प्रिdha!

|MBBS | MD Pathology |Proud to have XX chromosomes|

[प्रिdha! @PiddiLite]

@RailwaySeva Booked 2 wheeler parcel. People at station are asking for extra charges. They are not giving the delivery.
@RailMadad

[Aditya Agnihotri 🇮🇳 @adi_agnihotri]

🏆 #PathTweetAward Compilation – May 2026
Great cases, sharp observations, and valuable pathology discussions from across the community.
Have a look—you may discover something interesting. 🔬

[प्रिdha! @PiddiLite]

#NewProfilePic

[प्रिdha! @PiddiLite]

@DrKamleshDarji1 All the best🔥

[Mamtha Balla, MD, MPH, FACP @MamthaB]

🩸 Acute Myeloid Leukemia (AML) — Boards/ITE Power Thread
(Follow ASCO/ASH/NCCN for latest updates)

1️⃣🩸Clonal myeloid blasts → marrow failure (anemia, infections, bleeding). Disease of older adults (median ~68–69). AML + CLL = most common adult leukemias.

2️⃣🎯 Therapy‑related AML (t‑AML)
->Alkylators/radiation → 5–7 yrs → −5/−7, complex karyotype.
->Topo‑II (etoposide/anthracyclines) → 2–3 yrs → 11q23 (KMT2A).

💫Topo‑2 → 2–3 yrs → chr 11 💫

3️⃣🧬 Modern AML classification (WHO/ICC)
->Genetics > blast %. NPM1, CBF, PML::RARA, KMT2A, NUP98, MECOM, etc can define AML even <20% blasts. ->ICC adds MDS/AML (10–19% blasts + MDS‑type genomics).

4️⃣🧬 Germline AML clues
->Teens/young adults + cytopenias or family hx → think inherited.
->DDX41 = most common adult germline AML; often older, cytopenias, hypocellular marrow → refer for genetic counseling before choosing donor.

5️⃣🚨 AML emergencies (boards 😻these)
->Hyperleukocytosis/leukostasis → hydroxyurea ± leukapheresis → then chemo.
->DIC + AML → think APL → start ATRA immediately.
->TLS (esp VEN) → fluids + allopurinol ± rasburicase.
->Neutropenic fever → broad IV abx NOW.

6️⃣📋 Diagnostic core
->AML = ≥20% blasts OR AML‑defining genetics (e.g., inv(16), NPM1).
->APL: CD34− / HLA‑DR− promyelocytes, t(15;17), DIC.
Always send cytogenetics + NGS at dx.

7️⃣📊 ELN 2022 — memorize this grid
->Favorable: CBF (t(8;21), inv(16)), NPM1 mut (no adverse), CEBPA bZIP.
->Intermediate: all FLT3‑ITD (ratio no longer used).
->Adverse: TP53, complex/monosomal, inv(3), MDS‑related genes (ASXL1, BCOR, EZH2, RUNX1, SF3B1, SRSF2, STAG2, U2AF1, ZRSR2), therapy‑related/AML‑MR.

8️⃣🧪 Risk shift pearl
->FLT3‑ITD = always intermediate risk now.
->No more allelic ratio games. NPM1 no longer “rescues” FLT3‑ITD into favorable. You still add a FLT3 inhibitor if fit.

9️⃣💉 Fit patients (intensive)
->Backbone = 7+3 (never daunorubicin 45 mg/m²).
->CBF → add Gemtuzumab Ozogamicin (best in favorable).
->FLT3 (ITD or TKD) → add midostaurin; FLT3‑ITD only → quizartinib option.
->Therapy‑related / AML‑MR (esp 60–75) → CPX‑351.

🔟💊 Unfit / older AML
->Default = azacitidine + venetoclax.
->High response rate, better OS than AZA alone.
Watch: TLS (ramp up, cytoreduce first), profound cytopenias → do marrow after C1, then build in VEN breaks; reduce VEN with strong CYP3A4 inhibitors (azoles).

🧬 Genomics in AZA‑VEN era
->TP53 = terrible regardless of regimen.
->Signaling mutations (FLT3/RAS) = intermediate.
->Best outcomes = non‑TP53, non‑secondary genomics.
->ELN was built for intensive chemo, less predictive with AZA‑VEN.

📉 MRD = the real boss
->CR ≠ cure. MRD (flow ~10⁻⁴, PCR 10⁻⁵) refines risk.
->“Favorable + MRD+” → NOT truly favorable → think allogeneic transplant in CR1, especially NPM1‑mut MRD+.

🌱 Who gets allo‑SCT in CR1?
->Adverse risk.
->Most intermediate risk.
->Any favorable‑risk with MRD+.
->Relapse after CR1 → if 2nd CR achieved, go to transplant.

🎯 Targeted agents: know this mini‑table
1. FLT3: midostaurin (new dx ITD/TKD), quizartinib (new dx ITD only), gilteritinib (relapsed ITD/TKD).
2. IDH: ivosidenib (IDH1), enasidenib (IDH2).
3. IDH drugs & APL therapy = differentiation → beware differentiation syndrome → steroids early.

⭐ APL — guaranteed exam hit
->t(15;17) PML::RARA, CD34− / HLA‑DR−, DIC.
Management rule: ATRA NOW, then confirm.
->Treat coagulopathy (fibrinogen >100–150, platelets >30–50k).
->ATRA + ATO ± anthracycline/GO → cure rates >90%.

🧠 Ultra‑compressed AML hooks
NPM1 = Nice prognosis.
TP53 = Terrible.
CBF = Good + GO + HiDAC.
FLT3‑ITD = intermediate; ratio retired; add FLT3 inhibitor.
Unfit = AZA‑VEN.
MRD+ = transplant.
APL = ATRA ASAP.

#ITE #BoardReview #HemeOnc
#HemOnc #Leukemia #AML #MedTwitter #FOAMed #OncTwitter #ITE #BoardReview #IMResidency #FellowTwitter @ASH_hematology @ASCOorg @theNCCN @BloodJournal @JCO_ASCO @LeukemiaJnl #HemOnc #MedTwitter #FOAMed @realbowtiedoc @IMG_Oncologists @NazliDizman @ASH_hematology @HemOncFellows @OncoAlert @oncodaily

[प्रिdha! @PiddiLite]

@WhatsApp @Meta @AshwiniVaishnaw @GoI_MeitY

[प्रिdha! @PiddiLite]

Hello @WhatsApp @Meta @GoI_MeitY 9028232929 WhatsApp number has been banned without any violation of rules since 20 days. Kindly look into it.

[प्रिdha! @PiddiLite]

@DrKamleshDarji1 ♥️

[प्रिdha! @PiddiLite]

@DrKamleshDarji1 PTC!

[प्रिdha! @PiddiLite]

@boAtSupport1 9021124211

[प्रिdha! @PiddiLite]

@RockWithboAt Bought Smart watch Primia. Hardly used for 2 months and now it isn't working.

[Aditya Gupta @DrAditya2935]

I was found to be a match for someone with Leukemia and donated my Stem cells this year.
Considering my father passed away from ALL, this was the most cathartic thing I had done in recent times.

[Karvaan @Karvaan6]

When Irrfan Khan Said:

“Jab bhi tootna, akele mein tootna, ye dunya tamasha dekhne mein maahir hai.”

We all relate to every word of him.

[Z. Tariq @TheLabDoc]

Pathology &amp; Food - a thread 🧵
#PathTwitter

[Frontalforce 🇮🇳 @FrontalForce]

First patient declared ‘cancer-free’ using indigenous CAR-T cell therapy developed by Tata Memorial Hospital in Mumbai.

It costs 42 lakhs compared to 4 cr overseas.

“While it’s premature to claim a lifelong cure, the patient is currently free of cancer cells,” say doctors.

[प्रिdha! @PiddiLite]

Do you remember when you joined X? I do! #MyXAnniversary

[Madni Aghadi @hey_madni]

RIP PowerPoint.

No more wasting time on design work and tutorials.

Here are 7 websites to create presentations with AI in seconds: 🧵 👇

[Jay "Thymocyte" Hwang @Path4People]

I arise in the nipple-areolar area with eczematous or erythematous change

I am oftentimes associated with a high grade DCIS or invasive cancer

I am HER2 +

Who am I?

#pathagonia #breastpath #breastx #medstudentx #medstudent #usmle #dermpath #derm #dermx #pathx #fammed #medx

[प्रिdha! @PiddiLite]

@drkunalsehgal Sir not able to send DM.

[प्रिdha! @PiddiLite]

@drkunalsehgal Good morning Sir, how to contact you?