Hema-Derma-Onco
 Common pathway: X  V  II  I
 Hct: 38-47%
 Hgb: 120-160 g/dL
 RBC: 4.2-5.4 x 1012/L
 Normocytic: MCV 80-100 fL
 Normochromic: MCH 27-31 pg
 Iron: 11-23 umol/L
 EPO: 10-25 U/L
 Genesis of RBC: Proerythroblast  Basophil
erythroblast  Polychromatophil erythroblast 
Orthochromatic erythroblast  Reticulocyte 
Erythrocyte
 Anemia: M  Hgb <13 Hct <39%; F  Hgb <12 Hct
<37%
 Shift to the right: oxygen to tissue
 Shift to the left: oxygen away from the tissue
 10-15% Acute blood loss: vascular instability d/t
hypotension and decreased organ perfusion
 >30% loss: unable to compensate
 >40% signs of hypovolemic shock
 Acute anemia: Increase CO2, increase acidity
 Chronic anemia: Increase 2,3-BPG
 Anisocytosis: unequal size of RBC from PBS
 Poikilocytosis: unequal shape
 Polychromasia: increase number of immature RBCs
 Hypochromic-Microcytic: Later IDA, Lead poisoning,
Sideroblastic anemia, Thalassemia
 Normocytic-Normochromic: CKD, Early IDA,
Aplastic anemia
 Macrocytic-Megaloblastic: Folate, B12 deficiency,
Fanconi anemia
 Macrocytic-Nonmegaloblastic: Liver disease
 Normocytic Hemolytic: G6PD deficiency, Sickle cell
disease, HbC
 Howell-Jolly Bodies: Asplenia
 Tear drop cells: Myelofibrosis
 Target cells: Thalassemia, chronic liver disease
 Spur cells: uremia and liver disease
 Polycythemia: 17g/dL (Men); 15g/dL (Women)
 Prolonged menstrual bleeding: >7days
 Excess blood loss: >80mL
 Procoagulant: platelet adhesion + aggregation; fibrin
clot formation
 Anticoagulant factors: natural inhibitors of coagulation
and fibrinolysis
 Platelet adhesion: VWF
 Platelet activation & aggregation: Gp IIb/IIIa
 Extrinsic pathway: clotting factors VII and tissue
factor, and calcium
 Intrinsic factor: Factor XII activates factor XI
 Coagulation initiated through TF exposure
 Factor Xa: converts prothrombin  thrombin
 Thrombin: converts plasma fibrinogen  insoluble
fibrin matrix
 TFPI: inhibits tissue factor and factor VII complex
 Protein C & Protein S: inhibit factor V and VIII
 Plasminogen activator: plasmin activation  degrade
fibrin
 Anti-thrombin: acts on factors XII, XI, IX, X, and
thrombin
 Hemarthroses: moderate or severe congenital factor
VIII and IX deficiency
 S. lucidum: found only in thick skin
 Eczema: spongiosis
 Acute eczema: erythema, edematous plaque,
vesiculation
 Subacute eczema: erythematous plaques with scale or
crusting
 Chronic eczema: xerosis, scaling, lichenification
 Atopic Dermatitis: downregulation of cornified
envelope genes (filaggrin and lericrin); reduced
ceramide levels
 Distribution in AD:
o Infants: diaper area spared; face, scalp, extensors
o Older children: flexural folds of extremities
o Adult: chronic hand eczema
 AD Major Features (3 of 4):
o Pruritus
o Typical morphology and distribution of skin
lesions
o Chronic or chronically relapsing dermatitis
o Personal or family history of atopy
 Lichen simplex chronicus: chronic, pruritic; 30-50 y/o
 Irritant Contact dermatitis: inherent characteristic of a
compound (acid/base)
o Localized in dorsum of hands or fingers
 Allergic CD: delayed type hypersensitivity; prior
exposure to offending agent is necessary
o Nickel, thimerosal, fragrance mix
 Airborne allergens: prolonged and repetitive exposure
 lichenified, dried ACD
 Nummular eczema: discoid eczema; coin-shaped
plaques
 Asteatotic eczema: xerotic eczema/ winter itch
 Seborrheic dermatitis: chronic dermatosis (redness +
scaling)
o Face, scalp, presternal area, body folds
o Sebum overproduction + malazzesia
 Psoriasis: chronic, immune-mediated
 o Fingernail involvement (punctate, pitting, o Idiopathic Guttate Hypomelanosis: acquired
onchylosis, nail thickening, subungual leukoderma; chronically sun-damaged skin
hyperkeratosis) o Pityriasis versicolor: Malassezia species
 Types of Psoriasis: o Chemical leukoderma: occupational exposure to
o Plaque type: most common chemicals
o Inverse: intertriginous regions  Hypermelanosis
o Guttate: eruptive psoriasis; URTI with B- o Peutz-Jeghers’: LEOPARD Syndrome
hemolytic streptococci o Ephelides: freckles
o Pustular: palms and soles; with fever; o CALMs: neurofibromatosis, McCune-Albright
erythematous pustules and variable scale o Endocrinopathies: Addison’s disease, Nelson
 Pityriasis rosacea: pink scales; HHV 6 & 7; Christmas syndrome, Cushing’s, Hyperthyroidism, ectopic
tree pattern ACTH syndrome
 Papulosquamous Lesions o Metabolic causes: porphyria cutanea tarda,
o Primary cutaneous disorders hemochromatosis
 Tinea  Vesicles/Bullae
 Psoriasis o TEN
 Pityriasis rosea o EM
 Lichen planus o SSSS
o Drugs: o DM, Renal failure, porphyria
 Pityriasis rosea: BBlockers, ACEi,  Exanthems
metronidazole o Rubeola
 Lichenoid eruption: thiazides,
o Rubella
antimalarials, quinidine, Bblockers,
o Fifth disease: parvo b19
TNF-a inhibitors, anti-PD/PD-L1 Ab,
o Scarlet fever: GABS; pharyngitis; neck and
ACEi
o Systemic diseases: SLE, Lymphoma (mycosis upper trunk
o Kawasaki Disease: polymorphous cutaneous
fungoides), secondary syphilis, reactive arthritis,
sarcoidosis eruption
 Erythroderma:  Pemphigus: acantholysis, blistering, Nikolsky’s sign
o Primary cutaneous disorders:  Pemphigus vulgaris: desmogleins; flaccid blisters; heal
 Psoriasis without scarring
 Dermatitis  Pemphigus foliaceus: stratum corneum; mucous
 Pityriasis rubra pilaris membranes spared
o Drugs  Drug-induced pemphigus: resembles PV
 Penicillins o Thiol group: Penicillamine, captopril, enalapril
 Sulfonamides o Nonthiol: Penicillin, Cephalosporins, Piroxicam
 Carbamazepine  Paraneoplastic pemphigus: occult/confirmed
 Phenytoin neoplasm; painful stomatitis
 Allopurino  Bullous pemphigoid: BP antigen; hemidesmosomes;
 Hypomelanosis heal without scarring
o Oculocutaneous albinism type 1A: tyrosine  Dermatitis herpetiformis: intensely pruritic;
negative; AR symmetrical; gluten
o Oculocutaneous albinism type 2: tyrosine  Linear IgA disease: rare blistering disease; severe
positive; pigmented melanocytic nevi and pruritus; annular fashion
lentigines develop in sun exposed areas  Epidermolysis bullosa acquisita: type VII collagen
o Vitilgo: acquired  Dermatomyositis: heliotrope erythema; periorbital
o Leukotrichia edema; Shawl sign; Gottron’s papules; Calcinosis
o VKH syndrome  Acute cutaneous lupus: visceral involvement
o Systemic Sclerosis: “Salt and pepper  Chronic cutaneous lupus: skin/skin predominant
pigmentation”  Systemic sclerosis: “salt and pepper pigmentation”
o Melanoma-associated leukoderma: mottled or  Linear scleroderma: CREST syndrome; anti-
milk white centromere autoantibodie
CDKN2a, BRAF, MC1R  Risk factor for melanoma
CEBPA, DDX41, RUNX1,  Myeloid neoplasm
ANKRD26, ETV GATA2
t(8;21); t(15;17)  AML younger age
del(5q); del(7q(  AML older age group
t(8:21)  Myeloid sarcoma
t(15:17)  DIC; good prognosis
11q23  Extramedullary
