Share this page!

Enter URL or ID to Unroll

You can paste full URL like: https://x.com/threadreaderapp/status/1644127596119195649
or just the ID like: 1644127596119195649

How to get URL link on X (Twitter) App

  1. On the Twitter thread, click on or icon on the bottom
  2. Click again on or Share Via icon
  3. Click on Copy Link to Tweet
  4. Paste it above and click "Unroll Thread"!
  5. More info at Twitter Help
Matthew Ho Profile picture
@MatthewHoMD
Feb 25, 2022 • 9 tweets • 3 min read • Read on X
Scrolly
Summary tweet on my approach to anemias. credit to @n_gangat, @RichGodby, @zhuoerxie, Dr Ron Go, @VincentRK for teaching. Comments/critiques welcome!

1. Approach to anemia
2. Approach to iron deficiency anemia
3. Iron deficiency in chronic inflammatory states (ashpublications.org/hematology/art…)
4. Tests for hemolytic anemia
5. Differentials for autoimmune hemolytic anemia
6. Approach to hemolytic anemias
7. Thrombotic Microangiopathies differential
8. Approach to TMA
•PMID: 27497856
•PMID: 29042465
•PMID: 33953366
•PMID: 30504354
Another pearl. TTP suspected
- No PLEX? --> use FFP (contains ADAMTS13)
- FFP allergy? --> use FVIII concentrate (contains ADAMTS13)

• • •

Missing some Tweet in this thread? You can try to force a refresh
　

Keep Current with Matthew Ho

Matthew Ho Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @MatthewHoMD

Matthew Ho Profile picture
May 30, 2022
Some notes on Hepatic encephalopathy taught to me by @DelviseF and @KhushbooSGala

#1: HE is a sedated state. If hyperactive, suspect acute withdrawal (impt because Ativan worsens HE but should be used to prevent life-threatening withdrawals); PMID: PMID: 35598629
#2: West Haven Criteria
0: no encephalopathy
1: short attention span, euphoria/depression, sleep-wake disturbance ± asterixis (Ddx: OSA)
2: lethargy/apathy, disorientation, asterixis
3: somnolent but responsive to verbal commands, severe disorientation, no asterixis
4: coma
#3: Diagnosis is clinical; serum ammonia limited role ammonia in cirrhosis-associated HE (may have a role in acute liver failure); brain imaging (e.g., CT, MRI) if diagnosis uncertain or other causes for AMS suspected
Read 6 tweets
Matthew Ho Profile picture
May 22, 2022
UGIB. Hold low dose ASA or not?
1. Primary prev: stop indefinitely
2. Secondary: AGA guidelines rec continuing (conditional, very low certainty). When to restart: AGA rec on day hemostasis endoscopically confirmed (conditional, very low certainty)

🧵 : 1/3
Evidence for continuing (RCT small sample size)
- non significant increased risk of rebleeding in aspirin group
- significantly lower all cause mortality (and mortality 2/2 cardiovasc, cerebrovasc, GI complications) in aspirin group
Meta-analysis looking at timing of resuming ASA post hemostasis (very low certainty) but most thrombotic events ccur about 8d after aspirin stopped, and rebleeding occur within first 5 days in those who resume.

My takeaway, restart ASAP but definitely within 7 days!
Read 4 tweets
Matthew Ho Profile picture
May 17, 2022
Approach to conjugated hyperbilirubinemia taught to us by @dunleavy_katie.
1. Definition: T.bili elevation + >20% conjugated
2. Obtain RUQ US to look for ductal dilation
3. No dilation = intrahepatic cholestasis
- rule out non-ICU vs ICU causes
4. MRCP, ERCP, liver biopsy
Bilirubin thresholds:
- indirect bilirubin usually < 5-6 in massive hemolysis (if > 5-6, something else is going on)
- acute complete CBD obstruction: max bilirubin elevation usually around 15 (with time, hepatocyte dysfunction may cause higher elevations)
AST > ALT seen in
1. Alcohol (> 1.5:1): ALT usually only mildly elevated, AST usually < 300
2. Muscle damage
3. Wilson disease (> 2:1): usually < 2000. ALP:T.bili ratio < 4
Read 4 tweets
Matthew Ho Profile picture
Feb 26, 2022
Summary of oxygen delivery devices taught to me by Mayo RT

Source of oxygen
- Wall taps by bedside: 0–15L/min
- Home concentrator: 0–10L/min

Oxygen delivered at 100%, put through different devices at different rates to adjust the oxygen concentration that the patient inspires
TLDR
- Low oxygen (<35%): nasal prongs
- Moderate oxygen (35-60%): venturi (high flow but mix with room air)
- High oxygen (>60%): non rebreather or HFNC
- PEEP needed (e.g., ADCHF, OSA): CPAP
- Hypercapnic: BiPAP
- Failure, unable to protect airway: mechanical ventilation
0. Inogen (pulse-dose oxygen therapy); not used in hospital
- Delivers only during inspiration; not expiration
- Up to 4L but intermittent; much less oxygen as unlike continuous oxygen therapy which fills the oral cavity, naso/oropharyngeal with reservoir of oxygen, this does not
Read 12 tweets
Matthew Ho Profile picture
Feb 25, 2022
Differentials for hypoxemia based on Aa gradient Image
ABG vs VBG:
- pH: VBG
- pCO2: VBG (not accurate in shock or hypercapnia); ABG for severe shock or if precise pCO2 needed in hypercapnia
- PO2: ABG (but SpO2 generally good enough)
- CO or methemoglobin: co-ox
Rough correlation between PaO2 and SpO2. Image
Read 6 tweets
Matthew Ho Profile picture
Feb 25, 2022
Quantifying proteinuria has confused me for the longest time so I wanted to revisit some definitions. A thread.
1. Proteinuria =/= albuminuria
- Glomerular prot: mostly albumin
- Tubular prot: LMW proteins (e.g., B2M)
- Overflow prot: light chains, myoglobin, hb
- Postrenal prot: inflammation, bleed, malignancy
2. What is proteinuria?
- Normal protein excretion: < 150 mg/24h or spot PCR < 50 mg/g; < 300 mg/24h (pregnancy)
- Moderate prot: 150-500
- Severe prot: 500-3500
- Nephrotic-range: > 3500 mg/24h
- Proteinuria without albuminuria suggests nonglomerular causes
Read 6 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

Send Email!

:(