HEMATOLOGY G ONCOLOGYEMBRYOLOGY

Fetal erythropoiesisYolk sac 3 8 WkLiver 6wK birth

Spleen lo 28 wkBone marrow 18 wk Adult

Young Liver Synthesizes Blood

Hemoglobindevelopment

HbEmbryonic Fetal Adultglobins Mbf HbAiE epsilon dik Az BzGeeta Highaffinity

to Oz d t lessavid 2.3 BPGbindingYgamma holds on

to Oz from Mamma

From fetal to Adult HemoglobinAlphaAlways gammagoes Becomes Beta

RH HEMOLYTICDISEASE OF THENEWBORN

Rhove mother 1st pregnancyRh the baby

1Mother forms g During delivery fetal bloodantibody i e comes in contact c maternalAnti D IgG blood

but the firstbabyis safely delivered

1

Nextpregnancy Attacks Fetal RBCsPreformed AntiDIGG fcrosses placenta Hemolysis in the Fetus

ANATOMY

NEUTROPHILSYW

LAP Leukocyte Alkaline PhosphataseLi Lysosome

LTB 4 CSA Lac Lactoferrin

Collage CollagenaseIL 8

LAP Lilac collageLTB 4CSA Chemotactic factorsL8

PLA8 LETS8 todays lifespan

contains Densegranules CaADPSerotoninHistamine

4 ALFA Granules vWFFibrinogenFibronectin

Platelet Factor Four

MONOCYTE

MonorailFrosted glassCytoplasm

EOSINOPHILS

produces H Histaminase

s et E Eosinophil peroxidaseMA Major Basic proteinN Eosinophil derived Neurotoxin

Eosinophilia Parasitescausedby Asthma

Chung Strauss syndromechronic adrenal insufficiencyMyeloproliferative disordersAllergicprocessesNeoplasia

BASOPHILS

Readily stained c Basic stains

MAST CELLS

Begranulation prevented byCromolyn Sodium

Ig E independent Mast cell degranulationis something to VORE worry about

VancomycinOpioidsRadio contrast dyes

NATURALKILLERCELLS

kill intracellular pathogens

B CELLS

arise from Bone marrow

1 CELLS

Mature in Thymus8T 80 of lymphocytes

Ruleof 8MHC II CD 4 8MHC I X CD 8 8

PLASMACELL

Antibody productionplasmaorgo do not circulate in peripheral blood

Clock facechromatin

PHYSIOLOGYHEMOGLOBIN ELECTROPHORESISA Fat Santa Claus Can't cathode anoded

go far

PLATELET PLUG FORMATION

Endothelial damageiInjury I Vasocoinstriction vianeuralreflex

Endothelin releaseIWFbinds to exposedcollagenExposure1

Adhesion Platelets bind to WE1

Platelets releaseADP Ca TXAz

1Activation Bind to 1724,2 receptor

I

IAggregation inducesGp1161111a expression

at plateletsurface1

Fibrinogenbinds Gp1161111areceptors E links platelets

1

Temporary plugstops bleeding

THROMBOGENESIS

vWFdeficiency von Willebrand diseaseStBernardwearing

GpIb deficiency LSoulier Frenchforshoe

oathBernard Soulier syndrome

Gp II61 II a deficiency Glanzmann thrombasthenia

vWF carries 1 protects factor VII volkswagenFactoriesmake gr8 cars

VITAMIN K DEPENDENT COAGULATION

Vitamin K dependentFactor Seven Shortest half lifeFactor two Tallest longest half life

PATHOLOGYRBC Morphology

ACANTHOCYTES SPUR CELLS

Liverdisease Abetalipoproteinemiat t

ApolipoproteinAI LipidE Vit EdeficientLipoprotein deficiencyin plasma

1Cholesterol inRB

Spurcells

ECHINOCYTES BURR CELLS

Reversible

centralpallorsmallerEmoreuniformprojection

DACROCYTES

RBCsheds a tearbecauseitsmechanically squeezed out

ofits house

seen in Myersfibrosis

Fibrosis drytap

TY Imagine as if theHK fibrosis is pushingoutlBloodfroma sieveteardropwood

Hamw

DEGMACUTES BITE CELLS

in GGPD deficiencyd t removal ofHeinz bodies by splenic

macrophagesBite into some Heinz ketchup

TARGET CELLS

HALT Said the hunter to his targetNbc diseaseASplenicLiver disease

Thalassemia

RBC Inclusions

PAPPENHEIMER BODIES

Sideroplastic anemiaBasophilic granules

Hammer ciderfromthebase

MICROCYTIC HYPOCHROMIC ANEMIAS

Mcv 80ft

IRON DEFICIENCY

I 1 IBleeding 1 intake I absp T demand

malnutrition

itin Heme synthesis

Labs

Freetransferrindltlessiron T1 BC Iron I iron lead to

Ferritin decreased storesLimitingof free erythrocyteFinalstep Reticulocyte Index t iron to makeofHeme protoporphyrin RBCsynthesisditlessiron

Gradual 1 inironstoreslead RDWto T variation inRBC size0 soBonemarrowironstoredepletes

symptoms Conjuctival PallorPICA

Koilonychia dlt upward deformation

of lateral and distal portion of pliable iron deficient nailplates under mechanical pressure

L THALASSEMIA

16g o cis asian Er trans african like uglybelly E Bartsimpsonon the TV

16 chromosome gene deletion

Genedeletions No Disease

221 X L x T minima

x 1a 2 cis asian Q T minorxxl trans african

x l 3 HGH diseaseBa

4 Hb Barts diseaseYu

B THALASSEMIA

B TMirror HbAz 73 5 on electrophoresis

B 1Major

CREW CUT

CHIPMUNK FACIES

B 19 Aplastic crisis

Hepatomegaly

Anisopoikilocytosis

LEADPOISONING

Inhibitionof Ferrochelatase Er ALAdehydratase

Lead Lines

Encephalopathy 8 ErythrocytesAbdominal colic E sideroblastic Anemia

Drops wrist E footdropPx Dimercaprol 8 EDTA

Succimer chelation in kidsIt sucks to be a kid who eats lead

SIDEROBLASTIC ANEMIA

Ingenetic Acquired Reversible

ALA synthase Myelodysplastic Alcoholgene defect syndrome

gpperDeficiency

Drug

RINGEDSideroblasts

Re BG Pyridoxine

MACROCYTIC ANEMIAS

MEGALOBLASTIC ANEMIAS

RBC Macroytosis

Hypersegmentedneutrophils

seen inFOLATE DEFICIENCY

HomocysteineNO neurologic symptoms

If youtry methEr alchoe you'll fail at pregnancyfolate

causes TrimethoprimMethotrexateAlcohol

pregnancy

VITAMIN B121COBALAM IN DEFICIENCY

THomocysteine

is

028

AMethylmalonic acid

Neurologic symptoms dit involvementofvit1312 in fatty acidpathwaysEmyelinsynthesis

Causes E diagnosisMalabsorption

a M aastrectomy

FLY MEETpancreatic insufficiency

of Pernicious anemia FernFish tapewormi e Diphyllobohrium Latam

Schilling's test for diagnosisto differentiate b w insufficiency Eabsorption

OROTIC ACIDURIA

No hyperammonemia

Megaloblastic anemia refractory toTses BizE folatedefect

0D Treatment

NON MEGALOBLASTICANEMIA

Macrocytosis I no hypersegmented neutrophils

DIAMOND BLACK FAN ANEMIA

otosYiii.ii.YPureredcellAplasiaiii i CraniofacialAbnormalities

4 Triphalangeal thumbs

NORMOCYTIC AN EMI ASaintravascular Extravascular

Haptoglobin spherocytes in PsBinds tofreeHemoglobin

Hemoglobinuria CanpresentEurobilinogen in urineHemosiderinuria

Urobilinogenin urine

ANEMIA OF CHRONIC DISEASE

Initially Normocytic can become microcytic

T Ferritin Iron is sequesteredwithin cellst

Ferritinproduced as an Acutephasereactant

APLASTIC ANEMIA

Hypo cellular bone marrowc fattyinfiltration

Symptoms Fatiguetplaqi.se

AnemiaPancytopenia

pgyqgqe.eeea.e.gg mom appeniaPetechia

Infections Lenkopenia

INTRINSIC HEMOLYTIC ANEMIA

HEREDITARY SPHEROCYTOSIS

ID taMC NO central pallor in RBC

HANDS Labs I mean fluorescence inamale

remain eosin 5 maleimide

imidesinic sphere infragility in osmotic fragility teststain

GGPD DEFICIENCY

Hemolysis dlt oxidativestress sulfadrugsAntimalarial favabeans

1Antimalarial Lab RBC E Heinzbodies

Stress G Bite cells

BitesStress makes me eat bites

offava beans with HeinzHeinz ketchup

FAVA

PAROXYSMAL NOCTURNAL HEMOGLOBIN U R1AHEYBABY ENOUGHTEXTING1LET'SMIRLTziaf f Acquired PIGA mutation

impaired GPI anchor synthesisPIGss Daffodil for Decay Accelerating factor DAF 55

E Ml RLMembrane inhibitorof Reactivelysis1 CD59

Px Eculizumab

SICKLE CELL ANEMIA

1Vaseline glutamic acid replacedby valine inpalmon

irecwat

the GmpositionsaypYouilmareacamo

splenectomys

spifaias FindingsCrew cut appearance on KrayTowel

HowellJollybodies

Augite Complicationsyndrome

Aplastic crisissickle Autosplenectomy

Howell JollybodiesSplenic infarctSalmonella osteomyelitisAcute chest syndromeRenal papillarynecrosis

Hbc disease

glutamate to LycineHomozygotes Blood smear Crystals insideRBC

EXTRINSIC HEMOLYTIC ANEMIA

AUTOIMMUNE HEMOLYTIC ANEMIA

Warm AIHA IgG SLE CLLwarmweatheris Good

Cold AIHA IgM Mycoplasma pneumoniaeinfectious Mononucleosis

TreatmentSteroidsRituximab

Androidwearingtuxedo

MICROE MACRO ANGIOPATHIC HEMOLYTIC ANEMIA

Peripheral Blood smear SCHISTOCYTES seentosplit

LEUKOPENIAS

Neutropenia Lymphopenia Eosinopenia51500cells1mm's 51500cells1mm's 530cells1mm

Severeinfection5004mm

Causes

Sepsis SepsisRadiation RadiationSLE SL E

corticosteroids corticosteroids

Cushings

HEME SYNTHESIS E PORPHYRIA

Glycine sucks Glycine succinylCoA1AT Aminolevulinic acid

Partying PorphobilinogendHowever HydroxymethylbilaneYou UroporphyrinogenIcan CoproporphyrinogmdParty Protoporph

Igrin II

feet

Herne

ACUTE INTERMITTENT PORPHYRIA

Porphobilinogen deaminase defect5P's

Painful AbdomenPort wine colored Pee

PolyneuropathyPsychological disturbancePrecipitated by drugsCegicyt10450inducers

Rx Heminf inhibit initial ratelimiting stepofmemesynthesisglucose 4symptoms resolve

PORPHYRIA CUTANEA TARDA

C'YOU'TANEA

Uroporphyrinogen decarboxylase defect

IRON POISONING

IAcute Chronic

Aniongap ArthropathyMetabolic Acidosis Bronze diabetes

cirrhosis cardiomyopathy

Multiorganfailure DiabetesmellitusHypogonadism

Px gastricLavage Phlebotomy Reduces iron store

Chelation

COAGULATION DISORDERS

Extrinsic Intrinsicpathway pathway

Factors I II F All factorsexceptVII E VII XIII

PlayTennis Play Table TennisOutside Inside

MixingStudiesDone to differentiate b w

aclottingfactor or Factor inhibitorsdeficiencies

Eg Patient c RaisedPTt

PTMixing study1

Patient's plasma t Controlplasma

aPTNormalizes PT remains raisedI 1

This means that whatever This means that there is still

factor was deficient in patient's somethingthat is inhibiting

plasma was suppliedbythe clotting factors

control plasma Hence PTis now normal

i IClotting factor deficiency Factorinhibitorsidentified identified

HEMOPHILIA

Hemophilia A Rx D in 1factor VII concentratecauses release ofVonWillebrand'sAntigen

fromplatelets whichcarryfactorVIII hence also usedin vonWillebrand's disease

IMMUNE THROMBOCYTOPENIA

Px SteroidsRituximab

EltrombopagAndroidwearing CAgonistof c mpl receptortuxedo which is targetof

thrombopoietinSplenectomy if refractory

THROMBOTIC MICROANGIOPATHIES

MicroangiopathicHemolyticAnemia

kidneyinjuryThrombocytopenia

Normal PTC PTT Since coagulation pathway not activated

Shiga like toxin mechanism

t uCubs kidney

ST inactivates metalloproteinaseST binds to

globotriaosylceramideADAMTS 13ul Gb3 abundantinchildren

WFmultimerformation present on glomerularendothelium1plateletactivation 1

t signalsapoptosisMicrothrombi formationI 8binding of leukocytesMicroangiopathic to endotheliumHemolysis I1

Platelets used up Renal injuryThrombocytopenia

MIXED PLATELET E COAGULATION DISORDERS

VONWILLEBRAND DISEASEvWF carries factor Hence TPTTRs Desmopressin

DISSEMINATED INTRAVASCULAR COAGULATION

Causes Snake BitesSepsis gramc weTrauma SSTOP

MakingObstetric Complications NewAcute Pancreatitis Thrombi

MalignancyNephrotic syndromeTransfusion

Labs A Fibrin degradationproducts Ddimers

HYPERCOAGULABLE HEREDITARY THROMBOSIS SYNDROMES

ANTITHROMBIN DEFICIENCY

Antithrombin inhibits IIa Eaand also Ulla Ka Xia X11 a

Antithrombin deficiencyi e I AT

1

1

If Heparin administered

person AT deficiency1 t

PTT Tse Heparin has 4 AT tobind witht

1 Heparin actiont

i Comparativelydecreased increase in PTT

PROTEIN CES DEFICIENCYTRiskofThromboticskin necrosis cwarfarin

ProteinC

warfarin 0 II

I

warfarin inhibits all1

But proteinC conch is relatively t comparedto clotting factors

1Hence protein C stores depleted

1Hypercoagulation Prevented byheparin

bridging

In protein C deficiencyt

T Hypercoagulation1

Thrombotic skin necrosis

Together Protein C CancelsE Protein 5 Stops coagulation

PROTHROMBIN GENE MUTATIONS

VENOUS CLOTS

Leukemia vs LymphomaI 1

Bone marrow Lymph nodes

aMyeloid Lymphoid Hodgkin NmHodgkinAML ALL NSCML Icu LR

Haiyanth A

MatureB Mature1Cells cells

fBurkins Adult Tall1 DLBC

Mycosisfungoidest

fFollicular1Mantle

SE3arysyndromecell

Marginallicns

HODGKINS LYMPHOMA

REED STERNBERG CELLSiDistinctivetumorcygiantellsDerivedfrom B cells whereas

in majority Non Hodgkins Balls areinvolved

Bl TwoReedSternberg cells

2 owl eyesBIMODALdistribution

RS cells CD 15 theCD 30 Ct ve

15 2 30

BURKITT LYMPHOMA

Tinglebodymacryophagescomparectwinkling stars

STARRY NIGHT APPEARENCE

Endemic Jawsporadic pelvis

DIFFUSE LARGE B CELL LYMPHOMA

BCL 2,6 mutationsMost common NHL in adults

FOLLICULAR LYMPHOMA

waxingEWaning lymphadenopathy

MARGINAL ZONE LYMPHOMA

MALTing is a chronic process c MarginalprofitAlw chronic inflammationeg chronic gastritis MALT lymphoma

PRIMARY CNS LYMPHOMA

singlering enhancingToxoplasmosis lesion in CNS lymphomaMultiplering

enhancing lesions

ADULT T CELL LYMPHOMA

Common in Japan Tokyo

MYCOSIS FUNGOIDES

Skinpatches E plaquesE Cereberiform nuclei

Pantrier micro abscessintraepidermalneoplastic aggregates

fmay progress toSEZARY SYNDROME

Seizures are just my funny cerebrum Paurtying

PLASMA CELL DYSCRASIASTests1

Initial tests UrinalysisSerum protein 24 hour Urine proteinelectrophoresiselectrophoresis

1MonoclonalMspike

Free light chain assay

Confirmation Bone marrow biopsy

MULTIPLE MYELOMA

Clinical Features

HypercalcemiaRenal involvement

Anemia

Backpain Bonelytic lesionROLEX BENZ

CRABCLOCKPeripheral Blood smear Routeaux

formation

Urinalysis Bence Jones proteinuria Ig Lightchairs

Bone marrow analysis 10 monoclonal plasmacellsI clock face chromatin

WALDENSTROM MACROGLOBULINEM1A

IgMoverproduction largest IgCf Peripheral Neuropathy

HeadacheRetinalHaemorrhage 1 Blurredvision

Raynaud phenomenon

Bone marrow analysis 710 small lymphocytes c

IgM containg vacuoles

MYELODYSPLASTIC SYNDROMES

Risk of transformation to AMLPSUEDO PELGER HUET ANOMALY

DUET

Neutrophils E Bilobed Nuclei

typically after Chemopx

LEUKEMIAS

LYMPHOID

ACUTE LYMPHOBLASTIC LEUKEMIA ALL

All Mass media has come down to Today is

spreading TensionAct Irresponsibly

E Test people's patience

Presents as Mediastinal MassA w Down syndromeTdttCD 10 t

Most responsive to PxSpread CNS

PTestes

CHRONIC LYMPHOCYTIC LEUKEMIA CLL

Crushed Little Lymphocytes Smudgcells

Richter transformationi CLL transformation into more aggressiveDiffuse Large B cell Lymphoma

HAIRY CELL LEUKEMIA

Mature Bcedl tumor Hair like projectionsTartarate Resistant Acid Phosphatase G ve

trapped in a hairy situationRe QadribinePentostatin

MYELOIDACUTE MYELOGENOUS LEUKEMIA

65y o onset

Myeloperoxidase

AMLAuer rods

Alkylating chemoRx Risk factor

vitamin A AArsenio

APL Acute promyelocytic LeukemiaCtints E DIC

AML subtypes

CHRONIC MYELOGENOUS LEUKEMIA

1 Leukocyte Alkaline PhosphataseCDIE lessactivityofmalignant neutrophils

Rx BCR ABL tyrosine kinase inhibitorseg imatinib

CHRONIC MYELOPROLIFERATIVE DISORDERS

POLYCYTHEMIA VERA

10polycythemia IvEPOErythrometflegdigwe

discolouration

Aquagenic fµMMnPruritisµJAK2

Mutation

Rx Ruxolitnib

Hydroxyurea

phlebotomy

ESSENTIAL THROMBOCYTHEMIA

platelets

Symptoms Bleeding 8 Thrombosis

MYELOFIBROSIS Fibrosis drytapT Fibroblastactivity

www.amamaiii.a.itfi

CHROMOSOMAL TRANSLOCATIONS

t 8 14

Burk 8 lymphomaC Myc activation

11,14Mantle Cell Lymphoma

c Man the cell lymphoma14yearold 7Elevent Ili 14

cyclinD1

t 9 22 Philadelphia CreamL Cheese

LANGERHANS CELL HISTIOCYTOSIS

skinglendriticcells proliferative disorder

Presents as lytic Bonelesions

447APeriostinRANKLdysfunction

skin rash LangerhanscellRecurrent otitis media

dysfunction

Cells express S 100 Birc BeckCDI a

DEames

pgTennisRacketshaped

TUMOR LYSISSYNDROME

Px Hydration Renal perfusion improved

glomerular filtration4Acidosis

Allopurinol Iv uric acid productionRasbaricase recombinant urate oxidase enzyme1

converts uric acid to Allantoin

5 10X more solublethan uric acid

NEMOPHAGOCYTIC LYMPHIONISTOCYTOSIS

over activation ofMacrophagesFever t I

presentation ditPancytopenia I lHepatosplenomegaly inherited 20 toimmunologicactivation

PHARMACOLOGY

DIRECT THROMBIN INHIBITORS

Bivalirudin

Argatroban

Dabigatran reverted IDARUCIZUMABUsed in Thrombusforming conditions

Thromboembolism

Atrial fibrillationChant P M

cloningused when Heparin isBAD i e chancesof HIT

If no reversal agents availableuse Prothrombin complex concentrate

Antifibrinolytics

HEPARIN

Antithrombin 0

1 IyzaaFollowed by PTT

Use DVT SIE BleedingACS HITZ DH Abthat binds toMI EUnfractionedHeparin Heparin and platelet factor 4PE leadsto thrombosis E Ecytopenia

Osteoporosis dlt tosteoclastt osteoblastfunction

Antidote Protamine sulfatepositively charged

Datteparin IEnoxaparin g

Ia

Fondapaninaux Can be administered Subcutaneously

Heparin LMWHeparinI 1

Liver clearance Renalclearance

WARFARIN

ReducedVitk II I III Protein cis

Y CarboxylationEPortiedduedas

oxidizedvi Matured

ExtrinsicpathwayFollow PT

EX President went to war farin

ExPreidenftpotinarrestinJwarfarin1 inhibits

Epoxide reductase

SIE Initial Hypercoagulationmechanism

warearinoIAE.ITRelatively AFastprocess t

Hypercoagulation

warfarinhqfriag.mg EagneanonHypercoagulation

11initial

DIRECT FACTOR X2 inhibitors

Api XabanRivarola ban

Reversal And exa net alfaUse Prophylaxis PE

AF

DVTstroke

THROMBOLYTIC's

RetepeaseAltepease

TenecteplaseStreptokinaseplasmin

meshblood clot cleaving

T.npt.int

ADP RECEPTOR INHIBITORSTA Dog Person

feeds sugar Prasugrd PIto Dog clopidogrelwhich is sucked by Tics Tidopidine T TTP is a

Ticagretor T sideeffect

GPIIB HIa inhibitorsTiro fiban bind to FibrinogenreceptorEptifibatide

GP BIHIA

Abciximab

GlycoproTEAn inhibitorsUses

unstable T E AL TEA Used in Unstable

Angina

1 II l

ll ll

M Go S 1 GzI 1paclitaxel Busullan 1

I forO cL

T IIgallcycle

independentdrugs

I

Q din LBieomyciscisplatin methotrexatenitrosourease

1

microtubuleinhibitors

StorytimePacman escapes the microtube he was capturedin Runs after BYut Bashful escapesusing a pawn cycle with Niro and pedalstowards the sound coming from MIX speakertoucan bird blow s air signing as it is safeup in the tree where pacman cant reach

ANTITUMOR ANTIBIOTICS

Actinomycin D WATERWilm's tumor

Ewing sarcomaRhabdomyosarcoma

ANTI METABOLITES All cause myelosupression

fthiol analogs

AZATHIOPRINE 8 6MERCAPTOPURINETpurine analogsmetabolised

IBD

chronic diseases refractory to steroidRheumatoid arthritis

OrganrejectionSLE

Steroids weaningoff

CYTARABINE

causes pancytopenia

5 FLUOROURACILX

5FdUMPLcomplexes to Thymidylatesynthase Er

Folate

IofThymidylatesynthase

tI dTMP I DNA synthesis

prodrug Capecitabine

Uses Actinic KeratosisBasal cell carcinomacancer Colon

Pancreas

Leucovorin Folinic acid

SIE Palmar plantar erylhrodysesthesiaHand Foot syndrome

Foot on the Floor 5 Flooro uracil

METHOTREXATE

Leucovorin co administration Rescue

competitively inhibits Dihydrofolate reductaseDH FR

Renaltoxicity

µ Folate deficiencyHepatotoxicity

ALKYLATING AGENTSBUSULFAN

Use to Ablate Bone marrow

SIE Bone myelo supression

CYCLOPHOSPHAMIDE

C phosphorus can exist asSoup Solid tumors

Uses LIQUID Leukemia lymphomaGAS Granulomatosis c polyangitis

SIE fed by Mesna Hydration

NITROSOUREAS

Eg Carmustine LomustineCars E nitros blows your Mind

Uses CNS Ste CNS Toxicitytumors

PROCARBAZINE

weak 0 of MAO causes Tyramine inducedHypertensive crisis

MICROTUBULE INHIBITORS

WIN PACMANVincristine paclitaxelVinblastine

PACLITAXEL E other TAXANESmechanism Hyper stabilize polymerized

microtubule in M phasePaclitaxel

oca1

Mitotic spindle cannot break

TAXES STABILIZE SOCIETY

VINCRISTINE IN BLAST IN E

UINCA alkaloids binds to B tubulinto

inhibit polymerization intomicrotubule

VINCRISTINE CRISPS the nerves

VINBLASTINE Blasts the bone marrow

CIS CARBO OXALI PLAT INPlatinum agents

uses Bladder

OvaryLmesnquean

Platinum bolt

1

SIE Nephrotoxicity Fanconi1 dlt Free radical

ToAMIFOSTINE

ETOPOSIDE TEN110051DE

Topoisomerase II inhibitor1

DNAsynthesis G repair hindered1

Cellcycle arrest in Gz E S phase

TOPOTECAN IRI N OTE CAN

Topoisomerase I inhibitorto

prevent DNA unwinding 8 replication

HYDROXYUREA

Inhibits ribonucleotide reductaset

4 DNA Synthesis Sphase specific

Uses Myeloproliferative disorders1sickle cell disease

T HbF

BEVACRUMABinhibits Blood Vessels formation

uses Bloodvessels fformed in TumorsAge related maculardegeneration

5 E 0 of Blood vessel1

hemorrhageBlood dots

impaired wound healing

BORTE CARFIL 20M 1Bproteasome inhibitors

TAMOXIFEN

Antagonist AgonistI I

Breast Bone4 Uterus CT riskofEndometrial cancer

Usedfor breast cancer

RALOXIFENE you can RELAX

Antagonist AgonistI d

Breast Boneuterus

TRANSTUZUMABTrans 22am ab

Monoclonal Antibody against HER z

SIE Dilated cardiomyopathy

Heartceptin damages the heart

UEMURAFEN I B

V 600 E mutated BRAF inhibitionco administered I Trametinib MEKinhibitors

RASBURI CASERecombinant uri case

tMetabolizes uric acid to AUartoin

IAllartoin more soluble

1Avoids hyperuricemia