Itsinmyblood
@Itsinmyblood92
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Ana Cristina Tejada MD Hematology fellow from Guatemala 📍Monterrey Mx 🇲🇽 UANL
Joined March 2022
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27 yr old female
Weakness , headache 🤕
- WBC 71k
-Hb 5
Blood smear 👀
New year, new patient
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38 yr old female
Diagnosis of CML almost 10yrs ago.
Abandoned treatment 4 yrs ago.
Comes in with splenomegaly and 289k leukocytes.
PBS >35% myeloblasts.
BM no evidence of myeloblasts
Hb 10 pla 600k
Opinions!
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Plasma cells will always be my favorite cells.
But there is the patient, who has hypercalcemia, anemia, lytic bone lesions. 🤕
Patients take years to diagnose, bouncing from physician to physician, it’s sad! We need to educate!
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He doesn't like that I say I am his fan but I really I am 🤩 your work is amazing and you are such and inspiration for us haematology fellows. Looking forward to see more of your research and maybe collaborating at some point🩸🩸
@NicoGagelmann
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We finally got to meet
@AaronGoodman33
big big fans, a really nice and admirable person.
@yadithlopezz
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💜
Auer Rods. Beautiful myeloid blasts.
#hematologiaHu
@morcossandino
📸
@franja2104
@GomezDLeonMD
@PerlaRcp
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16yr old B ALL CD20+Ph - , no CNS involment during induction and consolidation.
EMR (-) after consolidation.
Presents blurred vision and headache.
His CSF 👇🏻
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Feliz cumpleaños a
@PerlaRcp
Una maestra excepcional que con amor nos ha enseñado el arte de la hematologia❤️
La quiero y admiro 🤩
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I wanted to make a morphology joke but couldn’t find the wright one.
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APL after induction therapy.
Made it out alive, with still some ugly promyelocytes in the BM, and other weeks of ato ahead.
I will forever live in fear of DS.
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@NicoGagelmann
@nihardesai7
@anujtiwari11
@BrownHospMed
@MedTweetorials
@pankti4299
@PanktiMehta24
@Torsadepointles
The 105 yrs old got me 😂 … show us the smear if you can please
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Development of CAR T cell therapy in México. Our admirable professors always a step ahead 👏🏻 it’s truly an Honor to learn from all of you. Special thanks to Dr. Urbano for all the knowledge shared with us.
I am beyond excited 🤩
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MM lytic bone lesions at their finest.
Beautiful plasma cells in the BM 🤩
- The patient went trough almost 6 different kind of physicians for 2 years complaining of back pain and fatigue 🥺
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UANL represent 🤩 it’s amazing to share this experience with people who inspire me to be better and grow together ❤️
@yadithlopezz
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Isn’t it pretty ?🩸
Our first haplo in our third year of residency, let’s hope for many more to come .
@yadithlopezz
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59 yr old female
History of deep vein thrombosis in lower extremity. ( 1wk)
Presents with anemia and spontaneous
ecchymosis.
Hb 6.11 MCV 143, RDW. 1C.3, % Ret 2.03, WBC 13.6, Neu 5.88, Lyn 2.3, Mono 4.4, plt 325
Morphology 👇🏻
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Proud to be part of the best hematology center in Mexico.
Accesible and LMIC affordable practice changers 👏🏻
Friends and colleagues presenting their projects 👇🏻
@Antonio_Vga_
@yadithlopezz
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I am doing my own “ASH highlights” from the fellow “need to know” POV
1. MRD in AML
2. Age adapted GMALL protocol (ALL in older patients)
3. TRIANGLE
4.Efgartimod in inmune thromocytopenia
Any other that I should add? Glad to take recomendations!
Lets get info out there✨
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In memory of my friend and colleague Gonzalo Diaz.
Excellent clinician, spectacular internist, but above all, an exceptional human being and unconditional friend.
You will be forever missed ❤️🕊️
1993-2024
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I woke up to 6 missed calls from a resident (surgical specialty) to evaluate a patient who had thrombocytopenia 15 years ago and was subsequently diagnosed with APS. She does not have any current hematological alterations.
It's unnecessary harassment.
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At least now I can identify an abnormal cell population 🙈 the first day of this rotation felt like I was a 90��s kid playing with paint. My whole admiration for experts on flow cytometry 🙌🏻👏🏻👏🏻
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During my formation in 🇬🇹 I didn’t get the chance to learn much about research. But during my hematology fellowship, I`ve been learning to do and love this work, learning more daily. My co-fellows are incredible at it and my mentors are researchers to admire❤️
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64 year old male
Diagnosis MM
I saw this huge cell in his bone marrow.
Is it a Dutcher body in a huge plasma cell? 👀
Enlighten me please 🙏🏻💡
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45 yr old male.
Refers he suffers a TIA 24h previous to his admission.
Presents with dizziness, fever, adynamia
Hb 5 pla 15,000. RTIC 12% Crea 2 LDH 1286 ,Unconjugated Hyperbilirubinemia
INR 1.19, PTT 26 HIV+
Approach? Diagnosis? Treatment ?
#MedX
#MedTwitter
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It’s a great honor and a pleasure to be able to learn from ground breaking hematology masters!!
Thank you 🙏🏻
#ASH23
@GomezDLeonMD
@GuillermoRuizA5
@dgomezalmaguer
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#ASHkudos
to my friends and colleagues for the amazing time!
#ASH23
was amazing, thanks for the laughs, the learning and the experience.
It’s a wrap and let’s do it again! ❤️
@Antonio_Vga_
@yadithlopezz
@vale_fuentesflr
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100 real
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The LOVE for the Art of Haematology ❤️ first pic 2018 first year resident of Internal Medicine, now first year haematology fellow 🩸🩸🩸
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pDC-AML 🤩😍❤️
What’s your experience with this type of leukemia?
- 7+3?
- add venetoclax ⬆️
- HyperCvd + Ven
- Aza - Ven
LMIC setting 👀
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I admire you both so much! You give your heart for your patients and have so much passion for haematology. It's a pleasure learning from you 👏🏻👏🏻🩸
#ASH22
@ASH_hematology
Great to see the work of Mexican acute leukemia working group
#GTLA
at
#ASH22
we are stronger together!
Here with my friend, acute leukemia expert
@RobertaDemiche3
now a leader of Mexican hematology.
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Our last presentation as second year residents. Time has flown by! Let’s make the best of this third year 🤓
Hope to be making this presentation again next January 👏🏻
@Antonio_Vga_
@yadithlopezz
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@nihardesai7
Huuh.. Thank you for this ! I tweeted something similar a few months ago, always good to have it fresh 🤩
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Platelets in 98k with high MPV, the surgeon needs 120k for an elective procedure 🤗
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I am incredibly PROUD of your work, so intelligent, so hard working and dedicated. Proud to be your Co fellow and friend. 🩸 And we are just getting started 😉
@yadithlopezz
#ASH22
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Every time I get a consult for some kind of coagulation disorder.
Me:👇🏻
For some reason the basics don’t seem to stick in my memory 😭 any tips?
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@AaronGoodman33
I would take this lecture at any time! Come to Mexico, we don’t have problems with decibels or being to loud 😅
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Paciente con leucemia mieloide tratada por “médico” naturista, quien le coloca catéter central para darle OLIGOPEPTIDOS 😢😮💨🫠 Cultivos positivos para pseudomonas y staph, llena de blastos mieloides en sangre periférica.
Esto es la vida real de un charlatán😢
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@nihardesai7
@BrownHospMed
@MedTweetorials
@Torsadepointles
@HemOncFellows
@DocSamDeshmukh
@Rafameed
@CPSolvers
Here I give you a pic of one of our patients .. I just LOVE the unique morphology ❤️
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@nihardesai7
@GomezDLeonMD
@GuiperiniMD
@Laura_SaavedraS
@DrNikitaMehra
You definitely learn a lot, all that info has to be used and adapted to our context, what is feasible and what is not, taking into account accessibility, technology and abilities.Innovative and inspiring ideas! still have to work on debugging what is useful for me and my patients
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When at first glance of the microscope you see this 👇🏻 .. you know it’s not good news.
2nd pic at 100x.
WBC 87k plat 36.6
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@nihardesai7
@BrownHospMed
@drsahilbhagat13
@KeMo_ketanmodak
@NicoGagelmann
@HemOncFellows
@lymphomahub
@sudhirkirar1
@ArijitBishnu
@myfight4cancer
@MatthewHoMD
I have this in my notes 🙈 not sure about the treatment. How do you treat?
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Ph like acute lymphoblastic leukemia.
44 yr old female
Pancytopenia.
Hb 7.64 WBC 0.57 Pla 128,000
BM ⤵️
#acuteleukemia
#leukemia
#leusm
#BMT
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@NicoGagelmann
@Alex_Rogonti
@navpreetentious
@Sthanu5
@BrownHospMed
@nihardesai7
@AvrahamCooperMD
@DrCindyCooper
@HermelinMD
@AaronGoodman33
Dont forget yourself 🤩✨👍🏻
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Lots of MM lately.
65yr old male
Creat 5// hemoglobin 7//Ca 11
🫶🏻
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28yr old female
1 wk, unexplained fever, sudden bruising and epistaxis.
Platelet 5k
WBC 3,720 mono 1,620 neu 0.960
Hg 7.7
PBS 👀🔬🩸
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This is the moment when you get cold sweats 🥹
WBC 21,000
Pla 10,000
Mono 7,000
@yadithlopezz
@paulo_ug
@franja2104
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Worth the thread!! Congrats 🎉
As Hematology fellow its only my biggest dream to be able to cure and provide stem cell transplant in my country, to grow and learn from such inspiring profesionals 🤩
As we approach our 500th transplant for
#myelofibrosis
in our clinic, I'd like to share our approach and short thoughts on the way to cure this disease.
Will focus on clinic.
Another 🧵 will follow soon on current developments.
#mpnsm
#bmtsm
(Kröger et al. Blood 2009👇)
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A book for 600 dollars? My 💔.. No one from my country is going to ever be able to afford that 😭
#ASH
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There is always that one resident on call on the weekend who receives new leukemias, tumor lysis, lymphomas, spinal cord syndromes.
Well that's me 😅🫠
Gonna be a long weekend I guess 🤓
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The simple use of curved glass to bend and refract light revolutionized how we see the world. In many ways, it's not all that different from everyday life sometimes seeing life through a different lens opens a new world of possibilities. 🔬🩸
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How great it is meeting people from around the world! Just met another brilliant new heaematology friend all the way from Kenya!
#ASH22
#ampathglobal
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@NicoGagelmann
@MedTweetorials
@Sthanu5
@nihardesai7
@AbbasiMuqtadir
@drsanjeev1980
@PanktiMehta24
Wow that’s got to hurt. 🫣
Eldery patients often present with confusion or disorientation.
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As a trainee thrombocytopenia during the treatment of SMD/AML is one of the most exhausting things to deal with, it causes a lot of stress to the patient, transfusions decrease quality of life and financial toxicity overall.
Any advice 🙃
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@nihardesai7
@BrownHospMed
@MedTweetorials
@HemOncFellows
@Rafameed
@Torsadepointles
@pankti4299
@DrCindyCooper
@DxRxEdu
Acute promyelocytic leukemia. t(15;17). Intermediate risk I suppose (Plt<40,000)
1. ATRA+ATO
2. DS prophylaxis if indicated or risk factors are present.
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I am incredibly proud of my co-fellow and friend for this achievement and others to come.
@yadithlopezz
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My alarm ⏰ this morning 😢
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55yr old patient with a long history of bone pain.
Hb 8.5 N/N
Creatinin 3.2
Calcium 14.5
PBS : >5% plasmatic cells
BMA : >20% plasmatic cells
👇🏻
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Recently I’ve found a special interest in geriatric hematology. I love it ❤️ so much to do , so much to learn, so much to give !
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17 yr old male.
#SCD
- Hydroxyurea
1 week of diarrhea, fever (40c) chest pain.
Physical exam : jaundice, chest pain, abdominal pain.
Blood cultur: Salmonella SP.
We suspect salmonella osteomyelitis in sternum and vertebra
#SickleCell
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16yr old ♂
2 wk of weakness and fever.
Sudden onset hematomas and gingivorrhagia.
WBC 31k Pla 20k
PBS 👇🏻
Flow cytometry -> MPAL B/myeloid
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Well updates.. Flow cytometry showed 2 clones one classic myeloid and another one taking the path of the dendritic plasmocytoid AML.
So I’ll be posting the beautiful morphology of the DP cells ❤️
59 yr old female
History of deep vein thrombosis in lower extremity. ( 1wk)
Presents with anemia and spontaneous
ecchymosis.
Hb 6.11 MCV 143, RDW. 1C.3, % Ret 2.03, WBC 13.6, Neu 5.88, Lyn 2.3, Mono 4.4, plt 325
Morphology 👇🏻
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