Discover and read the best of Twitter Threads about #hlh
Most recents (5)
Fantastic heme grand rounds on HLH at @DanaFarber @BrighamHeme today from @ZorefAdi @CCHMCPostdoc - a π§΅
Starting with a timeline, the pathogenesis and defining the clinical syndrome of HLH
#HLH #lymsm (1/8)
Starting with a timeline, the pathogenesis and defining the clinical syndrome of HLH
#HLH #lymsm (1/8)
How to diagnose HLH? Soluble CD25 and ferritin are the most specific inflammatory markers (best ROC), so @ZorefAdi et al combined them into an 'optimised HLH inflammatory' (OHI) index, with an improved specificity for HLH
ashpublications.org/blood/article/β¦ @BloodJournal (2/8)
ashpublications.org/blood/article/β¦ @BloodJournal (2/8)
Once you have made the diagnosis of HLH, the next step is to find the underlying cause.
Great flowchart from Paul La RosΓ©e et al in @BloodJournal: ashpublications.org/blood/article/β¦
A tip: 'lymphadenopathy is not a symptom of HLH so should raise suspicion for underlying lymphoma' (3/8)
Great flowchart from Paul La RosΓ©e et al in @BloodJournal: ashpublications.org/blood/article/β¦
A tip: 'lymphadenopathy is not a symptom of HLH so should raise suspicion for underlying lymphoma' (3/8)
Impressing πΎπ€π£π¨πͺπ‘π©ππ£π© π€π£ ππ€πͺπ£π β
Residents use the fancy diagnosis and terms like
πππ - Hemophagocytic lymphohistiocytosis
A 𧡠on what is πππ and how to diagnose it
#MedTwitter
#HLH
#MedEd
#usmle
Residents use the fancy diagnosis and terms like
πππ - Hemophagocytic lymphohistiocytosis
A 𧡠on what is πππ and how to diagnose it
#MedTwitter
#HLH
#MedEd
#usmle
πHyperinflammatory syndrome caused by β¬οΈcytokine release
π Either due to genetic or acquired overactivation of CD8 T cells and natural killer (NK) cells
β΄οΈ Hemophagocytosis is neither sensitive nor specific for HLH
π ²π »π °πππ Έπ ΅π Έπ ²π °ππ Έπ Ύπ ½ π
π Either due to genetic or acquired overactivation of CD8 T cells and natural killer (NK) cells
β΄οΈ Hemophagocytosis is neither sensitive nor specific for HLH
π ²π »π °πππ Έπ ΅π Έπ ²π °ππ Έπ Ύπ ½ π
Lets discuss one of the ππππ πππππππππ that came to AIIMS:
24,π, without any Co-morbidties
C/O Fever, Malaise, Sore throat, Headache
ππ§ ππ±ππ¦π’π§πππ’π¨π§ :
πΈHR ~125/min πΊ
πΈSevere Pallor
πΈCervical Lymphadenopathy
πΈPetechial Rash
Investigationπ
24,π, without any Co-morbidties
C/O Fever, Malaise, Sore throat, Headache
ππ§ ππ±ππ¦π’π§πππ’π¨π§ :
πΈHR ~125/min πΊ
πΈSevere Pallor
πΈCervical Lymphadenopathy
πΈPetechial Rash
Investigationπ
1/𧡠You are a BAD #GOLFER & have a big day with buddies & are in the tall grass a LOT. Later, you take off a #tickπand in 7 days develop a fever & headache. You have no rash. The emergency room gives you acetaminophen. Is that OK?
Β
#medtwitter #Nurse
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#medtwitter #Nurse
2/ Tick bites are a big deal in Summer months. Rocky Mountain Spotted Fever is a concern, and the absence of rash also brings up #Ehrlichiosis. This @NEJM paper showed that worse golfers retrieved balls from the rough & got the dz more often!
Β
bit.ly/3e6vQrF
Β
bit.ly/3e6vQrF
3/ Of those with #Ehrlichiosis, 20% get bad nervous system dz & 20% of those die. If you live in Southern US and find a Lone Star tick (pic above), and then develop fever & headache, get evaluated and probably start the antibiotic doxycycline quickly!
Β
bit.ly/3e5ndxF
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bit.ly/3e5ndxF
Proposed COVID-19 Pathophysiology [Part 2 of 3]:
Enter the magnificent macrophage.
What do #COVID-19 and hemophagocytic lymphohistiocytosis (#HLH) potentially have in common?
...letβs continue our journey onward into the cytokine storm.
Enter the magnificent macrophage.
What do #COVID-19 and hemophagocytic lymphohistiocytosis (#HLH) potentially have in common?
...letβs continue our journey onward into the cytokine storm.
First, letβs briefly summarize what we covered before:
What mechanism may be partly responsible for heterogeneity of COVID-19 disease phenotype as well as its severity?
What mechanism may be partly responsible for heterogeneity of COVID-19 disease phenotype as well as its severity?
Correct! Antibody-dependent enhancement (ADE) is the result of producing sub-neutralizing antibodies which paradoxically enhance the rate of viral replication and severity of viremia.
Starting a series on clinical Pearls I am gathering in #COVID19 patients based on experiences of many experts
Will add as we go along
Feel free to add your own observations/experiences
#covidclinicalpearls /1
Will add as we go along
Feel free to add your own observations/experiences
#covidclinicalpearls /1
Anosmia is likely the most specific #COVID19 related symptom
30% of patients have anosmia as their 1st symptom
#covidclinicalpearls /2
30% of patients have anosmia as their 1st symptom
#covidclinicalpearls /2
Around 90% of patients have fever.
50% maybe afebrile at the time of presentation
Fever tends to be very resistant to routine measures in hospitalized patients
There is no consensus that NSAIDs are to be avoided in #COVID2019 patients
#covidclinicalpearls /3
50% maybe afebrile at the time of presentation
Fever tends to be very resistant to routine measures in hospitalized patients
There is no consensus that NSAIDs are to be avoided in #COVID2019 patients
#covidclinicalpearls /3
