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Samer Al Hadidi, MD,MS,FACP Profile picture
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Nov 19 • 22 tweets • 30 min read
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣ classic Hodgkin's lymphoma
🩸Reed-Sternberg cell👇
🩸Most common: Nodular sclerosis 👇(fibrosis)
🩸Usually:CD30+, CD15+, weak PAX5 +. CD20-, CD45-
🩸9p24.1 alteration
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
2⃣ Nodular lymphocyte-predominant Hodgkin lymphoma
🩸popcorn cell (from germinal center B-cell)👇
🩸CD20+ (different than cHL),Rituxan used in ttt
🩸can transform(DLBCL)
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
3⃣ Follicular lymphoma
🩸Bone marrow with small lymphocytes👇
🩸CD20+,CD10+,BCL6+,BCL2+,CD5-
🩸t(14;18) in up to 90% of cases
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
4⃣ Splenic marginal zone lymphoma
🩸Spindle cell👇
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
5⃣ Burkitt lymphoma
🩸Starry sky appearance👇(can occur in other high grade B-cell lymphoma)
🩸vacuolated cells with deep basophilic cytoplasm👇
🩸t(8;14)(q24;q32):MYC
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
6⃣ MDS
🩸Dysplastic megakaryocytes (widely separated nuclear lobes)👇
🩸Ring sideroblasts, typically SF3B1 mutation👇
🩸Dysplastic neutrophil (hypolobation,hypogranular)👇
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
7⃣ MM-1
🩸plasma cells in BM👇
🩸Rouleaux&circulating plasma cells👇
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
7⃣ MM-2
🩸Russell bodies(intracytoplasmic)/ Mott/Grape cell👇
🩸Dutcher body(intranuclear)👇: can occur in LPL/Waldenstorm's, MYD88+
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
8⃣ Essential thrombocythemia
🩸mutations: JAK2,CALR,MPL
🩸Smear with thrombocytosis👇
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
8⃣ Primary myelofibrosis
🩸Tear drop cells (dacrocytes) 👇 with a blast in the center
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
9⃣ Eosinophils in the setting of FIPL1-PDFGRA rearrangement
🩸Hypereosinophilia
🩸CHIC2 gene (FISH or PCR)- cytogenetics does not pick it
🩸Responds well to imatinib
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
🔟Systemic mastocytosis
🩸Spindly mast cell clusters👇
🩸KIT D816V mutation is most common
⭐️Elevated tryptase levels
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣1⃣Hairy cell leukemia
🩸hairy cells👇
🩸CD11c+,CD22+,CD25+.CD103+
🩸BRAF V600E mutation
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣2⃣ CLL
🩸small lymphocytes/soccer ball/cobblestone pattern👇
🩸Smudge/basket cells: cells fragile and get smudged when smear is prepared👇
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣3⃣CMML
🩸MDS/MPN overlap syndrome
🩸monocytes (needs absolute monocytosis >1000 monocyte per mL)
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣4⃣Adult T cell leukemia/lymphoma(ATIL)
🩸associated with hypercalcemia and spastic paraparesis
🩸HTLV-1 infection, endemic in the Carribean and Japan
🩸Flower cells 👇
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣5⃣ Sezary syndrome
🩸Mature T-cell Leukemia
🩸Sezary cell 👇 CD3+/CD4+
🩸erythroderma, generalized lymphadenopathy
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣6⃣Acute erythroid leukemia
🩸glycophorin A-positive neoplastic cells in BM (Glycophorins=erythroid)
🩸Proerythroblasts: large cells with immature basophilic cytoplasm👇
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣7⃣ B-ALL
🩸CD10+,CD19+ (B-cell lineage), CD34+ (immature blastic phenotype)
🩸Myeloid associated markers: CD13+,CD33+,MPO-
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣8⃣ Acute megakaryoblastic leukemia
🩸Megakaryoblasts👇Large,cytoplasmic blebbing,pseudopod formation-granular basophilic cytoplasm
🩸CD41+(glycoprotein IIb/IIIa)&CD61+
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣9⃣ Acute promyelocytic leukemia
🩸Auer rods👇
🩸Faggot cell (many auer rods together)👇
🩸t(15;17), PML-RARA
End 🧵
Peripheral blood smear is important both for boards and for real life:

hematology.org/education/trai…

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More from @HadidiSamer

Samer Al Hadidi, MD,MS,FACP Profile picture
Nov 15
#MedTwitter #HemeBoards @HemOncFellows
🧵Summary of erythrocytes inclusion bodies:

1️⃣Howell-Jolly body
➡️composition: DNA
🔬associations: splenectomy, hyposplenism, megaloblastic anemia, hemolytic anemia, sickle cell disease Image
2️⃣Basophilic stippling
➡️composition: RNA
🔬associations: lead intoxication, thalassemia, abnormal heme synthesis Image
3️⃣Pappenheimer bodies
➡️composition: iron
🔬associations: splenectomy, hemolytic anemia, sideroblastic anemia, megaloblastic anemia, hemoglobinopathies Image
Read 6 tweets
Samer Al Hadidi, MD,MS,FACP Profile picture
Jun 26
#mmsm Hematologica published 3 articles for sub-group analysis for Isatuximab recently:
1-IKEMA pts with renal failure-Full article
2- ICARIA-MM elderly pt-letter to editor
3-IKEMA+ICARIA-MM: 1q-letter to editor
🛑All used 1-2 medical writers
Was this all the story ? 🧵
Same medical writers helped in a review of key subgroup analysis of ICARIA-MM 👇

Also in doing another subgroup analysis in high risk cytogenetics
You think we are done: NO

ICARIA-MM subgroup analysis 👇

Expert review article with the help of medical writer 👇
Read 12 tweets
Samer Al Hadidi, MD,MS,FACP Profile picture
Dec 4, 2021
#ASH21 Oral abstract:Ciltacabtagene Autoleucel for Triple-Class Exposed MM:Adjusted Comparisons of CARTITUDE-1 Patient Outcomes Versus Therapies from Real-World Clinical Practice from the LocoMMotion Prospective Study #mmsm 🧵
➡️ash.confex.com/ash/2021/webpr…
🛑some important issues👇
#ASH21 #mmsm
➡️Cilta Cel is effective in difficult to ttt pts, this is not the aim of the discussion
➡️In this abstract,authors compared a prospectively matched triple class ref MM pts who received diff ttt vs Cilta cel
➡️ what did they find? 👇 (Cilta Cel better) but wait🛑 Image
➡️Read results 👇
1️⃣countries:only 9% RWCP in US vs. 100% of pts who got Cilta Cel in CARTITUDE-1 were in US (16 Center) ➡️study compared pts across the ocean with diff access to ttt🙈
2️⃣>90 ttt options😅
3️⃣2 of the most frequently used regimens were doublet 🙈Kd (~14%),Pd (11%) Image
Read 6 tweets
Samer Al Hadidi, MD,MS,FACP Profile picture
Apr 30, 2021
Analyzing this study of defibrotide in VOD after transplant from Spain @amarkelkar @AkshaySharmaMD @hmgcoa2
➡️Link:tandfonline.com/doi/full/10.10… (accepted, not final)
➡️ Price data from Spain with €2019
➡️ FDA approved (March 30, 2016): fda.gov/drugs/resource…
➡️ VOD (~15% ,all types): a bad complication with high mortality (severe type, historically >80%)
➡️ Diagnosis &grading(see tables👇) (nature.com/articles/bmt20…)
➡️Authors question: is defibrotide cost-effective using price input from Spain (note this is likely different from US)
➡️ Simplified definitions:
1⃣ Cost-effectiveness analysis(CEA) is usually measured by incremental cost-effectiveness ratio (ICER) and it establishes how much extra has to be paid for extra benefit.
Read 14 tweets
Samer Al Hadidi, MD,MS,FACP Profile picture
Apr 3, 2021
Summary of cytoplasm/nucleus changes in leukocytes:
1️⃣ Hyposegmentation of neutrophils(peanut shaped, bilobed,or non-segmented nucleus with coarse chromatin)
🔬associations: Pelger–Huët anomaly(inherited) or pseudo-Pelger–Huët anomaly(acquired)

#MedTwitter @ASH_hematology #Heme ImageImageImage
➡️Pelger–Huët anomaly(inherited):affect majority of granulocytes: autosomal dominant- mutations in the lamin B receptor gene
➡️Pseudo-Pelger–Huët anomaly(acquired): <50% of granulocytes: usually occurs with other morphological changes of malignancy: can see in MPNs or MDS
#Heme Image
2️⃣Hypersegmentation of neutrophils
➡️≥ 6 lobes in granulocyte nucleus
🔬associations: megaloblastic anemia, chronic infections, MDS, familial(rare)
#Heme ImageImage
Read 8 tweets

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