Residents!!!

Quick Interpretation of a CBC in 30 Seconds

1️⃣ Hemoglobin (Hb)

Low Hb = Anemia → First question: Is it microcytic, normocytic, or macrocytic?

Microcytic (MCV < 80)
→ Iron deficiency, Thalassemia, Chronic disease

Normocytic (MCV 80–100)
→ Acute bleed, Hemolysis, CKD, early anemia of chronic disease

Macrocytic (MCV > 100)
→ B12/folate deficiency, MDS, liver disease, drugs (MTX, hydroxyurea)

#medtwitter
#MedEd 2️⃣ WBC Count Pattern

Neutrophilia

Infection (bacterial), steroids, stress, smoking
Lymphocytosis

Viral infections, CLL
Eosinophilia

Allergies, parasites, Hodgkin lymphoma
Leukopenia

Viral infections, autoimmune, drugs (chemo), marrow failure

PT/INR/PTT abnormalities MADE EASY.

What means what?

#MedTwitter So what is measured by PT and whats measured by PTT. PT/INR measures factor 7 activity. If any problem with factor 7 , only PT will be deranged, PTT will remain fairly normal.

Hesitate when you hear methemoglobinemia??

I promise, I ll make it a piece of cake for you.

Here you go. Learn and live , students and residents.

Easy peasy😇

#MedTwitter First thing first, start from the basic concepts.

How to treat hypercalcemia in adults. The options and there mechanism of action.

Here you go easy peasy. Students, Interns and residents. Here you go😁

#MedTwitter 1) Isotonic saline hydration >
Restores intravascular volume> Increases urinary calcium excretion>works during infusion only.

You give a severly malnourished patient a good nutrition, patient started to look good, you discharged the patient and two days later landed in ER in critical condition. Phosphate 0.2 ??? Severe hypophosphatemia.

Refeeding syndrome. What is it??

#MedTwitter Lets make it short and simple. When a malnourished patient who is deprived of phosphate starts to get replacement and is fed carbohydrates, insulin is released causing intracellular shift of phosphates. In addition the formation of variety of molecules like ADP, ATP utilises phosphate in significant amount causing further depletion.

Physicians , residents this is very important!!!!!!

You need to know the difference between anticoagulants and anti platelets. A lot of physicians consider them all as anticoagulants.

Lets take a simple example? Aspirin and Enoxaparin.

#MedTwitter Why in the coronary artery disease you give anti platelets and not anticoagulants? And why in a DVT you give anticoagulants and no aspirin?

Hematology residents, a lot of times we get confused as to what is light chain, heavy chain and free light chain with regards to myeloma? What is IgA, IgG,etc and likewise whats kappa and lambda exactly.

If you have the same question, you are in the right place.

Image source: Health Tree. So the IgA, G you consider in myeloma is the heavy chain of the antibody. The kappa and lambda are the light chain component of the antibody.

Lets learn the Iron Deficiency Anemia , the easy peasy way. Lets make it 2+2=4.

Medicine residents !!!!

#MedTwitter So I ll take you step by step.

First see patient is anemic, based on hemoglobin. What you look next is two other parameters from cbc. MCV and RBC. MCV should be low and also RBC should be low. If MCV is low and RBC is high or not low, then another differential comes in, which is hemoglobinopathy, usually thal minor.

So medicine residents!!!!

How to manage DOACS like Rivaroxiban, apaxiban peri operatively?

When to stop, when to restart.

Here is a brief easy method.

#MedTwitter First thing to decide is it high bleeding risk or low bleeding risk procedure. If high risk, skip 2 days dose before surgery , the day of surgery and the day after surgery. So a total of 4 days. And then resume.

Medicine residents!!!!
What is PCC ( prothrombin complex concentrate) ?

And whats its used for?

Lets learn guys in the easy way.

#MedTwitter There are 3 types of PCC. Unactivated (4 factor and 3 factor ) and activated 4 factor PCC (FIEBA).

Medicine residents!!!! Patient came with platelet counts of 30,000, with no history of bleed. You ordered a peripheral film morphology review? Here what you see. What is this?

Image: The blood project

#medtwitter Basically a lot of times due to the EDTA anticoagulant in the blood tube, phenomenon of platelet clumping is seen. This happens due to naturally occurring autoantibody against an epitope on GPIIbIIIa thats exposed by the EDTA. This causes, in vitro ( only in the tube and not in your body) clumping of platelets.

Medical student and residents, please dont ignore this.

Metformin, one of the commonest medicines used for the management of diabetes mellitis and for a a few other reasons, results in vitamin B12 deficiency 😲

#MedTwitter Vitamin B12 deficiency causes increased homocystein levels. Although different studies have reported different corelations. Anyways increase in homocystein levels can cause increased risk of cardiovascular diseases, cognitive disorders, cancer, chronic kidney disease, and other chronic diseases.

Medicine residents!!!

Lets know what is CRP

The C - reactive protein???

And is it really useful?

#MedTwitter C reactive protein is a protein secreted by liver in response to inflammatory process in the body mainly mediated by IL-6.

You prescribed iv iron to patient in iron deficiency anemia and 3 days later patient comes up with severe fatigue? Medicine residents!!!!

Very very important to know. So lets take a 21 year old female, who is advised ferrinject ( iv ferric carboxymaltose ) for a ferritin of 2 secondary to menorhagia. After receiving 1500 mg of ferrinject, she goes home stable without any complains.

Medicine residents!!! Here comes the most anticipated, guess what? Multiple Myeloma. Let's learn the easiest way. So, let's start from the beginning. Stem cells produce lymphoblasts. These lymphoblasts produce B lymphocytes and these further produce plasma cells, that produce antibodies like Ig A, G, E and M. These antibodies are further composed of Heavy and light chains, and they do a wonderful job in fighting infections.

What is anemia of chronic disease?🤔

Lets understand the easiest way🙃 Story starts when iron decided to go from his home( storage site) for work( being utilised for iron related construction, hemoglobin lets say). Iron hired a ship named " ferroportin" and he left for the destination. However suddenly...

Medicine residents !!! Let me teach you, Chronic lymphocytic leukemia the easiest way.

😋
#MedTwitter So lets revise, the stem cell > lymphoblast > b lymphoblast > b lymphocyte. There is a balance of creation and destruction of these lymphocytes (mature) to keep them in check.

So my lovely medical students and residents.

Lets learn iron deficiency anemia in females the easy way.

For sure you ll see that in your life as a physician even in your own family. All females less before menopause go through physiological loss of blood in the form of menses. This loss although physiological , but very frequently due to other commonly associated diseases like thyroid hormone abnormalities, uterine fibroids causes very heavy bleeds.

Hey medicine residents and physicians, let me explain to you what bone marrow transplant is , in the easiest way. Lets start.🫠 In my experience most physicians think of bone marrow transplant like liver or kidney transplant. Let me tell you thats not true. So bone marrow transplant does not any involvement of a surgical procedure where you take out bone marrow like an organ and then place it in another body. So then what is it?

Medicine residents!!! Let me teach you CML ( Chronic Myeloid Leukemia) the easiest way. So remember every cell in the body originates from its stem cell. Likewise goes for blood cells. All blood cells originate from a hematopoietic stem cell > blast cell> lymphoblast and myeloblast. There are approximately 5% normal blast cells in the bone marrow. Bone marrow is the factory of blood cells. The myeloblasts differentiates into granulocytes, megakaryocytes( platelets) and erythroblasts mainly.

Medicine residents, a very smart and easy tool to pick thallesemia minor. So please dont miss it or treat it as iron deficiency anemia.

When you see low Hb, low MCV and suspect IDA, immediately look at RBC count. In iron deficiency, RBC count should also be low. But.. If the Hb and MCV is low specially MCV in 50s lets say and RBC count is high rather than low, ALWAYS rule out thallesemia minor, which is specially prevalent in Indo Pak region and some other parts of the blood. There is reactive eryhtrocytosis due to minor hemolysis going on.