Mohammed Elfadl

[William Aird @WilliamAird4]

1/7

OXYGEN CARRIAGE ≠ OXYGEN SENSING

Thanks to the 234 people who voted in the poll asking what happens to EPO levels when a patient with Hb 3 g/dL is exposed to 100% O₂ at 3 ATA.

The majority got it right: EPO decreases.

[Liver Fellow Network @LiverFellow]

🧬 What happens?
Myeloablative therapy damages sinusoidal endothelial cells → sinusoidal obstruction → impaired hepatic outflow → post-sinusoidal portal hypertension.

⏱️ Timing
• Classic SOS usually presents within 21 days of stem cell transplant

[William Aird @WilliamAird4]

A patient has a hemoglobin of 3 g/dL and a markedly elevated serum EPO level.

The patient is then placed in a hyperbaric chamber breathing 100% O₂ at 3 ATA.

What happens to EPO secretion?

[ISTH @isth]

🚨Can we use standard D‑dimer thresholds in postpartum patients? How should we manage suspected PE during the postpartum period? Our NEW JTH Research Recap dives into this important topic!

📰 Read the paper: https://t.co/KOFBNgkbhr

📽️ Watch the recap: https://t.co/lAaO3WBWy8

[William Aird @WilliamAird4]

PRIMER ON RBC INCLUSIONS

1. Nucleated RBC
2. HJ body
3. Basophilic stippling
4. Pappenhemer body
5. Parasite

[William Aird @WilliamAird4]

3/3

In between are gray zones that the usual definition does not capture well.

Pica may be the most recognizable manifestation, not the entire phenotype.

Perhaps we should think more broadly about iron deficiency-associated changes in ingestive behavior.

[William Aird @WilliamAird4]

2/3

But among the many iron deficiency-associated cravings I have encountered in practice are:

toilet paper → ice → orange peel → raw rice or okra

At one end: classic pica.

At the other: an intense craving for nutritious food.

[William Aird @WilliamAird4]

1/3

PICA MAY BE ONLY ONE END OF A SPECTRUM

Pica is classically defined as the persistent craving for or ingestion of nonfood, nonnutritive substances.

That seems straightforward.

[William Aird @WilliamAird4]

1/3

CULTURE COMPLICATES PICA

The same ingestive behavior may represent a new, compulsive craving associated with iron deficiency in one person and a longstanding, socially accepted practice in another.

The behavior is the same. Its clinical meaning may not be.

[William Aird @WilliamAird4]

1/8

PERIPHERAL SMEAR

QUESTION:

Check out the peripheral smear (low power) in the graphic. How would you describe it?

[William Aird @WilliamAird4]

PSEUDOTHROMBOCYTOPENIA - A RARE CAUSE

65 yo M with platelet count 45K. Peripheral smear showed platelets clinging to fibrin strands due to a pre-analytical artifact from in vitro platelet-fibrin interaction.

Always confirm a low platelet count with a smear review!

[William Aird @WilliamAird4]

1/2

ACANTHOCYTE

BLOOD: A term (from Greek word meaning thorn) used to describe a certain type of spiculated RBC on peripheral blood smear.

URINE: A term coopted from the hematology field to describe a non-spiculated dysmorphic red cell on phase contrast urine microscopy.

[ASH @ASH_hematology]

Final call! Organize a poster walk at the 68th ASH Annual Meeting and Exposition and showcase emerging hematology research to an international audience.

Apply today: https://t.co/utf16qmzNS

#ASH26 #Hematology

[William Aird @WilliamAird4]

BEWARE THE IRON GUMMY

Many iron gummies contain only 5–18 mg of elemental iron per serving.

For comparison, one 325-mg ferrous sulfate tablet provides about 65 mg of elemental iron.

When a patient says they are taking iron, check the formulation and elemental iron dose.

[William Aird @WilliamAird4]

1/2

NEUTROPHIL DIFFERENTIATION IS A CONTINUUM

I know this is stating the obvious, but sometimes the obvious needs to be stated. 🙂

The classical scheme:

Promyelocyte → Myelocyte → Metamyelocyte → Band → Segmented neutrophil

is indispensable for communication.

[William Aird @WilliamAird4]

TOXIC GRANULATION

Fantastic response to yesterday’s poll, and most of you got it right:

Panel A showed toxic granulation.

But what exactly makes those primary granules become so conspicuous?

The familiar explanation is only part of the story.

[William Aird @WilliamAird4]

WHICH BLOOD SMEAR FINDING BEST MATCHES THIS CBC/DIFF?

Look closely at the CBC and differential.

Which image best matches the expected blood smear: A, B, C, or D?

[William Aird @WilliamAird4]

WHY RED CELLS?

Babesia lives inside red cells in mammals.

Yet in ticks it invades nucleated cells of the gut and salivary glands.

Why evolve an almost exclusive dependence on erythrocytes in mammals?

What makes a bag of hemoglobin such an ideal home?

[William Aird @WilliamAird4]

1/3

COLD AGGLUTININ DISEASE: A 360° VIEW

We've launched a new Topic Module on CAD.

Not just what CAD is, but how to think about it:

• clone vs complement
• diagnosis as reasoning
• treatment strategy
• landmark trials
• patient stories & lived experience

[William Aird @WilliamAird4]

CIRRHOSIS AND BLOOD

Cirrhosis is not just a “liver problem.”

It affects the whole hematologic system:

RBCs → target cells, spur cells
WBCs → leukopenia
Platelets → thrombocytopenia
Coagulation → not simply “auto-anticoagulated”