Comprehensive Heme Metabolism,
Hemoglobin Oxygen Affinity, Porphyrias,
Enzymatic Defects, Quaternary Structures,
R/T State Dynamics, Genetic and Acquired
Disorders, Lead Toxicity, Photosensitivity
Syndromes, Oxygen Dissociation Curve
Shifts, Iron Handling, p50 Modulation,
Clinical Correlations Exam Questions
Provided with Complete Verified A+ Graded
Rationales Latest Updated 2026
heme is a _______ structure
quaternary structure
heme [iorn containing porphyrin] + globin
R state of hemoglobin
Low or high affinity?
Oxygenated or Deoxygenated?
"relaxed state"
- high affinity for O2
T state of hemoglobin
Low or high affinity?
Oxygenated or Deoxygenated?
"taut state"
- low affinity for O2
more R state with a ________ p50
DECREASED p50 (aka a LEFT shift)
- the lower the p50 the more R state available
(higher affinity for oxygen)
1|Page
, Which way does carbon monoxide shift the curve?
to the LEFT (increased affinity)
- holds on REALLY tight to O2 which is why you end up suffocating because hemoglobin will not
let go of the O2
**more R-state
-Decreased Carrying Capacity & Decreased p50
more T state with a ________ p50
INCREASED p50 (aka a RIGHT shift)
- the higher the p50 the more T state
(lower affinity for oxygen)
there is more R state with a ________ shift
there is more T state with a _________ shift
LEFT shift (more affinity for oxygen)
RIGHT shift (less affinity for oxygen)
Which form, R state or T state... increases or decreases:
1. Temperature
2. Acidity ( dec. pH)
3. pCO2
4. 2,3 BPG
5. Exercise
"CADETS, march right"
R state... Decreases
T state...Increases
which way does sickle cell anemia shift the curve?
to the RIGHT (decreased affinity)
- once the Hb lets go of the O2 the cell sickles and cannot take up more O2
2|Page
Hemoglobin Oxygen Affinity, Porphyrias,
Enzymatic Defects, Quaternary Structures,
R/T State Dynamics, Genetic and Acquired
Disorders, Lead Toxicity, Photosensitivity
Syndromes, Oxygen Dissociation Curve
Shifts, Iron Handling, p50 Modulation,
Clinical Correlations Exam Questions
Provided with Complete Verified A+ Graded
Rationales Latest Updated 2026
heme is a _______ structure
quaternary structure
heme [iorn containing porphyrin] + globin
R state of hemoglobin
Low or high affinity?
Oxygenated or Deoxygenated?
"relaxed state"
- high affinity for O2
T state of hemoglobin
Low or high affinity?
Oxygenated or Deoxygenated?
"taut state"
- low affinity for O2
more R state with a ________ p50
DECREASED p50 (aka a LEFT shift)
- the lower the p50 the more R state available
(higher affinity for oxygen)
1|Page
, Which way does carbon monoxide shift the curve?
to the LEFT (increased affinity)
- holds on REALLY tight to O2 which is why you end up suffocating because hemoglobin will not
let go of the O2
**more R-state
-Decreased Carrying Capacity & Decreased p50
more T state with a ________ p50
INCREASED p50 (aka a RIGHT shift)
- the higher the p50 the more T state
(lower affinity for oxygen)
there is more R state with a ________ shift
there is more T state with a _________ shift
LEFT shift (more affinity for oxygen)
RIGHT shift (less affinity for oxygen)
Which form, R state or T state... increases or decreases:
1. Temperature
2. Acidity ( dec. pH)
3. pCO2
4. 2,3 BPG
5. Exercise
"CADETS, march right"
R state... Decreases
T state...Increases
which way does sickle cell anemia shift the curve?
to the RIGHT (decreased affinity)
- once the Hb lets go of the O2 the cell sickles and cannot take up more O2
2|Page
