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A 32-year-old man with HbS/βThalassemia presented to the ED with weakness in his left arm and slurred speech. His HbS is 71%. Take a look at his peripheral smear below, notice the drepanocytes, or sickle-shaped cells.
Since you are the #BloodBank resident on-call, Heme/Onc requests urgent erythrocytaphereisis, otherwise known as #RedCellExchange. 🗣️You reply?
⚠️Yes! You immediately confirm that the line is placed. According to the ASFA Guidelines, RBC exchange is a Category I Recommendation, first-line therapy, for the acute treatment of a stroke and should be started within 6 hours of admission.
⁉️In RBC exchanges for #SCD, what 🔢calculation is used to determine the red cell replacement volume?
🧮In order to know the RBC replacement volume, you will need to calculate the Fraction of Cells Remaining (FCR). It is the fraction of the HbScells remaining from the portion of blood removed & is dependent on the Hct.
🥅 The goal of RBC exchange is to reduce the HbS below 30%.
One of my favorite #Blooducation Apps is #RBCXCalculator by @terumobct
🛠️Another important tool in your #Blooducation kit!
Now that you have figured out your red blood cell replacement volume, it's time to order your units. There are special RBC indications for #SCD patients. Which of of the following is 𝙉𝙊𝙏 indicated in this clinical situation?
🙌🏽You got it! The RBC replacement must be ABO, Rh compatible and also be HbS negative, leukoreduced and antigen matched (typically C, E and K negative). The units do not have to be irradiated. Irradiation is used to prevent TA-GVHD in select patient populations.
📖To learn more about the role of red blood cell exchange transfusion in the treatment and prevention of complication of sickle cell disease read this great article
👉🏽onlinelibrary.wiley.com/doi/full/10.10…
🧐Any additional pearls from you experience, please add to the conversation below.
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Daniela Hermelin, MD
@HermelinMD
24 y/o w/ h/o of Crohn’s Disease presents w/ worsening fatigue, weakness & dizziness. He has mild abdominal pain, but no signs of bleeding. No transfusion history. Infliximab was discontinued for autoimmune hepatitis. Hb/Hct = 4.4/13.5. 👇🏽Check out his peripheral smear below.
🤨Since you are the Heme/Onc Fellow on-call, you are 📟paged to consult on this patient’s anemia. What are the first labs you would order to assess #hemolysis?
#Blooducation #BBRounds #PathTweetorial
🔎When suspecting a hemolytic anemia, 4 hemolytic indexes can help you quickly determine the etiology of the patient's bleeding.
📰🧪Our patient’s lab results: LDH= 408, Hapto<8, IndBili =3.8 %Retic >30% which indicate a hemolytic anemia with adequate bone marrow response.
Read 10 tweets
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Daniela Hermelin, MD
@HermelinDaniela
1/10
These are the lungs of a patient who died while receiving a PLT transfusion. He developed sudden respiratory distress and did not respond to O2 support. Lungs compressed by 3000 mL of transudative pleural fluid. Notice the increased neutrophils #PathTweetorial
2/10
The above clinical scenario along with the histologic findings is consistent with which type of transfusion reaction?
#Blooducation #TransfusionReaction
3/10
Yes, the histologic findings and clinical history is consistent with Transfusion-Related Acute Lung Injury (TRALI). Second to TACO, it is the most common cause of transfusion-related morbidities and fatalities. What causes it?
#Blooducation
Read 11 tweets
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Daniela Hermelin, MD
@HermelinDaniela
62 y/o man, O positive with de novo AML undergoes workup for Hematopoietic Stem Cell Transplant (HSCT). 😃Good news: Sibling with 8/8 HLA match! 👎🏽Bad news: Sibling is A positive. Can this sibling be a donor?
#Blooducation #PathTweetorial #HSCT
Unlike solid organ transplants, ABO-mismatch HSCT is not a barrier. In fact, 25-50% of all HSCT are ABO-incompatible. The most important factor in transplant survival outcomes is HLA compatibility (Chrom. 6p)
✅Critical to engraftment
✅ Balances potential harm of GVHD vs GVL
ABO carbohydrate glycosyltransferases are genes located on chromosome 9 and inherited completed independent of HLA. ABO Ags are not only on RBC membranes, but are also expressed on PLTs, vascular and organ endothelium as well as present in the plasma.
#Blooducation
Read 12 tweets

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("Ex parte" is Latin for "from." An ex parte communication is one coming from only one party, not providing any notice to the other party. Basically the opposite of a letter copied to opposing counsel, filed publicly, and served via the electronic filing system.)
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Ed Razek should stop doing interviews because this whole thing only makes VS seem even more out of touch.

vogue.com/article/victor…
Some comments:

1) It looks like Vogue inserted the word “two” in reference to VS models having natural hair. Alek Wek walked the VS runway w/ braids in 2001 + Ajuma Nasenyana walked with her natural hair in 2006. Maria Borges was hailed as the “first,” but that’s incorrect.
Several of the models in 1999 and 2000 *were* bigger than the models they use today. One thing that doesn’t get a lot of coverage is how Heidi Klum and Tyra Banks were both larger than the average runway model when they worked with VS.
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