This is the story of a girl.

Of a family.

Of tragedy and a devastating disease.

It all starts in the Åland Islands, an autonomous, Swedish speaking region of Finland.

1/ Hjordis Sundblom was the 5th child of 11, born to Klas and Augusta.

At the time of her birth, her parents had already lost 3 daughters (Dagny, Dagny, and Anna) due to severe bleeding.

Both Dagnys had intestinal bleeding while Anna died after biting her tongue.

Did you know there are sound biological reasons why incest is illegal?!

A 🧵

1/

https://twitter.com/cmclymer/status/1747692556538790142

Inbreeding, or mating with those genetically close to you, goes against the biological imperative of mating which is to shuffle DNA.

Certain congenital defects and diseases are inherited in a recessive manner, meaning you need 2 abnormal copies of a gene.
2/

In hematology we often transfuse red blood cells and platelets for a number of different conditions.

But what about neutrophils?

A short Schitts Creek themed tweetorial thread 🧵

1/ Turns out granulocyte infusions are a thing but there are many reasons why you haven’t likely heard of or used them.

They’re typically used when pt
🩸is very neutropenic
🩸has severe bacterial or fungal infxn unresponsive to antimicrobials
🩸marrow recovery is expected.
2/

Our recent study found that nearly 40% (!) of 12-21 yo females are iron deficient.



But did you know that in addition to many physical symptoms, iron deficiency is associated with multiple mental health issues?

A #tweetorial 🧵1/tinyurl.com/FeJAMA It is estimated that ~400 genes (~2% of genome) are involved in iron metabolism & homeostasis.

In addition to irons role in erythropoiesis (making red blood cells), iron participates in energy production & electron transport, cell metabolism, respiration, proliferation..

2/

We recently found that almost 40% (!) of “healthy” 12-21 year olds have iron deficiency.



But only ~6% were anemic so who cares?!

I do, and you should too.

A #hemetweetorial 🧵 1/tinyurl.com/FeJAMA First of all we used @WHO definition of anemia which is sexist & not supported by evidence.

The study used to support this cutoff found that when women were given iron the lower limit of normal ⬆️to ~that of men.

So 6% is likely an underestimate. 2/
tinyurl.com/Sexspecificane…

Met gala attire meets hematopathology

A #hemepath thread.

Red blood cells. Eosinophils.

Let’s talk about beautiful things.

Janelle Monae & blood cells.

An erythrocyte. An eosinophil.

In 2022, I read 52 books.

These were my favorites. Others I really liked too

A thread of Twitter gems is what we all need right now.

1/

https://twitter.com/sixthformpoet/status/1137658720698228736

2/

https://twitter.com/shockproofbeats/status/992006545473966082

Get your #HCWvsHunger apparel now!

🍎Proceeds benefit @FightHungerAAH

🍎First batch will arrive before the end of #HCWvsHunger22 but orders must be placed in the next TWO days.

bonfire.com/healthcare-wor… @DuchessSexpert @allisonp1979 @MSerdikoff @CardiacPA1 @kari_jerge @EShaughnessyMD @DrJenChen4kids @MSharifpourMD @Cate_Molina @rosc_md @_Mar_Y_Oceans_ @PonziniF @tmprowell @ETSshow @PedsHemeDoc @gbosslet @fuzzymittens @jmteakell @kevin_ro @fumikochino @01sth02 @rovingatuscap

An 18 month old boy presents to your office for a well child visit.

Parents have no concerns but do mention that he eats a lot of paper.

You astutely decide to check a CBC and iron studies but wonder why iron deficiency causes this strange symptom?

#hemetweetorial 🧵
1/ Pica in medicine refers to the compulsive eating of non edible substances.

It is classified as an eating disorder.

The word pica originates from Latin referring to the magpie which eats indiscriminately.

Pica was described by Hippocrates as “corruption of the blood”

2/

In case you missed it the US has been subtweeted today by the WHO, Canada, France, Spain, Norway, and Denmark.

https://twitter.com/who/status/1540362083065368577?s=21&t=t2rdzQBwTiKd1XV3tBMxRA

My brother died in 2016.

When I read things he wrote I can still hear his voice.

I recently came across an email he had sent years ago to a friend going through a rough time.

“I hope you're starting to feel better…

1/ I know how depression can be.

Go to the gym. Quit drinking/smoking for a while. Join a club or a group on campus or something. I just recently went through something like that and still am sort of dealing with it.

Those things are important though, man. Get some exercise.
2/

The polio vaccine, like other vaccines, is a medical miracle.

But the ethics of its development are not something we should aspire to.

A 🧵
1/ Dr Salk began his research in 1951 under a grant from the national foundation.

This was prior to the development of the National Research Act (1974) & the Belmont report (1976) that established research subject protections.

2/

It’s a new week, time for a new #hemetweetorial topic chosen by my followers.

So let's learn about vicarious menstruation!

Vicarious menstruation is cyclical bleeding in extra- genital organs.

This can occur alone or in addition to menstrual bleeding.

1/ Vicarious menstruation was alluded to by Hippocrates in Aphorism v.33 "In a woman when there is a stoppage the menses, a discharge of blood from the nose is good"

This illustrated the common theory that an outlet of some sort was necessary to relieve a monthly plethora.

2/

Medical specialties as #TedLasso characters. A #MedLasso thread.

Starting with @TedLasso whose eternal optimism and relentless cheer is so obviously pediatrics.

See also: Dani Rojas
1/ Another obvious choice is @SarahNilestar as Dr Sharon Fieldstone.

Shows vulnerability, always there to listen, but is going to tell it to you straight.

Psychiatry.

#MedLasso 2/

My 1st donation tweetorial goes out to the incomparable @james_paulad whose topic choice is sexism in the treatment of bleeding disorders.

A perfect topic for shematologists!

1/n One of the clearest examples of sexism in bleeding disorders can be seen in Hemophilia.

Wait, WHAT?
Women with Hemophilia?!

Yes, contrary to popular opinion (even amongst physicians), women CAN have Hemophilia.

2/n

Given a lot of questions after a recent tweet on iron deficiency, I thought a #tweetorial might be in order.

Iron deficiency anemia affects a large proportion of the worlds population and iron deficiency is even more common.

1/n It is more common is females than males and racial disparities exist.

Structural racism contributes to the fact that iron deficiency is seen in 4.3% of Black patients compared to 2% of white patients.
2/n

Based on a recent tweet about iron dosing, I’ve had a few requests for a #Tweetorial. #hemetwitter

Iron deficiency is relatively frequent and seen by all types of physicians.

For years, iron supplements were given multiple times a day.

So why the change? 1/n It all goes back to a little hormone called hepcidin, which is the primary regulator of iron absorption.

Hepcidin is mainly produced in hepatocytes, encoded as a propeptide and following processing, circulates in plasma.

Overexpression causes iron restricted anemia... 2/n