Dolly Fiallo

Hematóloga.
SMD, Hematogeriatria, Citologia y Citometría, VEXAS

[Ahmed Kotb @AhmedKo45911157]

Acute leukemia of ambiguous lineage: the known and the uncertain
https://t.co/aQXyOzYSK4

[GEHEG @hematogeriatria]

NUEVAS recomendaciones de valoración para pacientes con #SMD mayores de 50 años, incluye la GAH como herramienta de valoración. @gesmd @JGeriOnc @sehh_es

[Dolly Fiallo @DollyFiallo]

#Humanizando la #Hematología, mesa de pacientes en la reunión anual @gesmd. Gracias a los pacientes y a la Dra. Francisca Hernández por la iniciativa @sehh

[Dolly Fiallo @DollyFiallo]

Los macrófagos nodriza son #células especializadas que se rodean de eritroblastos para promover su maduración, nutrición y eliminación de núcleos expulsados, esenciales para la eritropoyesis @GHematologica #diagnosticointegrado #citodiagnostico #hematologia

[Manual Of Medicine @ManualOMedicine]

Antibiotic Susceptibilities

#medtwitter #foamed #meded

[Nishant Rajendra Tiwari @Nischistocyte]

🩸🔍 Stepwise Approach to New-Onset Pancytopenia 📚
*Educational post — not medical advice.*

1️⃣ Review baseline blood counts → Acute vs chronic? ⏳

2️⃣ Evaluate for serious/critical conditions:
- 🧫 Acute leukemia? Other aggressive hematological malignancies? *(Peripheral smear, flow cytometry, bone marrow biopsy as indicated)*
- 🔥 Neutropenic fever? Treat per algorithm if present! 🩺

3️⃣ Transfusions needed? Severe anemia or thrombocytopenia? 💉

4️⃣ Any signs of DIC or TLS? *(PT/aPTT, fibrinogen, LDH, uric acid, Phosphorus)* 🧪

5️⃣ Medication review — always check latest literature for drug associations! 📖💊

6️⃣ Investigate secondary causes (clinically guided):
- 🥗 Nutritional: B12, folate, thiamine, copper, zinc
- 🦠 Viral: HIV, Hepatitis, CMV, EBV, HHV-6, VZV, Parvo B19, HSV1/2
- 🍄 Fungal: Disseminated histoplasmosis
- 🦠 Bacterial: Typhoid, brucellosis, TB
- 🐛 Parasitic: Leishmaniasis, malaria
- 🤝 Immune: SLE, RA, Evans syndrome
- 🧬 Endocrine: TSH, Free T4, AM cortisol, ACTH *(rule out panhypopituitarism)*

7️⃣ Imaging? Look for lymphadenopathy, splenomegaly, liver cirrhosis, malignancy etc.
- 🖼️ I try to get a CT chest/abdomen/pelvis with contrast if renal function allows!

8️⃣ When to do bone marrow biopsy?
- ✅ Suspected hematologic malignancy
- ✅ Unrevealing workup
- ✅ Planning growth factor therapy (G-CSF, TPO mimetics)

9️⃣ Radiation? Heavy metals? Environmental toxins? Excess alcohol? ☢️🧪

1️⃣ 0️⃣ Syndromic features of inherited bone marrow failure syndromes (IBMFS)?
- Aplastic anemia morphology? Bone marrow exam clues?
- 👶 Young patients or syndromic features? → Consider germline testing!

1️⃣ 1️⃣ Rare but notable causes (investigate as indicated):
- 🩸 PNH
- 🧫 Post-transplant LPD
- 🍬 Glycogen/lysosomal storage disorders
- 🌀 Primary HLH *(especially in kids)*
- 🌿 Sarcoidosis
- 🧬 Primary immunodeficiencies

📌 Key Clinical Pearls:
- 🚨 Acute pancytopenia in a healthy adult = medical emergency → **always rule out acute leukemia**!
- 🟦 Microcytic anemia + pancytopenia? Think copper deficiency or severe malnutrition (B12/folate + iron deficiency!)
- 🔄 Secondary HLH is more common in adults than primary HLH.

🧠 This is a 'framework', not the full DDx — the differential is too vast for one tweet! Happy to hear any feedback for it's improvement.
#MedEd #Hematology #Pancytopenia #ClinicalPearls #MedicalTwitter 🩺✨

[Nishant Rajendra Tiwari @Nischistocyte]

My 12-Step Thrombocytopenia Workup 🧵
(Not Medical Advice)

1. Review baseline counts first. Rule out pseudothrombocytopenia.

2. Evaluate for critical conditions: TTP, HIT, or DIC?
• Assess heparin exposure - Calculate 4T score.
• Peripheral smear for schistocytes.
• Check LDH/Haptoglobin/Bilirubin, PT/aPTT/Fibrinogen.

3. Assess for acute leukemia or bone marrow involvement?
• Examine peripheral smear for abnormal/neoplastic cells.
• Consider imaging if clinically indicated.
• Do we need a bone marrow exam?

4. Active life-threatening bleeding? Do we need a platelet transfusion?

5. Review drug-induced thrombocytopenia. Always consult latest literature for implicated medications.

6. Investigate secondary causes:
• Nutritional deficiencies: B12, Folate, Copper, Zinc.
• Infections: HIV, Hepatitis, CMV, EBV, HSV (clinically guided).
• Sepsis leading to DIC.
• Endocrine disorders: TSH, Free T4.

7. Review imaging for cirrhosis/splenomegaly. If inconclusive, obtain abdominal ultrasound.

8. Consider mechanical causes: Dialysis/ECMO/IABP/cardiopulmonary bypass/artificial heart valve?

9. Evaluate pregnancy-related disorders: HELLP, AFLP, gestational thrombocytopenia.

10. Assess for autoimmune conditions if clinically warranted. Consider SLE and other rheumatological diseases.

11. Consider rare but serious differentials:
• CAPS, other TMA causes, PNH
• Post-transfusion purpura, HLH
• Pursue only with appropriate clinical suspicion

12. If no clear etiology identified, consider ITP as diagnosis of exclusion.

📋 Key Clinical Considerations:
• Critically ill patients frequently have multifactorial thrombocytopenia [A combination of some of the above].
• Primary HLH presenting de novo in adults is exceedingly rare.
• Thrombocytopenia with thrombosis: Consider DIC, TTP, HIT, PNH, or VITT.

[Image AI Generated]

#Hematology #MedTwitter

[Grupo Español de Citología Hematológica @GHematologica]

En este grupo de imágenes se presenta una reacción leucemoide neutrofílica.

A: tubo EDTA sangre total con aumento de capa leuco-plaquetaria. B y C: frotis de SP tinción May-Grünwald-Giemsa, D y E: tinción fosfatasa alcalina granulocítica (FAG) con aumento del índice de actividad

[Dolly Fiallo @DollyFiallo]

El envejecimiento biológico y las vulnerabilidades funcionales son determinantes en el pronóstico de #LMA
La #VGI emerge para:
✅ Identificar déficits
✅ Personalizar el tratamiento
✅ Mejorar la calidad de vida y supervivencia
📖DOI: 10.1007/s11864-025-01341-5
@SGerontologia

[HemaSphere Journal (prelim IF = 11.3) @Hemasphere_EHA]

🚨REPLAY🚨

In this second part of a 2-part episode, Dr Charles De Bock engages with Prof Dr Petya Apostolova and Dr Jörg Büscher to explore the intricate relationship between metabolism and hematology, particularly focusing on #AML. They discuss the challenges and advancements in metabolomics, the importance of integrating multi-omics approaches, and the future directions of research in this field. The conversation highlights the need for a deeper understanding of metabolic pathways and their implications for cancer treatment, emphasizing the significance of context in cellular behavior and the potential of spatial metabolomics.

"Metabolism in hematology”, is on our website, all major podcast platforms, and YouTube. Listen and enjoy casual, insightful discussions about #hematology research.
🎧 https://t.co/5dLm98ZeHz

You can find the referenced Review article and podcast, in full and open access, on the HemaSphere website https://t.co/io5VhqWDOn

[Dolly Fiallo @DollyFiallo]

:🧬 Hoy Día Mundial del Síndrome Mielodisplásico (#SMD).
Este grupo de trastornos afecta la médula ósea y la producción de células sanguíneas.
Promovamos la investigación, el diagnóstico temprano, la calidad de vida y el acceso a tratamientos innovadores.
#DíaMundialSMD @gesmd

[Dolly Fiallo @DollyFiallo]

🩸 New publication!
Proud to share our study in @AjHematology on coexisting #myeloproliferative and #lymphoid neoplasms.
MPN-first patients, especially with JAK2 mutations, showed poorer survival.
Thanks to all collaborators!
🔗https://t.co/qEmdlyf8uz
@sehh_es #GEMFIN @gellc

[Grupo Español de Citología Hematológica @GHematologica]

Empar Mayordomo nos hablo de SMD hipoplásico y anemia aplásica

[Dolly Fiallo @DollyFiallo]

🧠💉 Artificial intelligence in the diagnosis of hematologic diseases — Dr. @Torsten Haferlach.
La IA optimiza el diagnóstico hematológico integrado al mejorar la reproducibilidad y acelerar los resultados. #Hematology #AI #Hemato2025

[GEHEG @hematogeriatria]

🎉 Enhorabuena a la Dra. Boqué, galardonada con el 8º Premio Soledad Woessner a la trayectoria profesional y humana por @sehh_es.
Desde el grupo @hematogeriatria expresamos nuestra satisfacción y orgullo por este merecido reconocimiento a nuestra mentora 💐✨ #Hemato25

[Dolly Fiallo @DollyFiallo]

En #LMMC el Dr @GMontalbanBravo hace referencia a los nuevos tratamientos, los cuales deben acercarse a los procesos específicos claves en la enfermedad. Enhorabuena por la presentación @gesmd

[Dolly Fiallo @DollyFiallo]

Gran presentación del Dr. David Valcárcel sobre el momento óptimo y la reducción de recaídas post-#TPH alogénico en #SMD. #Hemato25 @gesmd

[Dolly Fiallo @DollyFiallo]

Excelente presentación Dr Robert P. Hasserjian en #SMD. #Hemato25 @gesmd @sehh_es

[Dolly Fiallo @DollyFiallo]

Empezamos!! Congreso Nacional @sehh_es y @SETH. Oviedo
#Hemato25

[Dolly Fiallo @DollyFiallo]

Empezamos 8 curso práctico de #citometriadeflujo. Enfermedades Hematológicas raras @sehh