetal (HbF) γ Adult (HbA1)
% of total 30
globin synthesis
20 β
ε Embryonic globins
10 ζ
Weeks: 6 12 18 24 30 36 6 12 18 24 30 36 42 >>
EMBRYO FETUS (weeks) POSTNATAL (months) ADULT >>
, HEMATOLOGY AND ONCOLOGY `H̀EMATOLOGY AND ONCOLOGY—EMBRYOLOGY SEC TION III 405
Blood groups
ABO classification Rh classification
A B AB O Rh Rh
RBC type
A B AB O
Group antigens on
RBC surface A B A&B Rh (D)
NONE NONE
Antibodies in plasma Anti-B Anti-A Anti-A Anti-B Anti-D
NONE NONE
IgM IgM IgM, IgG IgG
Clinical relevance Receive B or AB Receive A or AB Universal recipient Receive any non-O Can receive either Treat mother with
hemolytic hemolytic of RBCs; universal hemolytic Rh⊕ or Rh⊝ blood anti-D IgG during and
↑
↑
↑
reaction reaction donor of plasma reaction after each pregnancy
Universal donor to prevent anti-D IgG
of RBCs; universal formation
recipient of plasma
Hemolytic disease of Also known as erythroblastosis fetalis.
the newborn
Rh hemolytic disease of the newborn ABO hemolytic disease of the newborn
INTERACTION Rh ⊝ mother; Rh ⊕ fetus. Type O mother; type A or B fetus.
MECHANISM First pregnancy: mother exposed to fetal Pre-existing maternal anti-A and/or anti-B IgG
blood (often during delivery) formation of antibodies cross placenta hemolysis in the
maternal anti-D IgG. fetus.
Subsequent pregnancies: anti-D IgG crosses the
placenta attacks fetal RBCs hemolysis in
the fetus.
PRESENTATION Hydrops fetalis, jaundice shortly after birth, Mild jaundice in the neonate within 24 hours of
kernicterus. birth. Unlike Rh HDN, can occur in firstborn
babies and is usually less severe.
TREATMENT/PREVENTION Prevent by administration of anti-D IgG to Rh Treatment: phototherapy or exchange
⊝ pregnant women during third trimester transfusion.
and early postpartum period (if fetus Rh ⊕).
Prevents maternal anti-D IgG production.
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