Robert Brodsky
@DocsDock200
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ASH President 2023 @ASH_Hematology. Chief of Hematology Johns Hopkins.
Maryland, USA
Joined October 2022
Antiphospholipd syndrome (APS) antiphospholipid antibodies(aPL), lupus anticoagulant so confusing to students/housestaff but partly due to confusing terminology. Read on . .
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Blue blood and horseshoe crabs(Limulus): Limulus has existed millions of years, is cold-blooded and has a primitive immune system with 1 blood cell (ameobocyte), but why is their blood blue and why is it so valuable? (Pavid, K 2020 photo)
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Just walked thru NOLA convention center. All set for #ASH2022. Place looks great. 80 degrees and sunny.
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Important advance for patients with severe aplastic anemia in latest issue of Blood: Upfront haploidentical BMT. @pnhaacontact @aamdsif #aplastic
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Ever wonder what HELLP is? Hemolysis, elevated liver function tests, and low platelets but what causes it? Why is it almost exclusively in 3rd trimester? Why does it get better after delivery and what is the association with APS?.
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New heme/onc fellows: commit this simplified immunophenotyping of indolent lymphoprolif dz to memory. After that fill in the translocations. Remember that CD5 is T cell marker and basically found in just 2 B lymphoid diseases (CLL and MCL).
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High dose cyclophosphamide (HiCY) has changed landscape of alloBMT by expanding donor pool and allowing for relative safe and effective use of haplo donors. Esp useful in non-malig dz such as SAA and SCD where cure rates now approach 90%. Why does HiCY work?.
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The human body has a total of roughly 38 trillion cells; 25 trillion of them are red blood cells!!! Better learn some hematology.😄Name of cell? Disease?
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Fantastic #ash22! Great science and medicine. Power of in person meeting with over 25k palpable. Thx @JaneWinterMD and kudos to ash staff. I look forward to serving as President of this amazing society that does so much for pts with blood diseases.
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Most people don't think of RBCs as an important part of our immune system but they are! Complement receptor 1 (CR1, CD35) is a critical immune regulator. Expressed on RBC, polys, monos and B lymphs but 90% on RBCs. What does it do?.
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#hematology predictions for 2023: 1) single-board #classicalhematology will become fastest growing subspecialty in internal medicine. Thanks #HFFTP; 2) #bmt: Indications for BMT will decline for malignant disease. .
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What a spectacular lecture today honoring E Donnall Thomas by Dr. Katy Rezvani. 👏
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Shifting paradigm in treating severe aplastic anemia (SAA). #AA&MDSIF #aplasticanemia #bonemarrowfailure
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For those of you who remember ASH history, I think I just outdid @jmikhaelmd and @MikkaelSekeres. They had a lot of ribbons but I think I have the most family badges😂. So grateful to have everyone here with me. Pres. elect Narla may be a challenge.
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What is FLAER and why is it used in so many flow labs to dx PNH? Cool biology to follow:.
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Robert A. Brodsky, MD, Begins Term as 2023 ASH President -
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ASH has 3 mascots! Red is already saturated with knowledge. Leuk was on Boubon street playing it cool. He met a girl (Poly) and formed a band. They were having a blast! The noise gave Meg a headache. She took asa n now won't adhere to ASH rules. Dedicated to @redcell_doc
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Of all the events at ASH, Ashapalooza is among my favorite. Trainees are the future of hematology. Love their passion and enthusiasm. So bright and dedicated. Enjoy the ride. Amazing field (Pun) to be in! #Ash23 @ASH_hematology
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Looking forward to ASH. DYK the first ASH meeting was in AC, NJ in 1958. Approx 300 people attended including my Dad. One or more members of my family has been at every ASH meeting since. See you in New Orleans.
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66 yo female presents with fatigue and tea-colored urine. Hgb 8.9 g/dL, retic 9.2%, LDH 2.5x normal, BR 2.1. WBC and Plts normal. MCV 110. DAT + for C3d, - IgG. The antibody responsible for this condition is most likely.
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Dr. Rakhi Naik @redcell_doc has been named the new Director of the Organ Systems Foundations of Medicine (OSFM) course for Year 1-2 medical students at the Johns Hopkins University School of Medicine. JHU Med students very fortunate.
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ASH meeting #ASH2023 is just 3 months away. Don't miss Ernest Beutler lecture and Prize. Will feature development and use of emicizumab - one of the most creative hematology drugs in the past 20 years!
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Important paper with big implications for gene editing/therapy for hemoglobinopathies. @BloodJournal
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Evolutionary beginnings of hematopoiesis, clotting, and complement. #classicalheme #chesapeakebay. Science is so cool.
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Wow has this year flown! ASH is 1 month away. Reflections on a Year as ASH President | The Hematologist | American Society of Hematology
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ASH23 Practice Changing LBAs are out! 1)Perseus trial primary results. (dex,VRd over VRd) #myeloma 2)BMT-CTN1507: HaploBMT in adults with severe SCD. Curative therapy for SCD. Widely available in US. Cure rates ~90%. 10x less expensive than gene therapy/editing. #sicklecell.
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What are complementopathies? We have several in hematology.
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#ASH23 educational program is exceptional. So impressed by all the hard work of our 2023 educational co-chairs @AmyDeZern and @connors_md.
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Who liked that Ham-Wasserman talk by Dr. Greinacher? Amazing!.
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I was told to inspire them, but they inspired me. Met with some amazing hematology fellows in Hanoi.
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Diseases directly/indirectly associated with the erythrocyte P antigen (globoside): 1) red cell aplasia 2) hydrops fetalis 3) arthritis 4) erythema infectiosum 5) paroxysmal cold hemogloninuria (PCH) 6) hemolytic anemia 7) HLH.
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Human blood uses iron-based hemoglobin to transport O2 to tissues. Limulus uses copper-based molecule hemocyanin to bind and transport O2. When hemocyanin binds O2 it turns bright blue!.
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Adetola Kassim. Fantanstic job at LBA showing incredible cure rate of SCD following haploBMT with PTCy!
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10) #ASH23 with attract over 30k in-person registrants. Happy and healthy New Year to all! See you in San Diego.
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Don't miss #ASH23! I just spent 2 full days in San Diego with several of the ASH brain trust. Such an amazing group of dedicated people who make ASH what it is. Look what was on the the menu. It's going to be a spectacular meeting.
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2023 Ham-Wasserman lecture #ASH23 by Andreas Greinacher on thrombotic anti-PF4 Immune Disorders. Learn about classification of anti-PF4 Abs: 1) non-pathogenic, non plt activating 2) heparin dependent & plt activating 3) heparin independent & plt activating.
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Cryoglobulinemia classification: Type I monoclonal IgG; Type II monoclonal IgM that binds Fc of polyclonal IgG; Type III polyclonal immunoglobulin of > 1 subtype.
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Hematology workforce shortage? How we got here and how we are addessing it. #ASHTrainee#classicalheme#HFFTP
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PIGA mutations make one think PNH, but did you know there is another disease caused by PIGA mutations? Multiple congenital anomalies-hypotonia-seizure-syndrome 2 (MCAHS2) . read on.
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APS is characterized by arterial or venous thrombosis and/or recurrent fetal loss in presence of persistent aPL. So what does that mean and what's the mechanism? Let's start with the misnomers. .
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The cell is a schizont. Disease: P. Vivax malaria. Schizonts are cells formed from a tophozoite during the asexual stage of the life cycle of sporozoan protozoans, such as plasmodium vivax.
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They used this info to develop the Limulus ameobocyte Lysate (LAL) assay to detect gram (-) bacteria and endotoxin. This assay was approved by FDA in 1970s and is still used to test drugs, blood products, IV fluids etc. today.
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A robot served me lunch in the Frankfort airport on my way back from EHA. Do you tip the robot? 🤷♂️
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Program directors and Med students/residents interested in hematology. This is the wave 🌊 of the future. Don't miss this amazing opportunity from @ASH_hematology
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Excited for #ASH23 presidential symposium on complement Dec. 12,2023 @11am. @roumenina wll discuss the canonical complement cascade with an emphasis on defense against pathogens and host cell damage. Next @CKemperLab will discuss . .
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1) lupus anticoagulant: a) most patients with APS don't have lupus b) these patients clot; they don't bleed despite a prolonged aPTT. 2) there are no antiphospholipid antibodies. The antibodies primarily recognize proteins (eg B2GPI).
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You all were magnificent!.
@ASH_hematology .Ready for the Presidential Symposium at #ASH23! Join the Presidential Symposium today from 11-12:30 PT chaired by @DocsDock200 to hear @elenicelli, @roumenina, & @CKemperLab ! #AshGreenRoom
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Now you understand why aPTT and dRVVT are prolonged. A key reagent (phospholipid) is neutralized by aPL antibodies. The lab then spikes in extra phospholipid (confirm ratio) to prove the prolongation is phospholipid dependent and not due to a factor deficiency.
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ASH is so much more than an annual meeting. Do you want to get involved in ASH's scientific committees? Watch this 3.5 min video, go to ASH's website, and have a colleague nominate you for a committee that fits your expertise.
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Advancements and Challenges in Hematology: From Bone Marrow Transplants to Targeted Therapeutics Amazing advances in hematology since my fellowship training just a few years ago 😅. Time flies when having fun and I've had a lot!.
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1956: Fred Bang discovered that injection of only Gram (-) bacteria causes limulus blood to clot. Jack Levin found that the ameobocyte is mobile, contains granules, and purified a clotting factor known as coagulogen from Limulus.
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Spent last week at ASH Headquarters for the annual meeting #ASH23 Program Committee joint meeting. Amazing job by co-chairs Drs. Elizabeta Nemeth and Kojo Elenitoba-Johnson! We'll probably set a record for PhD speakers/Chairs in Scientific program. Great science!.
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The LAL can detect 1 femtogram of endotoxin in 1mL of water! Limulus was bled by inserting a needle into dorsal sinus ("heart") to withdraw a small amount of blood and then returned to the ocean. Recombinant methods now available.
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Don't miss this. I'll be giving out a special surprise.
ASH-a-Palooza is all about micro-learning, mentorship, networking, and more! Come hang out and network with your peers on Friday, December 8 at 12:45-5:00p.m. at Petco Park. The event will also be streamed on the #ASH23 virtual platform. Learn more:
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Amazing fellows now treasured colleagues. Fantastic memories.
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CD46 aka membrane cofactor protein (MCP) is an important complement regulator. CD46 is a cofactor to factor I (fI). Binds C3b and C4b and puts a brake on complement by preventing formation of C3 and C5 convertases.
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Check out the ASH Foundation and the ASH Donor Lounge in SD. A $250 donation gains you access to the lounge (beat the long coffee lines). 100% of funds go to ASH programs. @ASH_hematology
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ASH Celebrates 20 Years of Progress With Minority Recruitment Initiative | The Hematologist | American Society of Hematology
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HELLP is a TMA closely related to aHUS. Schistocytes, HTN, renal abnormalities seen in both. In fact, up to 40% of HELLP patients harbor rare germline variants in genes regulating the alternative pathway of complement (APC) just like aHUS.
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So proud of @elenicelli and @BloodClotDoc . I can't say rising stars anymore. They're just stars.
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The Limulus ameobocyte assay for detection of endotoxin is performed 70 million times a year. Assures our meds, IV fluids, bio prosthetic joints, vaccines etc are endotoxin free. Amazing to hear the story from Dr. Jack Levin who discovered it 60 yrs ago.
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. especially ALL, B cell lymphoma, CLL, and myeloma as non-transplant therapies improve (drugs, bispecifics, CAR-T, checkpoint inhibitors); 3) #bmt BMT indications for classical heme will increase as safety of allogeneic BMT increases. .
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This explanation explains many but not all cases; nevertheless, complement inhibitors are increasingly being used, off label, but often successfully, to treat HELLP. Clinical trials needed.
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Adult CAD is a distinct clonal lymphoprolif disease recognized by the WHO. The auto Ab in CAD is a monoclonal IgM that recognizes the big I Ag on RBCs. The Ag binds in periphery (acral circulation) fixes complement on rbcs and dissociates in central circulation.
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. haplo BMT with PTCy has higher cure rate than ATG/CSA/Epag and haplo BMT for SCD will have cure rates approaching 90%; 4) #MPD early treatment with interferon-based therapy will become standard for PV - decrease clonal burden;.
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>20 yrs ago JT Buckley and I established a proAERolysin variant that binds GPI but doesn't form channels. We added a FLuorescent tag to establish FLAER as a reagent to Dx PNH by flow cytometry.
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Hemolysis is mechanical. There is no liver function abnormality in most cases - increase in LDH, bilirubin and Aspartate amino transferase from intravascular hemolysis! Low platelets from consumption due to microvascular injury.
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Congrats to all the new ASH scholars. I received this award about 25 yrs ago. Huge jumpstart to your careers.
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7) #complement oral complement inhibitors will become available for PNH; 8)#myeloma bispecifics will outdual CAR-Ts for MM; 9)#AML use of dose intensive induction will decline, even in more fit patients;.
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Gene Therapy Risks in SCD: Myeloid Malignancy Mechanisms Revealed
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We mostly focus on the acute disease and manage with plasma exchange, rituximab and caplacizumab but new research from @BloodClotDoc teaches us that TTP pts continue to have silent and symptomatic cerebral infants even in remisssion. @ASH_hematology @HopkinsHeme
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Don't miss the 2023 EHA-ASH Joint symposium - Lymphoma: The way forward. 6/10/23, 9:45am Fantasie. I will co-chair with EHA President Elizabeth Macintyre. @eha2023 #Frankfurt @ASH_hematology
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In preparation for child birth complement levels normally rise after 20 weeks gestation. When this happens in a woman with inherent problems regulating complement a threshold is reached --> endothelial damage and microvascular thombosis (HELLP).
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Listening to ASH CRTI trainees deliver their 3 min elevator talk in La Jolla, CA. Such an impressive group! #ASHproud
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5) #CLL BTK degraders will encroach on BTK inhibitors - decrease resistance mutations; 6) #hemostasisthrombosis contact pathway inhibitors will begin to encroach on warfarin and factor X inhibitors for DVT prevention;.
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Clearly a blood smear with microspherocytes c/w w-AIHA but what's the mechanism(s) of hemolysis?
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Huge shout out to @jkw444, @Ashley_Rosko1 and @KerryARogersMD aka travel buddies! They all gave spectacular talks at ASH highlights in Hanoi. Without them I might not not have made my way back😂. Big perk of being ASH Pres is getting to know wonderful people. Thx!!!.
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Congrats! Great Beutler lecture on emicizumab. Game changer for hemophilia A.
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Welcome to JHU Heme.
We are so excited to welcome these brilliant Heme Track fellows to our @HopkinsHeme #HemeDreamTeam!!. The future of hematology is so bright!! 🩸🌟🩸 #Match2024 #ASHHFFTP
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Delivery of fetus often improves condition in days due to elimination of "trigger". APS is a strong amplifying condition and increases chances of a woman acquiring HELLP.
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30 yrs ago mortality from TTP was high and we didn't understand the pathophysiology. We now know it's due to deficiency of ADAMTS13 - usually due to an auto antibody.
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@ASH_hematology has 4 wonder journals @BloodJournal @BloodAdvances @ASHClinicalNews The Hematologist - and 4 wonderful Editors - Nancy Berliner @CathBollard1 @AaronGerds @myelomaMD Stay tuned - new journals from ASH coming!
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In short, Hit 1 often genetic and Hit 2, 3rd trimester complement levels +\- another complement amplifying condition. Now the acronym makes sense . !.
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Interesting poll results (unofficial) re: curative therapies for SCD(below). The exciting part is that we now have approved and potentially curative approaches for SCD in resourced countries and can have this discussion!.
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Alt path complement(APC) deep dive: C3,FD,FB,FP are 4 main proteins of APC. There r two C3 convertases in APC! Read this and previous tweetorial on HiCY and you'll be prepped for 2/6 LBAs at #ASH22.
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Two impressive new journal editors on the way for: 1) Blood Neoplasia and 2) Blood Vessels, Hemostasis and Thrombosis. Stay tuned.
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