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𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 𝗠𝗗🩸 Profile picture
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8 May, 9 tweets, 5 min read
CELLS in Hemat 💪🏻

Sickle cell=Drepanocyte➡️SCD
Tear drop=Dacrocyte➡️MF
Spur cell=Acanthocyte➡️Liver ds
Burr cell=Echinocyte➡️Uremia/PK def
Target cell=Codocyte➡️Hb'pathies
Bite cell=eccentrocyte➡️G6PD def
Pencil cell=ovalocyte➡️IDA
Pincered cell➡️Band 3 def
Prickle cell➡️PK def
@HaryaxPathak @AlishaAkhani @pankti4299 @VedangDesai02 @shreya__kataria @HemOncFellows @hard_dil @nitsoccer @docsamdeshmukh @BloodAdvances #MedTwitter #hemetwitter
Sickle cells, not hard to identify.
Can't miss these isn't it ?
Tear drop cells a/w marrow fibrosis.
Acanthocyte/spur cells , irregularly spaced "spikes" !!
A/w liver disease, abetalipoproteinemia.
In contrast to the above image, note how the "spikes" are regularly spaced !!
These are ecchinocytes/burr cells a/w uremia.
Bull's eye. Hard to miss these target cells. Seen in thalassemia and other Hb'pathies and also with asplenia.
That took a BIG "bite" out of that !!!
G6Pd deficiency.
All images are from the @ASH_hematology image bank. A big thank you for existing 💪🏻🙏🏻

P.S. I am not a hemato-pathologist. Those guys are from a different planet. RESPECT 🙏🏻

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More from @nihardesai7

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 𝗠𝗗🩸 Profile picture
7 May
#FERRITIN is being widely ordered these days. Let's dive into the details and learn more about this protein. A short thread for those interested. Covers some history, biology and practical aspects about FERRITIN.

1/n
It was discovered in 1937 by Laufbérger but it wasn't until 1972 that an assay was devised to measure serum ferritin.

Ferritin is present in 2 forms
👉 Intra-cellular (in the cytosol)
👉 Extra-cellular

2/n
It is a ~450kDa protein.
Has 24 subunits of 2 major types
👉 H : gene on chr 11q
👉 L : gene on chr 19q

Serum ferritin has ⬆️ L: H ratio.

3/n Image
Read 7 tweets
𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 𝗠𝗗🩸 Profile picture
4 May
So mucor is on the rise, time for a quick revision. A short thread for those interested.

It's a bad infection with an unreasonably high mortality(40-80%) which depends on the organ involved.

Risk factors: DM/ neutropenia/ HSCT

DM=rhino-orbital mucor
Neutropenia=pulmonary mucor
Mucormycosis is caused by fungi of order "MUCORALES" which includes rhizopus/mucor/licthemia/cunninghemela species. But DON'T WORRY species identification doesn't change treatment so we don't need to get to that.
Coming to the PRACTICAL POINTS that need to be remembered.

➡️IMAGING even at the slightest suspicion of mucor coz it's RAPIDLY PROGRESSIVE and kills quick.

➡️CT PNS/Orbits/ MRI Brain
➡️HRCT chest as per presentation
Read 8 tweets
𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 𝗠𝗗🩸 Profile picture
1 May
Got #covid ? Don't worry it's not a death sentence.

Step 1: Isolate and monitor

I assume u must have started isolating even before you tested + , if not, do so immediately. Get the others at home tested ASAP. Monitor your temperature and oxygen saturation.

1/n
Step 2: Managing Co-morbidities

If u have any co-morbidity continue to take the meds you were already on. Don't STOP meds for ur diabetes or hypertension or thyroid d/o.

2/n
Step 3: Managing fever

Fever is a very common symptom. Please dont panic. Take a paracetamol. An adult may take upto 3gm/day i.e ~650mg 6 hourly. Continue to monitor your oxygen sats every 4-6 hrs.

3/n
Read 9 tweets
𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 𝗠𝗗🩸 Profile picture
9 Oct 20
#MedTwitter how often do you use 𝐏𝐫𝐨𝐜𝐚𝐥𝐜𝐢𝐭𝐨𝐧𝐢𝐧 ?

A thread on 𝐏𝐫𝐨𝐜𝐚𝐥𝐜𝐢𝐭𝐨𝐧𝐢𝐧 for those interested 😉

#MedEd #MedStudentTwitter #oncology #hematology #tweetorial
⚡️Procalcitonin as the name suggests is a precursor of the hormone calcitonin

⚡️Coded by the CALC 1 gene on Chr 11,its a 116AA peptide

⚡️PrePCT >> PCT >> Calcitonin

⚡️Bact inf=⬆️IL6⬆️TNFa⬆️IL1b=⬆️Productn of PCT
⚡️Normal PCT in health <0.1ng/ml

⚡️In patients with bacterial infections PCT ⬆️ corelates with severity of infection

⚡️PCT starts to⬆️3-4hrs following an infection,
peaks at ~12 hrs post infection.
Read 11 tweets
𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 𝗠𝗗🩸 Profile picture
20 Jul 20
Humanity has always struggled to fight #viruses , best exemplified by the ongoing #Covid_19 #pandemic ,so I thought of doing a thread on a #virus which frequently troubles #hematology patients

It's called #CMV or #HHV5
It wrecks havoc #posttransplant

#MedTwitter @BloodJournal
⚡DNA virus ,1 of the MC infections post SCT

⚡It has the largest genome of any known human virus [230kb /200 genes]

⚡Most humans harbour latent CMV, infection MC aquired in childhood.

⚡Site of latency in humans- Not Known
In murine models - hepatic sinusoidal cells
⚡The risk of reactivation depends on CMV sero status and is as follows:
D-/R+ > D+/R+ > D+/ R- > D- / R -

⚡The other risk factors are
1️⃣ T cell depletion
2️⃣ HaploSCT
3️⃣ UCB SCT
4️⃣ GVHD requiring Rx

⚡ So why not give prophylaxis to these patients ??
Read 10 tweets
𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 𝗠𝗗🩸 Profile picture
28 Jun 20
So how safe is #Ibrutinib ?
A very relevant question given that it needs to be administered indefinitely.
41% discontinuation rate in the "real world", most d/t toxicity.

Thread [1/12]
So what are the major adverse events anyway ?
1. A fib
2. ⬆️ Risk of bleeding
3. ⬆️ Infections
4. Arthralgias
5. Htn
6. Diarrhoea
7. Pneumonitis

[2/12]
A very common concern is tox no.1 and 2 .
⬆️A .fib = anticoag for stroke prophylax. but that's when tox no.2 comes into play.
Very difficult to ⚖️ it out .
In RESONATE trial >grade 3 afib in 3% of pts.
Most events occur within 3 mts of starting #ibrutinib

[3/12]
Read 13 tweets

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