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Blood - Coggle Diagram

- - - - GpIIb/IIIa
        
        Disease
        
        Glanzman
        
        ITP
- - - - Bernard-Soulier
        
        vWF Receptor GPIb
      - Glanzman
        
        Fibrinogen Receptor GpIIb/IIIa
      - ITP
        
        Fibrinogen Receptor GpIIb/IIIa
      - AML
      - Essential Thrombocythemia
      - HSR-II
      - TTP
        
        Gene
        
        ADAMTS13
        
        Problem
        
        Increased vWF Multimers
    - - Ca+
      - ADP
        
        Pathway
        
        1st Adhesion (vWF binds GIb)
        
        2nd Activation (ADP Induces GIIb/IIIa on platelet)
        
        3rd (Aggregation) Fibrinogen Binds GpIIb/IIIa and links platelets
      - Serotonin
      - Histamine
      - alpha-Granules
        
        vWF (adhesion to Subendothelium)
        
        Disease
        
        TTP ADAMTS13 (Platelets)
        
        Pathophys
        
        Increased vWF Multimers --> increased Platelet Activation and Aggregation
        
        1 more item...
        
        ADAMTS13/vWF Metalloprotease Deficiency
        
        1 more item...
        
        Presentation
        
        Neurological
        
        Renal Insufficiency
        
        Fever
        
        Receptor
        
        GpIb
        
        Disease
        
        Bernard-Soulier (Platelets) (-) Ristocetin
        
        2 more items...
        
        Anatomy/Physiology
        
        VwF synthesis
        
        Endothelial + Megakaryocytes
        
        Location
        
        Subendothelial Matrix
        
        Circulation
        
        Platelet Alpha Granules
        
        Function
        
        Adhesion of platelets to subendothelium
        
        Stabilizes Factor VIII in circulation
        
        RX
        
        Desmopressin (DDAVP)
        
        MOA: Increases Factor VIII and Endothelial secretion of vWF
        
        vWF Disease (AD/AR)
        
        Presentation
        
        NoseBleeds
        
        Gingival Bleeding
        
        Easy Brusing
        
        PathoPhys
        
        Severe Case
        
        Factor VIII (Intrinsic) deficiency due to vWF deficiency
        
        No Platelet Adhesion or Carrier for VIII
        
        Labs
        
        Increased
        
        PTT (Types I and 3)
        
        Decreased
        
        Ristocetin cofactor
        
        1 more item...
        
        Factor VIII
        
        Function: Ligand for platelet adhesion
        
        Fibrinogen (platelet Aggregation + converted to Fibrin to form Mesh)
        
        Receptor
        
        GpIIb/IIIa (Adhesive receptor on platelet)
        
        Disease
        
        Glanzman (AR)
        
        3 more items...
        
        ITP HSR-II (Platelets)
        
        5 more items...
        
        Fibronectin
        
        Platelet Factor 4
    - - Megakaryocytes
        
        Nucleus
        
        Large
        
        Multi-lobed
        
        Location
        
        Bone Marrow
        
        Adjacent to Sinusoids
        
        Cytoplasm
        
        Protrudes into sinusoid
      - Platelets
        
        Broken off cytoplasm from Megakaryocytes
        
        Storage: Spleen
    - - Intrinsic (PTT)
        
        XII
        
        Disease
        
        XI
        
        Hemophilia-C AR
        
        IX (Vit K Dependent
        
        Disease
        
        Hemophilia B (Gene F9) X-Linked (Christmas Disease)
        
        Labs
        
        Increased
        
        1 more item...
        
        Normal
        
        2 more items...
        
        VIII
        
        Disease
        
        Hemophilia A (Gene F8) X-Linked Most common
        
        Labs
        
        Increased
        
        1 more item...
        
        Normal
        
        2 more items...
        
        RX: Desmopression (DDAVP)
        
        MOA: Increases Factor VIII and Endothelially secretion of vWF
        
        Severe vWF causes VIII deficiency
        
        VIIIa Function
        
        Cofactor for IXa (Protease)
        
        Presentation
        
        Easy/spontaneous Bleeding
        
        Joint/Soft Tissue Pain
      - Extrinsic (PT)
        
        VII (Vit K dependent) Shortest Life time :!:
        
        VIIa
        
        Function
        
        Activates X (extrinsic pathway)
        
        Activates IX (Intrinsic Pathway)
        
        III (Tissue Factor)
        
        Function
        
        Cofactor for Factor VII (VII --> VIIa)
        
        VII then activates Factor IX and X
        
        RX: Warfarin (Intrinsic + Extrinsic)
      - Common
        
        Xa
        
        Factor X Vit. K Dependent :!:
        
        Antithrombin & Heparin Targets Xa + IIa (Thrombin) :fire:
        
        IIa (Thrombin)
        
        Pathway
        
        II --> IIa by PL, Ca
        
        IIa activates... :fire:
        
        Intrinsic/extrinsic Pathway
        
        Soft Clot/Hard Clot Formation
        
        Protein C (Vit. K Dependent) :!:
        
        Function:
        
        Clotting Inhibition
        
        Degrades Factor Va
        
        Platelet Activation
        
        Factor II (Prothrombin) Vit. K Dependent Longest Life time :!: :fire:
        
        Antithrombin & Heparin Targets IIa and Xa :fire:
        
        Va
        
        Function
        
        Cofactor for Factor X
        
        Inhibition
        
        Inhibited by Protein C
        
        Disease
        
        Factor V Leiden Mutation
        
        Factor V mutation inhibits Protein C Degradation of Factor V
        
        I (Fibrinogen)
        
        Pathway
        
        I (Fibrinogen) --> Ia (Fibrin Aggregate/soft Clot) by IIa (Thrombin)
        
        XIIIa (Hard Clot)
        
        Catalyzes
        
        The only enzyme that is not a serine Protease)
        
        Catalyzes a Transamidation between Gln and Lys (Hard Clot)
  - - - Myeloid
        
        Eosinophil (induced by IL-5, GM-CSF, IL-3) FceRII
        
        Armamentarium
        
        MBP
        
        ECP
        
        Function
        
        Innate
        
        Anti-Parasitic
        
        Eosinophil-FcER-FcE-IgE-Parasite
        
        Attenuate Basophil (allergic) Reaction
        
        Histology
        
        Disease
        
        Eosinophilia
        
        Hodgkin
        
        Parasite
        
        Asthma
        
        Myleoproliferative Disorders
        
        Eosinopenia
        
        Cushing Syndrome
        
        Glucocorticoids
        
        Activation
        
        IL-5 from Th2
        
        Basophil (Induced by: IL-3, IL-5, GM-CSF) FceI
        
        Basophilia
        
        CML
        
        Function
        
        Innate
        
        Proinflammatory
        
        Release
        
        Histamine (vasodilator)
        
        Heparin
        
        Anticoagulant
        
        Histology
        
        Location
        
        Blood
        
        Class Switch
        
        IL-4 to IgE
        
        Neutrophil (induced by G-CSF)
        
        Chemotactic agents
        
        C5a
        
        IL-8
        
        LTB4
        
        Disease
        
        Neutropenia
        
        Pathological
        
        SLE
        
        Aplastic Anemia
        
        Therapy Induced
        
        Chemo
        
        Radiation
        
        Function
        
        Phagocytosis Bacteria
        
        Acute Inflammation
        
        Neutrophil-FcYR-IgG-Pathogen
        
        Neutrophil-CR1-C3b/C4b-Pathogen
        
        Histology
        
        Markers
        
        Neutrophils + Mono/Macrophage
        
        LFA-1 (integrin)
        
        CD11a + CD18
        
        Function: Binds to ICAM-1/ICAM2 on Endothelium
        
        Mast Cells (induced by: SCF, IL-3, IL-5, GM-CSF) FceI
        
        Disease
        
        HSR-1
        
        Vancomycin (Red Man)
        
        Vancomycin (rapid
        
        Mastocytosis
        
        Histology
        
        Location
        
        Loose Connective Tissue
        
        Function
        
        Innate
        
        Proinflammatory
        
        Mast Cell-FcERI-IgE-Allergen
        
        Produces
        
        5 more items...
        
        Activated By..
        
        3 more items...
      - Granulopoiesis
        
        Lineage
        
        Myeloblast (Induced by: GM-CSF)
        
        Nucleus
        
        Round
        
        3-5 Nucleoli
        
        Cytoplasm
        
        Basophilic
        
        Prominent Golgi
        
        Promyelocyte
        
        Nucleus
        
        3-5 Nucleoli
        
        Oval
        
        Cytoplasm
        
        Non-specific Granules
        
        Myelocyte
        
        Nucleus
        
        Oval
        
        No Nucleoli
        
        Cytoplasm
        
        Specific Granules
        
        Metamyelocyte
        
        Nucleus
        
        Indented
        
        Cytoplasm
        
        Specific and non-specific granules
        
        5. Band Myelocytes (Neutrophil)
        
        Nucleus
        
        Band Shape
        
        Cytoplasm
        
        Many neutrophil specific granules
    - - Lymphoid (lymphocytes) IL-7 causes Lymphoid Progenitor to differentiate into B, T, NK-Cells
        
        B-Cells (adaptive) FceRII
        
        Plasma Cell
        
        Plasma Cells
        
        Antibodies
        
        IgM
        
        4 more items...
        
        IgA (low serum concentrations)
        
        6 more items...
        
        IgE (least abundant - Serum)
        
        5 more items...
        
        IgG (most abundant - Serum)
        
        4 more items...
        
        Disease
        
        Multiple Myeloma
        
        Function
        
        Tags antigens for destruction by..
        
        3 more items...
        
        Histology
        
        Anatomy
        
        Bone Marrow
        
        Connective Tissue
        
        CDs - Markers
        
        CD19
        
        Pro-B Cells
        
        CD20 :fire:
        
        RX: Rituximab (against CD20)
        
        CD21 :fire:
        
        Receptor for EBV
        
        Binds opsonized antigen
        
        CD40
        
        Binds MHC-II
        
        CD80/86 (B7) - All APCs
        
        Fc and C3b Receptors (phagocytosis)
        
        Binds to CD28 on T-Cells
        
        Anatomy
        
        Produced in Bone Marrow
        
        Migration
        
        Superficial Cortex of Lymph Node
        
        Follicles (Nodules) of Lymph Node
        
        3 more items...
        
        Spleen White Pulp
        
        Unencapsulated lymphoid Tissue
        
        Memory B-Cells
        
        Development
        
        Pro-B Cells
        
        Expressed: RAG1/RAG2
        
        Heavy Chain Starts recombination
        
        Marker: CD19
        
        Pre-B Cell
        
        Expressed: Mu-VDJ heavy & Delta-Light chain
        
        Signal Transduction: BTK
        
        Disease: X-linked Agammaglobulinemia
        
        Immature B-Cells
        
        Expressed: IgM
        
        Negative Selection
        
        Mature B-Cells
        
        Expressed: IgM + IgD
        
        T-Cells (CD28 Costimulatory Signal) Adaptive - Binds B7(CD80/86)
        
        **Th-1 Cell mediated
        
        Th1 CD4/TCR Recognize APC's MHC-II
        
        Activated by
        
        IL-12 :fire:
        
        1 more item...
        
        IFN-Y :fire:
        
        1 more item...
        
        Produces
        
        IFN-Y :fire:
        
        1 more item...
        
        TNF
        
        1 more item...
        
        IL-2
        
        Disease
        
        Chronic Inflammation
        
        Inhibited by
        
        IL-4
        
        IL-10
        
        Gene: T-BET
        
        Th-2 Humoral-mediated
        
        Th2 CD4/TCR Recognize APC's MHC-II
        
        Gene: GATA3 (IL-4 activates Stat --> GATA3 :fire:
        
        Secretes
        
        IL-4 :fire:
        
        1 more item...
        
        IL5 :
        
        3 more items...
        
        IL-6
        
        5 more items...
        
        IL-10
        
        2 more items...
        
        IL-13 :fire:
        
        4 more items...
        
        Disease
        
        Activated by
        
        IL-4 :fire:
        
        IL-2
        
        Inhibited by
        
        IFN-Y
        
        Th-17Neutrophils and Proinflammatory
        
        Th17 CD4/TCR Recognize APC's MHC-II
        
        Activated by
        
        IL-1 :fire:
        
        IL-6 :fire:
        
        2 more items...
        
        TGF-B :fire:
        
        IL-23 :fire:
        
        Produces
        
        IL-17 :fire:
        
        2 more items...
        
        IL-21
        
        IL-22 :fire:
        
        1 more item...
        
        Disease
        
        Job Syndrome (Hyper IgE) :fire:
        
        2 more items...
        
        Increased Th17
        
        4 more items...
        
        Inhibited by
        
        IFN-Y
        
        IL-4
        
        Gene:RORyt + STAT3
        
        Induced by: Bacteria + Fungi
        
        Cytotoxic T-Cells CD8/TCR Recognize MHC-I CD8
        
        Function
        
        Bind to viral infected cells for apoptosis
        
        Anatomy
        
        Maturation
        
        Thymus
        
        Cortex
        
        1 more item...
        
        Medulla
        
        1 more item...
        
        Disease
        
        1 more item...
        
        Lymph Node
        
        Diffuse Tissue
        
        Deep Cortex (T-Cell Rich)
        
        T-Cell Activation
        
        Macrophage
        
        Less MHC-II (Less effective APC)
        
        Dendritic Cells
        
        More MHC-II (more effective APC)
        
        T-Reg Prevent autoimmunity
        
        T-Reg
        
        Activated by
        
        TGF-B :fire:
        
        2 more items...
        
        IL-2 :fire:
        
        Produces
        
        TGF-B :fire:
        
        IL-10 :fire: Inhibits T-Cell activation by APC suppression
        (NO CD80/86)
        
        IL-35
        
        Disease
        
        IPEX
        
        1 more item...
        
        CDs
        
        CD4
        
        CD25
        
        Inhibited by
        
        IL-6
        
        Gene: FOXP3 :fire:
        
        Lineage
        
        Pro-T-Cells
        
        Express
        
        Antigen Independent
        
        Pre-T-Cells
        
        Express
        
        Pre-TCR
        
        1 more item...
        
        CD3
        
        Zeta
        
        Antigen Independent
        
        Immature T-Cells
        
        NK-Cells
        
        Function
        
        Innate
        
        Lysis (NK-FcR-FcY-IgG-Infected Cell)
        
        Perforin :fire:
        
        Granzymes :fire:
        
        Produce IFN-Y
        
        Th--> Th1
        
        Increases MHC-II Expression (all cells)
        
        Increases expression of Antigen Presentation (All Cells)
        
        Stimulates Macrophages
        
        CDs
        
        CD16
        
        CD56
        
        Recruited by IL-12
        
        Histology
        
        Disease
        
        X-SCID (Gamma Chain of IL-2R)
        
        Mechanism
        
        No IL-2R = No Proliferation of T-cells/NK-Cells
        
        Complications
        
        Fungal
        
        2 more items...
        
        Viral
        
        Bacterial
        
        Lymphocytopenia
        
        Thymic Atrophy
        
        Labs
        
        Low
        
        2 more items...
        
        Present (not functioning)
        
        1 more item...
        
        Gamma Chain
        
        CD132
        
        Tyrosine Kinase
        
        JAK3
      - Myeloid
        
        Monocyte (induced by M-CSF)
        
        Macrophage (innate)
        
        Activated by:
        
        IFN-Y
        
        Th2 Release IL-4
        
        Produces
        
        IL-12
        
        Th-->Th1
        
        Inhibits Th-->Th2
        
        Triggers NK + T-Cells to secrete IFN-Y
        
        Acute Inflammation
        
        IL-1
        
        1 more item...
        
        IL-6
        
        2 more items...
        
        IL-1 + TNF (also in Mast Cells)
        
        2 more items...
        
        Chemokines
        
        CCL2 (MCP-1)
        
        1 more item...
        
        Disease
        
        Granulomas
        
        TB
        
        Sarcoidosis
        
        Kupffer Cells
        
        Liver
        
        Connective tissue
        
        Bone
        
        Microglial (brain)
        
        Histology
        
        Function
        
        Innate Immunity
        
        Phagocytosis
        
        1 more item...
        
        Binds to Th-Cells as MHC-II APC
        
        Inactivated by
        
        IL-10
        
        CDs/Markers
        
        CD14
        
        CD40
        
        CD80/86 (B7) - All APCs
        
        Fc and C3b Receptors (phagocytosis)
        
        Binds to CD28 on T-Cells
        
        CCR5
        
        Disease
        
        1 more item...
        
        Therapy
        
        Histology
        
        Markers
        
        Monocytes
        
        Monocytes + Macrophage
        
        VLA-4 (Integrin)
        
        CD49 + CD29
        
        Function: Bind to VCAM-1
        
        Monocytes + Macrophage + Neutrophils
        
        LFA-1 (Integrin)
        
        CD11a + CD18
        
        Function: Binds to ICAM-1/ICAM2
        
        Neutrophils + Monocytes
        
        Chemokines that attracts Neutro/Monocytes
        
        LTB4 (from Mast Cells)
- - - - Microcytic
        
        Hemoglobin Affected
        
        Defective Globin Chain (Hemoglobinopathies)
        
        Alpha-Thalassemia (AR) (south east asia)
        
        Pathophys
        
        a-gen deletion(s) Chromosome 16
        
        Decreased alpha-chains leads to...
        
        2 more items...
        
        Decreased RBC Stability leads to...
        
        3 more items...
        
        Labs
        
        Normal
        
        3 more items...
        
        Increased
        
        4 more items...
        
        Decreased
        
        1 more item...
        
        Variants
        
        Minima (-a/aa) asymptomatic
        
        Minor (trait)
        
        2 more items...
        
        Intermedia (--/-a) HbH disease
        
        3 more items...
        
        Major (--/--) Hb Bart's
        
        2 more items...
        
        Beta-Thalassemia
        
        Pathophys
        
        B-gene Point/mutation(s) Splice Site Chromosome 11
        
        Decreased Beta-Chains leading to..
        
        1 more item...
        
        Decreased RBC Stability leading to...
        
        1 more item...
        
        Variants
        
        3 more items...
        
        Associations
        
        1 more item...
        
        Labs
        
        Normal
        
        3 more items...
        
        Increased
        
        5 more items...
        
        Decreased
        
        1 more item...
        
        RX: Blood Transfusions
        
        Iron Overload
        
        Hereditary Persistence of Fetal Hb (HPFH) Chromosome 11
        
        Pathophys
        
        HbF present in Adulthood
        
        Gamma-Chain Expression
        
        Caused by Deletions of Beta and Delta Genes
        
        Normal Phenotype
        
        Defective Heme Synthesis
        
        ACD
        
        Labs
        
        Low
        
        4 more items...
        
        High
        
        1 more item...
        
        Mechenism
        
        Chronic Inflammation leads to Increased IL-6
        
        1 more item...
        
        Late IDA
        
        Decreased
        
        MCV
        
        Fe
        
        Ferritin
        
        Increased
        
        TIBC
        
        Transferrin
        
        Fe Absorption: Duodenum
        
        Lead Poisoning
        
        Siderblastic Anemia
        
        Causes
        
        ALA Synthase Mutation
        
        Alcohol
        
        Lead Poisoning
        
        B6 Deficiency
        
        Copper Deficiency
        
        Drugs
        
        2 more items...
        
        Treatment
        
        B6
        
        Labs
        
        Increased
        
        2 more items...
        
        Decreased
        
        1 more item...
        
        Histology
        
        Ringed Sideroblasts
      - Macrocytic
        
        megaloblastic
        
        Defective DNA Synthesis
        
        Folate Deficiency
        
        B9 is absorbed in Duodenum
        
        Labs
        
        Low: Reticulocytes
        
        Causes
        
        Methotrexate
        
        1 more item...
        
        Dilantin
        
        Oral Contraceptives
        
        B12 Deficiency
        
        Low
        
        Reticulocytes
        
        B12 is absorbed in Terminal Ileum
        
        Pernicious Anemia
        
        Decreased: Reticulocyte
        
        Mechanism
        
        1 more item...
        
        Orotic Aciduria
        
        Defective DNA Repair
        
        Fanconi Anemia
        
        Nonmegaloblastic
        
        Diamond-Blackfan Anemia
        
        Liver Disease
        
        Chronic Alcohol
      - Normocytic
        
        Nonhemolytic (low Reticulocyte index)
        
        Early IDA
        
        Labs
        
        Normal
        
        MCV
        
        Increased
        
        TIBC
        
        Transferrin
        
        Decreased
        
        Fe
        
        Ferritin
        
        ACD
        
        Labs
        
        Decreased
        
        Fe
        
        TIBC
        
        Transferrin
        
        Increased
        
        Ferritin
        
        Aplastic Anemia :fire: (platelts
        
        Cause
        
        Medication
        
        chloramphenicol (treats meningitis)
        
        Hemorrhage
        
        Labs
        
        Increased
        
        Leukocytes
        
        Platelets
        
        Erythopoietin
        
        Normal: Reticulocytes
        
        Hemolytic (high Reticulocyte index)
        
        Intrinsic
        
        Membrane Defects
        
        Hereditary Spherocytosis Extravas :fire:
        
        Mutation AD
        
        3 more items...
        
        Histology
        
        2 more items...
        
        Labs
        
        2 more items...
        
        Complications
        
        3 more items...
        
        *PNH Intravas* :fire:
        
        Pathophys
        
        2 more items...
        
        Presentaion
        
        4 more items...
        
        Enzyme Deficiencies
        
        G6PD Deficiency Intravas :red_flag:
        
        Lab :fire:
        
        3 more items...
        
        Mechanism: Oxidative Stress (Low NADPH) :fire:
        
        Presentation :fire:
        
        2 more items...
        
        Hemoglobinopathies
        
        Sickle Cell Extravas :explode:
        
        Point Mutation Beta-Globin
        
        1 more item...
        
        Hemolysis
        
        3 more items...
        
        Complications
        
        5 more items...
        
        Labs
        
        2 more items...
        
        Treatment :
        
        1 more item...
        
        Histology
        
        1 more item...
        
        X-Ray
        
        1 more item...
        
        Presentation
        
        7 more items...
        
        HbC Disease (AR) Extra vas :red_flag:
        
        Pathophys
        
        2 more items...
        
        Variants
        
        2 more items...
        
        Presentation
        
        4 more items...
        
        Extrinsic
        
        Autoimmune Hemolytic Anemia HSR-II :fire:
        
        Warm AIHA Extra Vas
        
        Labs
        
        3 more items...
        
        Treatment
        
        3 more items...
        
        Causes
        
        2 more items...
        
        Cold AIHA Extra Vas
        
        Labs
        
        3 more items...
        
        Treatment
        
        2 more items...
        
        Causes
        
        3 more items...
        
        Microangiopathic
        
        intravascular hemolysis
        
        Disease
        
        4 more items...
        
        Histology
        
        1 more item...
        
        Macroangiopathic :!?:
        
        Histology
        
        Schistocytes (Helmet)
        
        Infection
        
        Malaria
        
        Babesia
      - Heme Disorders
        
        Heme Synthesis
        
        Hepatic Acute
        
        No Photosensitivity
        
        AIP
        
        Pathophys
        
        2 more items...
        
        Presentation
        
        PLP
        
        Photosensitivity
        
        HCP
        
        Pathophys
        
        2 more items...
        
        Presentation
        
        VP
        
        Pathophys
        
        2 more items...
        
        Presentation
        
        Hematopoietic (Photosensitivity)
        
        CEP
        
        EPP
        
        Hepatic Chronic (Photosensitivity)
        
        PCT
        
        Heme Degradation
    - - Location
        
        Red Marrow
    - - Lineage
        
        Proerythroblast
        
        Nucleus
        
        1-2 Nucleoli
        
        Size
        
        Largest
        
        Cytoplasm
        
        Light Blue
        
        2. Basophilic Erythroblast
        
        Nucleus
        
        Nucleoli Not Visible
        
        Size
        
        Large
        
        Cytoplasm
        
        Basophilic (ribosomes)
        
        Polychromic Erythroblast
        
        Nucleus
        
        Small
        
        Heterochromatin patch
        
        Size
        
        Medium Small
        
        Cytoplasm
        
        Eosinophilic patches
        
        Ribosome Disappear :red_flag:
        
        4. Orthochromic Erythroblast (normoblast)
        
        Nucleus
        
        Pyknotic :red_flag:
        
        Size
        
        Small
        
        Cytoplasm
        
        Light Purple to Pink
        
        Polychromic Erythrocyte (Reticulocyte)
        
        No Nucleus
        
        Size
        
        Small
        
        Cytoplasm
        
        Light purple to pink, ribosomes
    - - HbA1
        
        Majority of Adult Hb
        
        aaBB
      - Hb-A2
        
        Some in Adult Hb
        
        aaDD
        
        Increased in disease
        
        B-Thalassemia
        
        Sickle Cell
      - Hb-F
        
        Majority in Fetus
        
        aaYY
        
        Low 2,3BPG Affinity
        
        High O2 Affinity
        
        RX: Hydroxyurea (sickle Cell) increases HbF
      - B4-Tetramer
        
        BBBB
        
        Disease
        
        Hb-H Disease (a-Thalassemia)
      - Y4-Tetramer
        
        YYYY
        
        Disease
        
        Hb Bart's (a-thalassemia)
      - Hb-S
        
        aaBB
        
        Disease
        
        Point mutation on B-Globin Gene
        
        aaBB
        
        Sickle Cell (E6V)l
        
        (HbC Disease) E-K mutation
      - Hb Gower1 (Z2E2) Embryonic