John Sherbeck MD
@TeamCaptainJohn
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#GoGreen ! | Pathologist 🔬 Transfusion Doc🩸 #Blooducation #bloodbank #GIPath #GynPath #BreastPath #CytoPath #Pathology | He/Him | OAMO
Ann Arbor/Ypsilanti
Joined September 2010
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@AstroKatie
People don’t realize what intubation actually is. They don’t know how violent CPR is. Honestly I wonder what effect medical TV dramas has had on the lay image of a critical patient.
They think covid is just nursing home patients lying in bed with little oxygen masks on.
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A single unit of FFP for an adult pre-procedure for an INR of 1.6 is a violation of “first do no harm.”
#blooducation
#transfusionmed
#pathology
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@DrJenGunter
As a non vagina-having person, I find the existence of people who want “more out of their vagina” to be perplexing. Who are these people? To what vaginal ends to they seek? Do they have many items in their vagina, and they want an increased number of them evicted?
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Dear literally everyone in medicine,
When we get a stomach bx, we look for H. pylori. Every time. We look, with our eyes. We can see the bugs. Our eyes are the test. Sometimes we use IHC or an awful special stain. But it’s our eyes. Every time. I promise.
#pathology
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@MikeSullivan
Taking your mask off is the worst thing you can do in public Mike. These are different. Fomite transmission is incredibly rare. Unmasked indoor while eating/drinking/talking is how this virus spreads. It’s sucks. Restaurants need PUBLIC support.
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@fuzzymittens
We get this asked everyone couple of weeks. Most donors are vaccinated. Because most donors are compassionate and trust science
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There’s something going on in the mucosa of this duodenum. Thoughts? Do you want any IHC?
#pathology
#GIPath
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@DrJenGunter
@RepSeitz156
This is like making chemotherapy and oncologist surgery illegal because you’re impacting the variability of the tumor cells “life.”
Mtx and salpingectomy literally save lives. Anything to the contrary is draconian and endangers the lives of tens of thousands of women each year
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@TimTravis2
@ScottGottliebMD
This is categorically false. HI is a moving target. Serologic surveillance shows the maximum %+ rates are <20%. At best, the % needed for HI FOR COVID19 May be ~40-50% IF we drop R0 enough with masks and social distancing....so that’s TWO NYC outbreaks, and we STILL need masks.
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@WHO
@WHOAFRO
@WHOEMRO
@WHO_Europe
@pahowho
@WHOSEARO
@WHOWPRO
This is a really disingenuous title. We don’t know if neutralizing abs prevent reinfection or how long cellular/humoral immunity lasts. But there’s evidence from hundreds of other viral pathogens that can guide us.
Save the “no evidence” for grifters and snake oil pitches.
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#BreastPathology
tweeps: what do you think about this intraductal proliferation?
#pathology
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@jmugele
Dr. Mugele’s tweet embodies the shared frustration at the intersection of dogmatic policy and the humanity of medicine.
Much of the rest is piling on the faceless “lab” as a bunch of “technicians” who lack nuance and understanding -nothing could be further from truth
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@AngelaSNMF
As a blood banker: if you’ve been given a card after getting a blood transfusion that says you have an antibody, tattoo that on your chest with the phone # of the lab that ID’ed it.
As a surgical pathologist: for the love of all things holy get the HPV vaccine.
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Our study in
@JNCCN
on
#quality
in
#surgpath
: lymph node counts. Think it’s black and white? Anyone in
#pathology
knows it’s not, and there are major implications in patient prognosis, trial eligibility and continued
#oncology
research.
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@DGlaucomflecken
Day 1 of my opthy rotation:
Attending: what do you want out of this rotation?
Me: I wanna learn how to triage a pink eye for if/when I have kids. Also can mess around on the slit lamp?
A: Let’s go!
*90 min later*
A: that wraps it’s up! Enjoy your month off!
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Metastatic lobular breast ca Mets to GI tract. Can be SNEAKY. Always scrutinize an expanded lamina propria
Differential dx: myeloma, poorly diff/diffuse type gastric ca, melanoma, among others
🔑s: History!! Low-grade cytology, discohesive epitheloid cells
IHC: Ck, ER, Gata-3
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@tmprowell
If
@DGlaucomflecken
hasn’t taught us all this already, then we’ll never understand…
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@acweyand
Girl dad here. My take would be
Menarche: According to an antiquated (potentially made up) lunar calendar. Extra points if its from a society that doesn’t count base 10. Transliterate, don’t translate.
LMP: Smarchuary 82nd
Eff the Christofascist patriarchy.
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Squamous (CIN-3) and endocervical (AIS) dysplasia. Looking forward to the day when these cases are rare.
#Vaccinate
#HPV
#CervicalCancer
#CervicalDysplasia
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@tmprowell
@Delta
@united
@AmericanAir
They’ve literally shown in the past they have the authority and the will to kick passengers off of airplanes for a dress code. Can’t wait for the first in-air confrontation video where a masked person is attacked for making that “choice”
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As a laboratory medical director, its imperative to help my
#medlab
team
#wellness
any way I can.
#medlablife
#clinlab
#pathology
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Wide local for ulcerated vulvar lesion. Middlish aged woman. This is the surrounding mucosa 🔬
❓What is going on here🔮
❓What do you think the ulcer is🧬
❓What is (or isn’t) the etiology🦠
🔆BONUS: Can IHC be helpful?
#Pathology
#gynpath
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Abortion is healthcare.
Healthcare is a right.
Say it again and again.
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@KurteL10
Good work. I’m bummed to see some of these responses. We’re doctors and our job is to help you take care of your patients and answer questions/give guidances on lab interp, diagnostic workup, blood product usage, etc.
So call us.
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Quick rundown of various
#TransfusionMed
and
#Bloodbank
conditions and their classically associated antibodies. Anything you'd like to add?
#KnowOrFail
#PathBoards
#Blooducation
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@Aiims1742
I don’t want to make light of things...so let’s just put it out there that a 9.5 hour meeting in a conference room should probably never have been normal in the first place 🤮
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@DrJenGunter
@RepSeitz156
The whole purpose of these bills is to create outrage, and then when the lunacy is removed, it’s just another run of the mill abhorrent anti-choice bill that further limits women’s right to seek safe and appropriate healthcare.
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“A transfusion is a transplant.”
We do a lot to make sure it DOESNT engraft. But transfusion decisions warrant that level of scrutiny.
This includes when to transfuse, what product to give, how much to give.
#blooducation
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@drjudymelinek
@4n6doctora
The higher risk of A was not statistically significant. Relative protection of O is significant. Be aware many viruses show differences by ABO type. All viruses need to recognize proteins to bind to. Every protein on the surface of your cell has ABO antigens on it. 1/
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Blood shortages are bad right now. And they’re about to get a WHOLE lot worse. How do I handle these? First and foremost:
1.) Be available. Triage orders with BB staff. Reach out to ordering docs. Get on huddles. It’s more than just “communication.” 1/
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#Pathologists
are communicators: translating 🔬🧪🦠🧬💉into clinically meaningful words to our clinicians colleagues.
Whether at a tumor board, message of new cancer diagnosis, or phone call to manage complex RBC antibodies, there’s nothing more valuable than the conversation
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After nurses (and their allied peers who provide direct hands on patient care), perhaps no group is more important to the diagnosis and treatment of hospitalized patients than laboratory professionals. And they are being crushed. Say their name.
I know I'm petty and I don't need "thank you" for doing my job. But I want our profession to be mentioned once in a while too, since we are the profession doing the covid testing, you know?
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Me: you should get on
#PathTwitter
Resident: I don’t have time for that
Me: so you don’t have time for learning?
#PathBoards
#TweetOrFail
#ChallengeYourself
#SoManyCasesToSee
100% of the residents who were participating in Twitter reported that daily microblogging prompted them to engage in academic reading
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Mesonephric hyperplasia in a hysterectomy. Mimic of minimal deviation carcinoma:
⏹Glands/Tubules with low cuboidal epithelium
🔴Dense eosinophilic material in lumen
☁️Lobular and diffuse patterns but no stromal reaction
IHC: CD10 PAX-2 GATA-3 ➕
#Pathology
#GynPath
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Who/what is this? Wrong answers only.
#Pathology
#Anthropomorphic
#Histology
#whatdoyousee
#BreastPath
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So my wife
@DrDarland
is both a world-class
#dermatologist
and
#Baker
. Here’s her most recent creation...which I was able to share with my
@stmarymercy
Laboratory colleagues to thank them for all their hard work with recent
#CAP
@Pathologists
lab inspection!
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Before considering whether or not to use prophylactic FFP for an elevated INR, 2 necessary questions:
1.) why was the INR ordered?
2.) why is the INR elevated
#TipsForNewDocs
#blooducation
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@acweyand
So much of medical documentation is performative. Too much emphasis on documenting something, anything, usually for billing, rather than making a meaningful record for yourself, colleagues, and the patient.
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The
#clinlab
#medlab
is not a black box. It is the engine that drives modern diagnostics. Failing to invest in lab STAFF and capital is a failure.
@badasslabrat
@globalhlthtwit
To clarify: the healthcare system will collapse from the lab no longer being being self-sustsinable between lack of qualified staff, the existing staff being treated as the scapegoat by clinicians, and equipment or reagent shortages making our jobs impossible.
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A llama spit in my mouth today, so that’s where I’m at.
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@bansar_bansaria
@DrGeeONE
@DrAhmedKalebi
@BinXu16
@VijayPatho
@kriyer68
@pembeoltulu
@smlungpathguy
@Path_Matt
@sam_albadri
@SansanoValero
@lara_pijuan
@DrAldehyde
@Chucktowndoc
@luishcruzc
@TheKarenPinto
@marenwhymd
@SueEPig
@mreyesm
@drkennethtang
The point of using social media professionally is to grow both yourself and your networking sphere. It’s not about “getting it right” or having people give you accolades. The only hierarchy present on Twitter is one you falsely perceive or one you seek to create.
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This is are real America. And this is how real Americans all over the country and feeling today.
Cleaned up the audio on this so you can hear this delightful exchange more clearly on a phone.
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THE CV OF THE PLT COUNT APPROACHES 10%. SO REALLY THERE IS NO DIFFERENCE BETWEEN 45 AND 50. EVIDENCE TO SUPPORT TX IS ALL RETROSPECTIVE AND LOW QUALITY. ALSO WE HAVE A BLEEDER IN THE OR AND IVE ONLY GOT 3 UNITS IN HOUSE SO I CANT ISSUE FOR A PLT OF 47 PRIOR TO THEIR LP.
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PJP (aka PCP) infection on BAL. Frothy debris filled with “crushed 🏓 balls” on GMS.
#Pathology
#PulmPath
#Microbio
#ClinMicro
#KnowOrFail
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@DrSomedayMaybe
@soumya_goblue
Have been involved with multiple liver transplants that used 100+ units.
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@JuliPerezBot
@Dr_Oubre
Every once in a while, you come across something so succinct and yet so profound, it makes time briefly stop as you contemplate the magnitude.
This is that moment.
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Hey
#MedTwitter
,
Im working on updating my blood bank basics lecture for medicine residents. What’s the one thing you wish you knew as a trainee, or the one question you wish you’d asked, re: transfusion medicine?
#blooducation
#residency
#MedEd
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@gibbspath
@JMGardnerMD
@UMichPath
The left is our report, the right is "patient friendly". Have versions for AAA, ALH, FEA, Lob neoplasia, etc
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I reached out to the ordering docs re a patient using lots of platelets to discuss transfusion strategies. The fellow taking care of the patient said “ya know I thought I should have called that helpful pathologist.” That was me. I’ve never felt so appreciated
#blooducation
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Everyone is spot on. This is a high-grade DCIS colliding with LCIS. Elsewhere showed invasive ductal. Here’s the e-cas
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Cytokeratin (AE1/3) and ER. patient had remote history of lobular breast carcinoma
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@oni_blackstock
It’s hard to pretend that Covid is over ™️ in the US if you don’t put containment efforts against places where the public knows Covid isn’t over ¯\_(ツ)_/¯
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Im not gonna repost that horrendous video of inappropriate and ineffective CPR making the rounds, cause I know all of
#MedTwitter
has seen it. But that’s what 1 u of FFP to “correct” an INR of 1.8 is doing.
#Blooducation
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Triaging blood products orders w/ very limited inventory, to guide the care of patients, is challenging yet rewarding.
Triaging blood product orders w/ no units, to let clinical teams know we can’t do anything, is heartbreaking.
Please
#donateblood
#SaveALife
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@RyanMarino
The shortage of laboratory professionals is here, it’s real, and it’s harming patients. But Medical Lab Scientists don’t get the same notoriety as nurses, PT/OT, or even radiology techs, etc
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Differentiated Vulvar Intraepithelial Neoplasia (d-VIN), NOT HPV related, adjacent invasive squam is common
🔑Marked basal cell atypia & mites
🔑Hyper/para epi w/ red/grey cytoplasm
🔑Adjacent LS
IHC: Mutant P53 (limited to lower 1/2), loss of GATA-3 also can be useful
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#Cytokeratin
pearls: 1.) Nomenclature matters! 2.)"Pan-keratins" are not all equal: Cam5.2 in HCC is classic example!
#pathology
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@MikeSullivan
We’re also bending our curve down while things are getting worse in Ohio. These efforts work to stop the spread. The government doing nothing to financially support these industries is the problem. Every other nation is doing it.
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The last 9 mo we’ve gone all-in to improve our PBM/utilization. It’s been a huge ask of my lab team. They’ve responded amazingly:
-cut O- utilization in half
-cut system-wide platelet wastage
-almost eliminated single FFP tx
Today they made this for me.
#Blooducation
#SoProud
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Everyone loves a DOAC until I they get a message that the 1u plasma they ordered isn’t going to reverse its effect. Cause no amount of plasma is gonna reverse it, I’m sorry. I really am. And it doesn’t matter that the INR is 1.8 (stop ordering that).
#Blooducation
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Its been a while since i've posted any AP images...but heres a fun one. Striking ring mitoses in a condyloma. No history available.
#Pathology
#GynPath
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Striking Verocay-like area in an uterine leiomyoma. Very common to see focal areas like this; occasionally they are diffuse.
#pathology
#gynpath
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@ASlavitt
Listen I hate the guy too. But we need to get things done. We can worry about finger pointing and politics once it’s better under control
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Hey
@Newsweek
and Benjamin Fearnow. Appreciate your piece including DOCTOR Alicia Wilson, the forensic pathologist in the indepdt autopsy of George Floyd. Why not refer to her as “Dr. Wilson” while Baden gets that recognition.
#CallHerDoctor
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First official day of the medical calendar.
Yearly reminder to anyone who writes orders: if you aren’t sure about your transfusion options/decisions, call your transfusion service laboratory or transfusion medical director 😁
#blooducation
#TipsForNewDocs
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"what you lookin' at?!" - Reed-Sternberg cell in AITL. EBER+ immunoblasts. EBER+.
#pathology
#anthropomorphizing
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Hello
#AABBjc
and
#blooducation
colleagues! John Sherbeck from Ann Arbor, section head of the BB/TS at
@stjoesannarbor
. No COI. This is my favorite book. That says a lot about me,
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All the amazing nurses and pharmacists speaking up is a great lesson for us all.
A reminder that if a clinical laboratory scientist (this isn’t 1980, they’re not “techs”) reaches out re: a question or concern over a lab order, please give that inquiry equal respect.
Me: orders anything for a patient
Phone rings: “I see an order for X, do you really want that?”
Me: “Yes.”
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No one needs more than 2 units of uncrossmatched RBCs.
If you think they do, they really need an MTP activation.
Change my mind.
#blooducation
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AP/CP boards passed and my residency Magnum Opus manuscript submitted!
#pathology
#CrossingFingers
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@joshmcgoo
I know you’re waking up to a lot of flack. It’s important to understand how words matter.
Most hyperK is from preanalytical error. If you are entirely a “lab draw” shop, then kinda? But the lab is not some black box. Ask your PD for elective time. Gemba walk a specimen.
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Last day at
#UMichPath
before new interns start!
#Pathologists
and
#PathResidents
: look back, whats 1 thing you wish you knew when starting?
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#Massivetransfusion
protocols exist for a reason. Proper storage is as important as ratios. Keep platelets room temperature. Keep everything else on ice.
Just wasted all these products issued to a patient.
1.) Please don't panic order.
2.) If you're not going to use them, please ensure they're stored appropriately until needed.
Could've taken the red cells and platelets back into stock had they not been mixed in an open box.
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@PaulCormack
@jameshohmann
No. Was being used in the spring. And he had access to inside information. This is shameful and illegal.
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@smlungpathguy
@JitinMakker
@coolfrog1988
@JMGardnerMD
@ClinChemCham
I can change my perception of the color of the main part by telling myself what the stripe is.
I either have Buddhist monk level control of my subconscious, or, and more likely, I’m crazy.
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From the last week in Leelanau and Pictured Rocks
#PureMichigan
Also
#BidenHarris
outnumbered the Oompa Loompa signs 2-1.
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Next up: How to remember the (historically) important Lectins for
#PathBoards
-Here's a
#MemoryPalace
set to help you out.
#KnowOrFail
#TransfusionMed
#BloodBank
#Immunohematology
#Pathology
#Blooducation
#ClinPath
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It’s been WAY too long since I’ve been able to get in a donor chair…
#ABplasma
#SaveALife
#DonateBlood
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Here’s your reminder that most people, even doctors, don’t view labs as anything other than a black box. Here’s what we need:
MT/CLS
Reagents.
Instrumentation.
Reliable LIS.
All test results should be returned within 72 hours. It's not responsible for labs to pretend they can do a useful, timely test when they can't. If a lab can't keep up with the volume, it should stop accepting new tests. We have to prioritize.
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This one goes out to all my US physician colleagues. Team
#buffycoat
you can disregard.
#blooducation
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“I can’t wait to go to Tampa in the Summer.”
-No Pathologist, ever
BB/TM board travels begin tomorrow AM! 🛫💉🎧🅰️🅱️🆎🅾️
#PathBoards
#KnowOrFail
#OddsEqualsProbabilityOverOneMinusProbability
#DoIReallyNeedToMemorizeFactorIXDosage
#CallPharmacy
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@choosybeggars
@GiankaKnowBest
@DashiellHammlet
@CourtSideClips_
@mike_puterbaugh
@ToLey88
Based off of estimates of the disease course in Wuhan, there’s likely over 100k cases in the PNW right now. There’s an inherent lag time between infection => clinical presentation => confirmatory testing. And that’s assuming you can even test everyone with symptoms.
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Breast is one of my favorite organs for finding adorable incidental nothings. For example, some sort of squamous metaplasia in a small duct.
#Pathology
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Please also stop sending 20cc for cytology when you took out a liter.
All of it. We will take all of it.
Failing to send fluid for basic studies after a first thoracentesis for pleural effusion should be a never event.
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@medlabmaria
Honestly, the deemphasis of laboratory medicine and pathology in medical schools is a problem. While the lab is increasingly a black box, the need for lab data to make a diagnosis only grows.
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