Latest Twitter Threads by @CharlesMilrod on Thread Reader App

May 30, 2023 • 10 tweets • 5 min read

Picture this:

A patient presents with an enlarging neck mass, and you find this 👇 on your evaluation.

What’s going on? 🤔

A #tweetorial 🧵 1/8

To guide our thoughts, let’s start with two Hodgkin lymphoma (HL) facts-

1) Cancer cells can ⬆️ PD-L1, which interacts with T-cells’ PD-1 and ⬇️ immune activity

2) 🔑 Immune checkpoint inhibitors (ICIs) block the PD-1/PD-L1 interaction & have strong activity in HL 👇

🧵 2/8

Apr 12, 2023 • 14 tweets • 1 min read

It’s a great joy to share (and teach) what’s exciting about hematology!

Here are my go-to threads 🧵 for blood cancer fundamentals 👇 APML & DIC

Apr 4, 2023 • 9 tweets • 6 min read

Picture this:

Your patient with myeloma presents with hypercalcemia.

You find this 👇 on your evaluation.

How (and why) is this an emergency? 🤔

A #tweetorial 🧵 1/7

To guide our thoughts, let’s start with 2 hypercalcemia facts-

1) Severe hypercalcemia often presents with polyuria and dehydration

2) 🔑 Poor skin turgor is one of the more sensitive exam findings of dehydration 👇

🧵 2/7

Feb 21, 2023 • 8 tweets • 5 min read

Picture this:

A patient presents with easy bruising, and you find this 👇 on your evaluation.

What’s going on? 🤔

A thread 🧵 1/6

To guide our thoughts, let’s start with two amyloid facts-

1) AL Amyloidosis is a syndrome caused by light chains depositing in organs

2) 🔑 Symptoms depend on the affected organ- these include:

- ❤️ heart disease
- 🫘 kidney disease
- 🙌 neuropathy

🧵 2/6

Jan 12, 2023 • 11 tweets • 6 min read

Picture this:

Your patient presents with a fever, and you find this 👇 1 week after starting treatment for APL.

What’s going on? 🤔

A thread 🧵 1/9

To guide our thoughts, let’s start with 2 acute promyelocytic leukemia (APL) facts-

1) The hallmark translocation of APL involves the retinoic acid receptor (RARA)

2) 🔑 The RARA translocation BLOCKS 🙅‍♂️ differentiation at the promyelocyte stage

🧵 2/9

Dec 13, 2022 • 10 tweets • 7 min read

Picture this:

A patient presents with a headache, and you find this 👇 on your evaluation.

Why (and how) is this an emergency?

🧵 1/8

To guide our thoughts, here are 2 scleroderma renal crisis (SRC) facts-

1) SRC is a syndrome of kidney injury, elevated blood pressure, +/- hemolysis

2) 🔑 Prior to modern therapy, one-year mortality for SRC was 85-100%

🧵 2/8

Dec 5, 2022 • 10 tweets • 6 min read

Picture this:

A young boy presents with mononucleosis, and you find this 👇 on your evaluation.

Why (and how) is this happening? 🤔

🧵 1/8

To guide our thoughts, let’s start with 2 autoimmune hemolytic anemia (AIHA) facts-

1) AIHA is caused by autoantibodies that bind & destroy RBCs

2) 🔑 Antibodies can be active at core temperature (warm 🥵) or below (cold 🥶)

🧵 2/8

Nov 21, 2022 • 7 tweets • 4 min read

Triage is life-and-death responsibility!

First step? Recognize the emergency.

5 threads on blood cancer emergencies (and how to treat them)👇 Acute promyelocytic leukemia

🆘 1/5

https://twitter.com/CharlesMilrod/status/1582730560149278720

Nov 16, 2022 • 10 tweets • 6 min read

Picture this:

A patient is found unconscious at home, and you find this 👇 on your evaluation.

Why (and how) is this an emergency? 🤔

🧵 1/8

To guide our thoughts, here are 2 superior vena cava (SVC) syndrome facts-

1) Principle of physics:
🔑 For a fixed flow, volume is inversely related to pressure

2) SVC obstruction (⬇️ volume), causes edema (⬆️ pressure) of brain 🧠 & larynx 🫁

🧵 2/8

Nov 10, 2022 • 9 tweets • 6 min read

Picture this:

A patient presents with palpitations, and you find this 👇 on your evaluation.

Why (and how) is this an emergency? 🤔

A #tweetorial 🧵 1/7

To guide our thoughts, here are 2 tumor lysis syndrome (TLS) facts-

1) 🔑 Electrolyte balance across a membrane drives action potential

2) When cells die, they release electrolytes (& nucleic acids) from intra ➡️ extracellular space

🧵 2/7

Nov 2, 2022 • 8 tweets • 6 min read

Picture this:

A patient presents with leg weakness, and you find this 👇 on your evaluation.

Why (and how) is this an emergency? 🤔

A #tweetorial 🧵 1/6

To guide our thoughts, let’s start with 2 spinal cord facts-

1) Compression causes white matter edema & necrosis 👉 motor/sensory deficits

2) Steroids ⬇️ edema and may ⬆️ neurologic function

🧵 2/6

Oct 26, 2022 • 8 tweets • 6 min read

Picture this:

A young man presents with a WBC of 100k, and you find this 👇 on your evaluation.

Why (and how) is this an emergency? 🤔

A #tweetorial 🧵 1/6

To guide our thoughts, here are 2 leukostasis facts-

1) 🔑 Leukostasis is a syndrome of ⬇️ perfusion due to WBC plugs in small vessels

2) One-week survival is ~25% when presenting with symptoms (🫁, 🧠, or 🫘)

🧵 2/6

Oct 19, 2022 • 7 tweets • 4 min read

Picture this:

A young woman presents with gum bleeding, and you find this 👇 on your evaluation.

Why (and how) is this an emergency? 🤔

A #tweetorial 🧵 1/6

To guide our thoughts, here are 2 acute promyelocytic leukemia (APL) facts-

1) 🔑 APL is a hematology emergency because of ⬆️ rates of DIC

2) ~10% of patients died from hemorrhage in the first 10 days 🤯 in the pre-ATRA era

🧵2/6

Sep 23, 2022 • 6 tweets • 3 min read

I learned so much from @NEJM's review of Burkitt lymphoma!

I'll share what I learned in my quick review (of the review) in 5 tweets or less👇

👴🏻 Where we were in 1958:
- Dr. Burkitt described 38 children in Uganda with rapidly-growing facial tumors (below👇)
- thought to be a sarcoma
- 100% fatal

👶🏻 Where we are now:
- Children & adolescents: >90% cured
- Adults: ~85% overall survival

We've come a long way!

Sep 21, 2022 • 7 tweets • 2 min read

Picture this 📸

Your patient with relapsed Hodgkin lymphoma presents to the ER like this 👇 4 weeks after starting an immune checkpoint inhibitor.

Hours later, he’s intubated for respiratory failure.

What’s going on? 🤔

A #Tweetorial 🧵 1/6

To figure this out, let’s start with 2 guiding thoughts-

1) The immune checkpoint inhibitor (ICI) used in relapsed Hodgkin lymphoma blocks PD-1

2) 🔑 If you disinhibit the immune system, risk of autoimmune disease ⬆️

With this in mind…

🧵2/6

Sep 19, 2022 • 7 tweets • 2 min read

Reflecting on my first month of hematology consults-

Here are the 5 most classic peripheral smears my team and I saw 👇 Smear: Blasts and myeloid cells of different ages

Diagnosis: CML, blast phase

🩸1/5

Sep 13, 2022 • 9 tweets • 4 min read

Picture this 📸

Your patient with primary CNS lymphoma is in the hospital for high-dose methotrexate (& fluids).

They’re doing great, until you find them like this 👇 on day 4.

What do you do next?

A thread 🧵 1/7

To guide our thoughts here are 2 cancer principles:

1) Fluids are the #1 defense against kidney injury in tumor lysis syndrome, methotrexate, and acyclovir. Common thread? 💎 Crystals!

2) 🔑 Crystals precipitate in the tubules and cause damage

With that in mind-

🧵 2/7

Aug 31, 2022 • 6 tweets • 3 min read

Picture this 📸

Your patient with multiple myeloma walks into your clinic like this👇 3 months after CAR-T cell infusion.

What happened?

A thread 🧵 1/5

To figure this out, let’s start with 2 principles-

1) General rule in cancer therapy:
🔑 the more specific your target, the less off-target toxicities

2) CAR-T cell therapy in multiple myeloma is directed against B-Cell maturation antigen (BCMA)

🧵 2/5

Aug 25, 2022 • 4 tweets • 2 min read

Clickbait (kind-of): Can you get leukemia from breast milk?

Yes 🤯

(from ASH Image Bank)

Acute Adult T-Cell Leukemia-Lymphoma (ATLL) is a VERY aggressive leukemia that typically follows decades of asymptomatic HTLV-1 infection.

Long-term carriers usually acquire in childhood via breastfeeding.

The lifetime risk of ATLL is 1-5% in carriers.

ashpublications.org/blood/article/…

Share this page!

Enter URL or ID to Unroll