Andrea Rivera Sarabia

“En una persecución lenta, pero con paso imperturbable”

[Andrea Rivera Sarabia @andrearsarabia]

¿Porqué Hematología? Por Mamá linda

[Dr.hou @DrHou_pathology]

Diagnostic Approach to Large B-Cell Lymphoma

Large B-cell lymphoma (LBCL) is the most common type of aggressive mature B-cell lymphoma. In the 5th edition of the WHO Classification of Haematolymphoid Tumors, LBCL has been further refined into as many as 17 distinct specific subtypes. Cases that do not fit into any defined subtype are classified as diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS). The increasing precision of LBCL classification requires pathologists to adopt more accurate and comprehensive diagnostic strategies. Meanwhile, the continuous development of novel therapeutic agents and the diversification of treatment approaches have placed higher demands on precise LBCL subclassification and the identification of clinically relevant molecular alterations.

The diagnostic workup typically includes an immunohistochemical panel consisting of CD20, PAX5, CD3, CD5, CD10, BCL2, BCL6, MUM1, CD138, Cyclin D1, CD30, p53, MYC, Ki-67, and Epstein–Barr virus (EBV)-encoded RNA (EBER) in situ hybridization. In addition, fluorescence in situ hybridization (FISH) analysis is performed to detect genetic rearrangements involving MYC, BCL2, BCL6, and IRF4, among other relevant molecular abnormalities.

[Benlazar S M A @smbenlazar]

How doI séquence therapies for anemia in LR-MDS #mds

[Mehak Trehan @mehak_trehan]

Its' Anemia Week this time. ⏰
CKD anaemia: some important shifts in KDIGO 2026

🔹 Don’t look at Hb alone. Ferritin + TSAT should be part of routine assessment.

🔹 Iron thresholds are now clearer:
• Non-HD CKD: consider iron if ferritin <100 with TSAT <40%, OR ferritin 100–300 with TSAT <25%
• Haemodialysis: IV iron preferred if ferritin ≤500 AND TSAT ≤30%
• Withhold routine iron if ferritin >700 or TSAT ≥40%

🔹 Iron deficiency without anaemia matters: ferritin <30 + TSAT <20% may warrant treatment even with normal Hb.

🔹 ESA remains first-line when pharmacologic treatment is needed. HIF-PHIs are an alternative NOT the default AND should be avoided with active malignancy or recent cardiovascular/thrombotic events.

🔹 In dialysis, ESA initiation around Hb ≤9–10 g/dL is suggested; do not maintain Hb ≥11.5 g/dL.

For Indian practice:
This argues for moving beyond the common “low Hb → ESA” approach. Check iron properly, correct reversible causes first, and avoid escalating ESA for what may actually be iron-restricted erythropoiesis.

Particularly relevant where iron deficiency, inflammation, CKD and anaemia frequently overlap.

[Abdul Muqtadir Abbasi @AbbasiMuqtadir]

How do hematologist know, which coagulation factor is the problem?

🩸 PT + aPTT + Fibrinogen: a practical clotting-factor algorithm

1️⃣ PT ↑, aPTT normal
→ Think FVII deficiency
→ Check FVII assay

2️⃣ PT normal, aPTT ↑
→ Think VIII, IX, XI, XII
→ Do a mixing study
• Corrects → factor deficiency → factor assays
• Fails to correct → inhibitor/heparin → investigate further

3️⃣ PT ↑ + aPTT ↑
→ Think common pathway (II, V, X, fibrinogen) or multiple-factor deficiency
→ Check fibrinogen, D-dimer, platelets, LFTs + medication history

4️⃣ PT ↑ + aPTT ↑ + fibrinogen ↓
→ Strongly consider DIC/consumption

🔑 Rule of thumb:
Screen → Mixing study → Factor assay → Confirm the diagnosis

#Hematology #MedTwitter #MedicalEducation

[Histopathology @Histo_Journal]

An excellent update on primary cutaneous lymphomas, lymphoproliferative disorders and reactive lymphoid proliferations, including discussion of possible pitfalls, new markers, support from AI, and relevant genetic alterations. #OpenAccess #dermpath #pathX https://t.co/pXidhvokf4

[William Aird @WilliamAird4]

1/2

WHAT DOES COPPER HAVE TO DO WITH IRON?

More than I realized.

Copper-dependent ferroxidases help move Fe from cells → transferrin → erythron.

So copper deficiency can impair Fe delivery even when Fe is present.

And that’s only one way copper deficiency causes anemia.

[Daniel Coyne @DrDanMO]

In Pure Red Cell Aplasia in a CKD or ESRD patient who develops anti-EPO Ab, Hb falls at about 1g/dL per week. Because erythropoiesis has stopped, Iron utilization halts, and there is a jump up in serum iron and TSAT. Retics are essentially zippo.

[Vincent Rajkumar @VincentRK]

For physicians who deal with lots of referrals on “abnormal free light chain ratio” incidental finding.

Our recommendation is unless the FLC ratio is <0.125 or >8 or unless you are worried about myeloma clinically, or dealing with biopsy proven AL amyloid or MIDD or PGNMID, ask referring physicians to repeat in 6 months and if stable consider it as possible LC-MGUS with subsequent testing only if symptoms concerning for myeloma, amyloid etc develop. Defer bone marrow biopsy or bone survey.

See algorithm below. @nejm
Note labs report K/L ratio. Not involved /uninvolved. For ease of use you can calculate involved (high value) / uninvolved (low value). And use 8 as cut off as shown in figure. Otherwise you have to follow one cutoff for lambda and one for kappa.

https://t.co/vxDm5hpoPx

[Andrea Rivera Sarabia @andrearsarabia]

Es muy triste que instituciones educativas exijan a una maestra a regresar a clases porque “ya terminó su quimio e inmuno terapia”… aún presentando secuelas, efectos secundarios, cansancio, depresión, etc
Pero ese justificante laboral se consigue por las buenas o las malas…

[Andrea Rivera Sarabia @andrearsarabia]

Bien triste y si, aplica también para el “plasma rico en plaquetas”

[Alejandro Castillo @MediCasos]

Hoy me tocó ver un especialista inyectando plaquetas en la columna.

Si se supone que los pobres somos los internistas oigan.

[Adriana Cristina Pineda 🫀 @LaMalaC]

🚨CITLALLI COBRO 1 MILLON 989 MIL PESOS COMO SECRETARIA DE LAS MUJERES🚨

Durante 15 meses, @CitlaHM cobró 132, 637 pesos. Es decir 1 millon, 989 mil 555 pesos, en un puesto que no es tan necesario porque puede durar cuatro meses sin tener una titular.

¿Le regalaron casi 2 millones de pesos o si se necesita Secretaria?

[Carla Erika Ureña∞︎︎ @CarlaEUrenaA]

Con la MATERNIDAD NO SE LUCRA.

Qué MARAVILLOSA respuesta de @teresaortuno como mujer, madre y política a @AndreaChavezTre .

Gracias por visibilizar a las millones de mujeres sin salud, sin seguridad, que buscan a sus hijos y el regalo que es la maternidad.

Aplausos DE PIE 👏🏻👏🏻

[Guilherme Perini, MD @GuiperiniMD]

One of the most relevant Lymphoma meetings (I go every year), @LymphomaEx has also a session where we discuss new data and how it should be applied in LatAm.

It is not an easy task: therapies are far from being ZipCode-Agnostic. So, in a 4 hour session, we discuss with multiple experts from different regions how we should approach these therapies.

The result is our LexAct. And it is open to discussion for everybody now.

I am already confirmed in 2027! Join me in beautiful Puerto Varas for great science, amazing wine and late-night lakeside Karaoke.
https://t.co/fK7dm6eW2R

[Andrea Rivera Sarabia @andrearsarabia]

Sentimientos encontrados con este fin de semana (amor/odio)

[Andrea Rivera Sarabia @andrearsarabia]

Saber que morat está a unos km dando concierto y no estoy ahí… es un golpe bajo. Si, soy fan y que 👐🏻

[Andrea Rivera Sarabia @andrearsarabia]

¿Cómo regalar sentido común? Carayyy

[Julen Bollain @JulenBollain]

“Fuera están ocurriendo cosas terribles.
Personas indefensas son sacadas a rastras de sus casas.

Las familias son separadas. Separan a hombres, mujeres y niños. Niños y niñas regresan de la escuela y descubren que sus padres han desaparecido.”

Diario de Ana Frank.
13/01/1943.

[Simons @Simon_Ingari]

“Can I bring my baby to the interview?”

The message came in at 11 PM:

“Hi, I have an interview with you tomorrow at 2 PM. My childcare fell through. Can I bring my 8-month-old? I understand if you need to reschedule.”

Old me would have rescheduled.
Unprofessional. Distraction. Red flag.

New me replied:
“Absolutely. See you tomorrow.”

She showed up with her baby on her hip.
She apologized three times before even sitting down.

Ten minutes in, the baby started crying.
She tried to soothe him while answering questions.
She apologized again.

I stopped the interview and said:

“Hey. You’re managing a fussy baby, answering complex questions, and staying calm under pressure. That’s literally the job. Handling chaos while staying professional. You’re already proving you can do it.”

Her eyes filled with tears.

We hired her.

She’s been with us for a year now.
The most reliable team member we have.

Why?

Because when you’re used to handling a screaming infant at 3 AM and still showing up to work the next day, workplace stress feels like nothing.

Working parents, especially mothers, are some of the most organized, efficient, and resilient people you’ll ever hire.

Yet we lose them because our hiring processes are built for people with zero caregiving responsibilities.

If your interview process can’t accommodate a parent facing a childcare issue, you’re not filtering for professionalism.

You’re filtering for privilege.

[Zito @_Zeets]

She wrote a beautiful essay about facing cancer for the New Yorker that also condemns RFK Jr. for destroying the same healthcare system that she was relying on.

[WolverHeme @WolverHeme]

RIP 7+3 (1973-2025)? Why PARADIGM Doesn't Deliver the Eulogy. Listen to our take on the #PARADIGM #Plenary from #ASH25 @ajperissinotti @Berninini https://t.co/oVQCvnyRYm