Most recents (16)

1-year-old girl with severe pallor and irritability. Points to remember in children who present with very low haemoglobin.
1/7. Child will be in CCF. It may be difficult to document. Do not start IV fluids unless absolutely needed. If starting, give 1/2- 2/3 maintenance.
2/7. Many children present with cardiogenic shock. Clinically - severe pallor, absent pulses, respiratory distress. Start inotropes early. They do not tolerate fluid boluses as in other shocks.
3/7. There is no "blood-bolus". Always transfusion is given in small aliquots of 5-10 ml/kg slowly over 4-6 hours with ample frusemide. Monitor HR and RR closely. Start O2 for all shocks.
Anticoagulants and antiplatelets during GI bleed🩸with the 👸 of #CardioGI herself, @NeenaSAbrahamMD!

Regardless of cardiovascular indication for AC/AP, GIB risk ⬆️ with AGE
⚠️Disparities in AC/AP prescribing: black, Hispanic, and women are ⬇️ likely to be appropriately prescribed
MGUS/multiple myeloma @InternAtWork #BJHM #MGUS #Myeloma #MedEd
@InternAtWork @WCHospital Another infographic on CRAB criteria #IMPearls
I love deep dives and I mean it!

My latest focus --> Hodgkin's lymphoma.

This is the original series of 7 cases published by Thomas Hodgkin.

#hematology
#Hodgkinlymphoma
1/5 How can you calculate the estimated DAILY risk of ischemic stroke (and other events) in patients with atrial fibrillation?

Note: the original post was deleted due to a mathematical error
2/5 While the CHADSVASc is helpful for annual estimation of ischemic stroke risk (and other events), what is the risk of DAILY risk? Turns out we can do some math to derive it from the annual risk estimation!
3/5 The math here doesn't EXACTLY reflect the daily risk of for patients because there are countless variables that we cannot control. @JessieCurrier17 describes the rationale using probability quite nicely.
1/12 The jump from classroom teaching to clinical rotations is made tougher by the fact that physicians have illness-specific frameworks for presentations and documentation. Let's explore a bunch of them (feedback is most welcome)!

2/12 Let's start with anemia. It is ideal if you report the baseline Hgb and an interpretation of the MCV. #HemeTwitter
3/12 For VTEs, it is helpful to tell the listener/reader if you think it is provoked vs. unprovoked. A hypercoagulable work-up should not be sent routinely.
Okay one more thread before bed! Lots of Qs asking "what IS VITT?" Before I get to that, if you'd like an AWESOME metaphor about vaccine choice, please read my buddy @DrKateJMiller's, then read on for some FACTS about VITT clots caused by AZ and J&J...
@COVIDSciOntario has published an evidence based brief on VITT (which includes a lay summary). All science, no spin. (Seriously, no spin.) @heysciencesam has helped us break the VITT facts down into tasty evidence bites. covid19-sciencetable.ca/sciencebrief/v…
These are the facts. 4-28 day window for symptoms to start (typical immune reaction... just like autoimmune HIT for the #hemetwitter nerds). Those incidence figures are referenced in the brief. covid19-sciencetable.ca/sciencebrief/v…
CELLS in Hemat 💪🏻

Sickle cell=Drepanocyte➡️SCD
Tear drop=Dacrocyte➡️MF
Spur cell=Acanthocyte➡️Liver ds
Burr cell=Echinocyte➡️Uremia/PK def
Target cell=Codocyte➡️Hb'pathies
Bite cell=eccentrocyte➡️G6PD def
Pencil cell=ovalocyte➡️IDA
Pincered cell➡️Band 3 def
Prickle cell➡️PK def
Sickle cells, not hard to identify.
Can't miss these isn't it ?
Some current Hematologic diagnostic & management dilemmas of Adenovirus #JNJ & #AstraZeneca #VITT:
1⃣VITT seems to behave like autoimmune (Type 2) HIT rather than non-immune (Type 1) HIT (more common).
(Greinacher et al, @JTHjournal, 2017)
1/
2⃣High enough doses of heparin or LWMH can outcompete these PF4-polyanion complexes for binding sites & reduce platelet aggregation (similar to HIT).
➡️BUT, we can't yet tell where/if there's a consistent dose breakeven point at which aggregation⬇️
(Schultz et al, @NEJM, 2021)
2/
➡️While many cases reported using LMWH (mostly low-dose Dalteparin), lab results were inconsistent on whether this sufficiently reduced/prevented platelet aggregation.

(Greinacher et al, @NEJM, 2021)
3/
#JNJ Vaccine Cerebral Venous Sinus Thrombosis Surveillance🧵after @CDCgov #ACIP (for now ...):
1⃣Watch for symptoms like headache, aphasia, paresis, papilledema, seizure, mental status changes
2⃣High-risk groups *seem* to be young women (~20-50), 6-20 days after #JNJ vaccine

1/
3⃣True #CVST event rate is TBD (as is the true background rate)
4⃣PF4 IgG ELISA in all patients for screening (#publichealth reporting) & management (avoiding heparin if positive)
5⃣Consider IV steroids & IVIg for thrombocytopenia
2/
6⃣Report any suspicious events to #VAERS vaers.hhs.gov/reportevent.ht…
7⃣Remember that these are RARE events and the proposed cause of #VITT remains theoretical. This pause is proof that the safety/surveillance system works!

3/
The @CDCgov Advisory Committee on Immunization Practices (ACIP) emergency meeting on the #JNJ vaccine is ongoing. Currently, they're reviewing known data on 8 cases of thrombotic thrombocytopenia. Follow this thread for updates. 1/ #COVID19 #MedTwitter ustream.tv/channel/VWBXKB…
This was the initial @US_FDA announcement yesterday describing the #COVID19Vaccine #JNJ hold. In summary, 6 post-market cases of cerebral venous thrombosis reported as of yesterday (in ~6.8 million doses delivered) prior to the hold.
The awesome @acweyand excellently summarized the data known as of yesteday from the similar #AstraZenaca adenovirus vector vaccines and background on #CVST! #hemetwitter 3/
Long 🧵 on vaccines and blood clots (from somebody who spends an inordinate amount of time thinking about, preventing & treating blood clots). #COVID19 #COVID19vaccine #hemetwitter #thrombosis 1/n
Yesterday @GovCanHealth, @MHRAgovuk, @EMA_News and my profession's organization @ThrombosisCan made clear statements that risks posed by AZ vaccine are far outweighed by its benefits. Does that square with media reports? Should we really get the first shot available to us? 2/n
I love my job as a blood and blood clot specialist. (LOVE IT!) So much of it focuses on talking to people about risks & how to stay safe DESPITE those risks. A lot of common medical procedures, drugs & life experiences [aging, pregnancy] increase your blood clot risk. BUT... 3/n
1/ Paraproteinemic kidney disease: Cast nephropathy, myeloma kidney, MGUS, MGRS, LCCN, AL, AH, MIDD, LCPT…)

Lost in the alphabet soup!!!

Time for an #MGRS #tweetorial
2/ Let’s start with a poll: which of the following disease states can cause MGRS (monoclonal gammopathy of renal significance):
3/ Before we get to the answer, let’s dissect the term MGRS:

Monoclonal Gammopathy:
⚡️Signifies the presence of a "monoclonal" immunoglobulin or its components
⚡️Seen as a spike in the "gamma" region on protein electrophoresis

Let's talk about cytopenias in cirrhosis. Many patients with cirrhosis will have at least one cytopenia (sometimes pancytopenia) attributable to their liver disease, let's talk about some of the mechanisms! #medtwitter #hemetwitter
First up, thrombocytopenia! The potential mechanisms are laid out in the image below (aasldpubs.onlinelibrary.wiley.com/doi/full/10.10…):
- decreased thrombopoietin production
- sequestration
- alcohol/viral causes suppressing marrow
- peripheral destruction
Next up, anemia! The ddx should include the causes we think of in all anemia patients (nutritional, GI losses, hemolysis etc...) but what are some liver-specific etiologies? Spur-cell anemia (ashpublications.org/blood/article/…) typically only reverses w/ transplant

Many specialty-society/focused registries launched in last few weeks, attempt to collect them here

List 👇🏽

1/n
2/n: @SCCM's VIRUS: Viral Infection and Respiratory Illness Universal Study @covid19registry

Inclusion criteria 👇🏽

sccm.org/Research/Resea…

#Pulmonology #Pulm #CriticalCare #PCCM
3/n: International #COVID19 Dermatology Registry led by @DrEstherFreeman @AADskin

Looking for:
1. #COVID19 pts who develop #skin findings
2. #dermatology pts who develop #COVID19