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Aaron Goodman - “Papa Heme” Profile picture
@AaronGoodman33
Jan 4, 2022 • 7 tweets • 2 min read • Read on X
Scrolly
Per pathologists, cancer cells (kind of) look like something else

Cleaved = Follicular lymph
Grapes = Mott cell = Myeloma
Horseshoe = Hallmark cell = ALCL
Brain = Cerebriform = Sezary
Kidney = Reniform = Langerhan's
Owl eyes = Reed Sternberg = cHL
Popcorn = NLPHL

Flower = ATLL
Cleaved cell = Follicular lymphoma
Bunch of Grapes = Mott cell = Multiple myeloma
Horseshoe = Hallmark cell = Anaplasmic large cell lymphoma
Cerebriform nuclei = Sezary cells = Sezary syndrome
Owl eyes = Reed Sternberg = Classical Hodgkin lymphoma
Popcorn cell = Reed Sternberg = Nodular lymphocyte predominant Hodgkin lymphoma

• • •

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More from @AaronGoodman33

Aaron Goodman - “Papa Heme” Profile picture
Jun 2
DOAC Jewels - Tweetorial

Effects of DOACs on Tests of Hemostasis

All⬆️PT (dabigatran slightly)
All ⬆️PTT (rivaroxaban/apixaban very slightly)

Mixing studies demonstrate incomplete correction

Dabigatran can falsely ⬆️fibrinogen
Only dabigatran ⬆️TT Image
Anticoagulant Mechanism Name Jewels!

Drugs target Xa = Xa in name
ApiXaban
BetriXaban
EdoXaban
RivaroXaban

Drugs target BOTH Xa+thrombin = PARIN (pair) in name
HeParin
EnoXaParin
DalteParin

Drugs target only IIa = B (2nd letter)
ArgatroBan
Bivalrudin
DaBigatran
DOACs and Renal Impairment

% Renal Excretion:
Dabigatran: 80%
Rivaroxaban: 66%
Edoxaban: 40%
Apixaban: 25%
Betrixaban: 11%

To remember order from worst to best to give for patients with renal impairment: DR. Ed ABe Image
Read 4 tweets
Aaron Goodman - “Papa Heme” Profile picture
Dec 21, 2023
Below is a Tweetorial on all the things Vitamin D supplementation does not do based off high quality evidence (randomized controlled trials!)

Vitamin D does not prevent cancer
nejm.org/doi/full/10.10…
Vitamin D does not prevent bone fractures
nejm.org/doi/full/10.10…
Vitamin D does not increase bone density

ncbi.nlm.nih.gov/pmc/articles/P…
Read 11 tweets
Aaron Goodman - “Papa Heme” Profile picture
May 20, 2023
Tweetorial - How to learn an antibiotic!
Podcast up soon!

I learn following about every abx

Does it cover?
1. MSSA
2. MRSA
3. Enterococcus
4. Pseudomonas
5. Anaerobes
6. Scary gram negatives (ESBL)
7. Unique coverage (ampicillin = listeria)
8. Unique toxicity
MRSA/Enterococcus

Ampicillin = Enterococcus

Ceftaroline = MRSA

Quinupristin/dalfopristin = VRE (faecium)

Vancomycin = MRSA+Enterococcus

MRSA+VRE
Daptomycin (Not lung infections)
Linezolid
Tigecycline
Telavancin

Community MRSA
Clindamycin
TMP-Sulfa (Bactrim)
Doxycycline
Pseudomonas!

Cephalosporins =
Cefepime
Ceftazidime

β-lactam+β-lactamase inhibitor =
Pip-tazo
Ticracillin-Clav
Not Augmentin/Unasyn

Quinolones =
Ciprofloxacin
Levofloxacin
Not moxifloxacin

Carbapenems =
Meropenem
Imipenem
Doripenem
Not ertrapenem

Aminoglycosides

Aztreonam
Read 6 tweets
Aaron Goodman - “Papa Heme” Profile picture
May 13, 2023
Diagnostic testing for monoclonal gammopathies!
A tweetorial for internists to clear some confusion!

Serum protein electrophoresis(SPEP)
Urine protein electrophoresis (UPEP)
Serum immunofixation (SIFE)
Urine immunofixation (UIFE)
Serum free light chains(sFLC) (kappa/lambda) Image
Electrophoresis (SPEP/UPEP) = how much

Charge based separation of protein on gel
Low sensitivity
May miss small monoclonal proteins and light chains
Quantifies M-protein (g/dL)
Does not qualify M-protein (IgG, IgA, IgM, IgD, IgE) Image
Immunofixation = Determines the flavor

Ab’s against the heavy chains and κ and λ light chains
Allows for identification of isotype (IgG, IgA, IgM, IgD, IgE)
Detection of small proteins missed on electrophoresis
More sensitive than SPEP
Unlike SPEP/UPEP, not quantitative Image
Read 5 tweets
Aaron Goodman - “Papa Heme” Profile picture
Apr 23, 2023
USMLE Step 1/2 Review for Med Students!

Brief Tweetorial
5 Leukemias
5 Blood smears
Be able to differentiate them

1. AML
2. ALL
3. CML
4. CLL
5. Adult T-cell leukemia/lymphoma
AML

Typically older patient, although can occur in younger patients.
Abrupt symptoms
Needs urgent Rx
Myeloblasts have Auer rods, but not always
However, if Auer rod seen it has to be AML
APL subtype t(15;17) commonly has Auer rods! Image
ALL

Question will typical have child 1-9, although can occur in older patients.
Mediastinal mass possible usually T-cell (unlike AML)
Abrupt symptoms
Needs urgent Rx
ALL blasts look like AML blats
Would be tricky ? to identify based only on smear
Absolutely no Auer rods Image
Read 6 tweets
Aaron Goodman - “Papa Heme” Profile picture
Mar 27, 2023
Recite this from your head. It's a good party trick.
(Tweetorial 1/10)

t(8;14) = MYC-IgH = BL
t(2;8) = IgK-MYC = BL
t(8;22) = MYC-IgL = BL
t(14;18) = IgH-BCL2 = FL
t(2;18) = IgK-BCL2 = FL
t(18;22) = BLC2-IgL = FL
t(11;14) = CCND1-IgH = MCL
t(11;18) = API2-MALT1 = MZL H. pylori-
t(2;5) = NPM1-ALK = ALCL ALK+
t(6;7) = DUSP22-FRAH7H = ALCL ALK-
iso7q = HSTCL
inv(14) = t(14;14) = MTCP1 = T-PLL
t(X;14) = TCL1 = T-PLL
del(11q) = ATM = CLL (intermediate)
del(13q) = RB1 = CLL (good)
+12 = CLL (good)
9p24.1 amp = PDL1/PDL2/JAK2 = Hodgkin
t(11;14) = CCND1-IgH = Myeloma (standard risk), AL amyloid, plasma cell leukemia
Trisomies 3,5,7,9,11,15,19,21 (odd chromosomes) = Myeloma (standard risk)
t(6;14) = CCND3-IgH = Myeloma (standard risk)
Read 10 tweets

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