😱Challenges in hematology😱

Crisis in sickle cell disease (SCD)

A short 🧵

1/15 Short intro to sickle cell disease (SCD):
-group of inherited red blood cell disorders
-affects ~ 1 in 500 African American and 1 in 36,000 Hispanic American children
-results in anemia
-main clinical feature is acute painful crisis
👉 often requires hospitalization
2/15

😱Challenges in hematology😱

acquired von Willebrand Syndrome (aVWS)🩸

A short 🧵

1/14 Intro:
-rare but underestimated bleeding disorder
-lab and clinic similar to inherited form
-usually occurs more frequently in adults with no history of bleeding
-renewed interest
👉association with 🫀disorders (eg aortic stenosis), cancer, autoimmune disease...
2/14

😱Gastrointestinal (GI) manifestations in hematology😱

A short visual 🧵with diagnosis

1/19 Intro:
-lympho-/myeloproliferative disorders
-nodal and/or extranodal
-GI tract one of the most common extranodal sites
-diagnosis of GI hematologic malignancy challenging
👉esp in absence of documented nodal/extranodal disease
👉due to higher incidence of other pathologies
2/19

😱Challenges in hematology😱

Richter transformation (RT)

A short 🧵#MedTwitter #MedX

1/20 History part I:
-1928, Maurice Richter reported generalized swelling of lymph nodes, liver + spleen in a patient with chronic lymphocytic leukemia (CLL)
-due to infiltration by rapidly growing cells
👉termed it generalized reticular cell sarcoma
-patient died after 22 days
2/20

When I started med school, I subscribed to the New England Journal of Medicine. Apart from published trials, case records are the world's treasure for education & help navigate clinical courses & differentials better than any class.

A visual 🧵of selected cases #MedTwitter #MedX 50-year-old man with back pain, fatigue, weight loss, and knee swelling

Final diagnosis: Ankylosing spondylitis
-affects 0.5% of population
-strongly associated with HLA-B27 allele
-90% of patients with ankylosing spondylitis are positive for HLA-B27
nejm.org/doi/full/10.10…

😱Complications in hematology😱

Hemorrhagic cystitis (HC)

A short 🧵 #MedTwitter #MedX

1/18 Short intro:
-sterile cystitis characterized by relevant hematuria
-most common after ifosfamide and high-dose cyclophosphamide in bone and soft tissue sarcoma and BMT
-viral
-or as a late toxicity of pelvic radiation therapy
2/18

Eye manifestations in hematology

A visual 🧵with diagnosis #MedTwitter #MedX

1/23 Short eye anatomy

2/23

Skin manifestations in hematology

A visual 🧵 with diagnosis
#MedTwitter #MedX

1/24 Koilonychia

Anemia due to nutrient deficiency
-eg iron, folate, vitamin B12
-other signs:
--pallor of the conjunctiva and palmar creases
--glossitis
--pruritus
--poikilodermatous hypopigmentation
--hyperpigmentation may be a sign of B12 and folate deficiencies
2/24

😱Challenges in hematology😱

Invasive aspergillosis

A short 🧵 #MedTwitter
1/18 Aspergillosis:
-refers to illness due to allergy, airway or lung invasion, cutaneous infection, or extrapulmonary dissemination caused by
--Aspergillus fumigatus (most commonly, ~2/3 of infections)
--A. flavus (~15%), A. niger (~10%), and A. terreus (~7%)
2/18

🧐Spotter in hematology🧐

A short 🧵 with some snapshots and diagnosis

#MedTwitter

1/13 Osteolysis in multiple myeloma

-myeloma activity sometimes appears as "lytic lesions" (with local disappearance of normal bone due to resorption) or as "punched-out lesions" on the skull X-ray ("raindrop skull")
-lesions may also be sclerotic, which is seen as radiodense
2/13

10 rules for life on how to deal with toxicity by seniors and colleagues.

A guide for trainees' well-being and humanity.

1/12 Intro:
Being a trainee in a toxic work environment can be incredibly challenging. Toxicity can hinder growth and well-being. It is often soft and hidden.
One of the meanest instruments of toxic people is ignorance against yourself while putting on a happy face in public.
2/12

🩸Smears in hematology🩸

A short 🧵 with spapshots and diagnosis

#MedTwitter

1/21 Short intro to hematopoiesis:
-formation of blood cellular components
-long served as paradigm of stem cell biology
-genomics introduced powerful new methods for investigating the hematopoietic system -hematopoiesis may be continuous rather than discrete/punctuated process
2/

Many of us love medicine because it is a visual discipline.

A short 🧵with snapshots on tongue changes #MedTwitter

1/ Short anatomy of the 👅:
-unique organ in oral cavity
-not only facilitates perception of gustatory stimuli but also plays important roles in mastication and deglutition
-integral component of speech
AND THUS
-human interaction and love
👉bad looks may impose social shame
2/

😱Complications in hematology😱

Human herpes virus 6 (HHV-6) infection

A short🧵 #MedTwitter

1/19 HHV-6 intro I:
-large double-stranded DNA virus in the β herpesvirus family that primarily targets CD4+ T lymphocytes
-other: monocytes, macrophages, epithelial + fibroblastic cells, hepatocytes
-BUT ALSO: astrocytes, oligodendrocytes, neurons👉important for later🧠❗️
2/19

10 rules for life of a young doctor.

How to deal with death and suffering.

A short 🧵

#MedTwitter #1 Embrace empathy.

Understand that every patient is unique and has a story worth hearing.

Listen.

Connect with your patient on a deeper level than just a "health provider".

Provide comfort and support.

It's necessary to reflect upon their pain.

😱Emergencies in hematology😱

Hyperleukocytosis and leukostasis

A short 🧵 #MedTwitter

1/12 Intro:
-Hyperleukocytosis (HLC) often defined as WBC of 100×10^9/L or more
BUT
-symptoms of leukostasis (LS) can occur at lower counts
-HLC👉microvascular obstruction👉tissue hypoxia+ infarction👉LS
-most common in acute leukemia, esp AML (5%-20%)
-children>adults
2/12

😱Emergencies in hematology😱

Hypercalcemia of malignancy (HoM)

A short 🧵 #MedTwitter

1/17 What causes hypercalcemia?
Before you think malignancies, think Chimpanzees:
Calcium supplementation
HCT
Iatrogenic
Myeloma, milk-alkali syndrome, medics
Parathyroid hyperplasia/adenoma
Alcohol
Neoplasm
Zollinger Ellison
Excessive vitamin D
Excessive vitamin A
Sarcoidosis
2/17

😱Emergencies in hematology😱

Malignant spinal cord compression (MSCC)

A short 🧵 #MedTwitter

1/11 Intro:
-true oncological emergency❗️
-up to 6% of cancer patients
-annual incidence of hospitalizations secondary to MSCC among patients with advanced cancer ~3.5%
-multiple myeloma and non-Hodgkin lymphoma with highest cancer-specific incidence
-prognosis poor
2/11

😱Challenges in medicine😱

Thrombotic microangiopathy (TMA)

A short 🧵#MedTwitter
1/16 Intro:
TMA syndromes are extraordinarily diverse❗️
They may be
-hereditary or acquired
-occur in children and adults
-onset can be sudden or gradual
BUT
despite their diversity, they are united by common, defining clinical and pathological features
2/16

Calling all early career people!

Relations between us are often poisoned by fights for the best spotlight, position and papers.

Here are 10 things we should say to one another more often.

A 🧵 1️⃣ "You're not alone." Remember, everyone goes through ups and downs in research. Reach out to your peers, share your struggles, and lean on each other. Together, we can overcome challenges and celebrate successes.

😱Hematological emergencies😱

Disseminated intravascular coagulation (DIC)

A short🧵#MedTwitter
1/20 Intro DIC:
-systemic activation of coagulation
👉resulting in microvascular thrombosis & haemorrhage
-devastating condition, poor prognosis
-clinic variable, depends on ⚖️of clot formation in microvasculature & consumption of coagulation factors, inhibitors, platelets
2/20