Panagiotis Christoforou

MD, Haematologist specialising in Haemophilia and Rare Bleeding Disorders. Currently Clinical Fellow in RLH @QMUL EHC steering committee member. Mountaineer⛰️

[Shadi Yaghi @ShadiYaghi2]

New AHA acute stroke guidelines are out!

[Md Riyazuddin @riyazmd774]

R.I.P. POWERPOINT

ChatGPT can now build a presentation in under 2 minutes.

Use these prompts instead and witness the magic :

[Faheema Hasan 🩸 🩺 @faheema_hasan]

Primary prophylaxis recommendations with Bispecifics and CAR-T s in myeloma by @MeeraMohanMD at the 49th annual conference of MHG

[Talha Badar @TalhaBadarMD]

25 years of TKIs in CML — how I treat CML-CP today @BloodPortfolio https://t.co/LJoG2U54dw
#weekend_review @MayoCancerCare

1️⃣ BCR-ABL1 drives disease; all frontline TKIs deliver excellent survival.

2️⃣ Choice ≠ OS → it’s about risk (ELTS>Sokal), comorbidities, toxicity, and DMR/TFR goals.

3️⃣ Imatinib = safest CV, slowest.
2G TKIs/asciminib = faster, deeper responses (watch toxicity).
Nilotinib → vascular risk. Dasatinib → lung toxicity.

4️⃣ Asciminib → allosteric, avoid b2a3/b3a3.
The art is matching the right TKI to the right patient.

#How_I_treat_CML #BloodPortfolio

[Elliot Tapper @ebtapper]

🇨🇦Choosing Wisely: Hepatology

1️⃣Say no to Ammonia
2️⃣no FFP, Vit K, or plt for EGD/para
3️⃣No HFE based on ferritin alone
4️⃣no CT/MRI to monitor benign liver lesions
5️⃣no repeat HCV pcr outside treatment
https://t.co/B1udk9dQvv

[Dr. Chokri Ben Lamine @abouabdrahman0]

📊 Magnitude vs Precision vs Significance — don’t mix them up (EBM essentials 🧠)

🔵 1️⃣ Magnitude = Effect Size (Clinical impact)
📏 How big is the effect?
➡️ Reported as:
⚖️ Odds Ratio (OR)
📉 Risk Ratio (RR)
⏳ Hazard Ratio (HR)
✅ Answers: Is this effect clinically meaningful?
❗ OR/RR/HR far from 1 = potentially important

🟢 2️⃣ Precision = Confidence Interval (CI)
🎯 How reliable is the estimate?
📦 Usually 95% CI
➡️ Narrow CI = high precision 👍
➡️ Wide CI = uncertainty ⚠️
❗ CI crossing 1 (for OR/RR/HR) → effect may be null

🔴 3️⃣ Significance = P-value
🎲 Is this likely due to chance?
📌 p < 0.05 = statistically significant
⚠️ Driven by sample size, not effect size
🚫 Does NOT mean clinically important

🍎 Classic cherry-picking trap
❌ “p < 0.05” highlighted
🔍 OR/RR/HR small + CI wide + clinical effect trivial
➡️ Statistically significant ≠ clinically relevant

🧠 EBM Golden Rule
✅ Magnitude (OR/RR/HR) → impact
✅ CI → precision
⚠️ P-value → secondary, supportive only

💡 If forced to choose:
👉 Effect size + CI > p-value every time

#EBM #CriticalAppraisal #EffectSize #ConfidenceInterval #Pvalue #CherryPicking #MedicalEducation #Statistics #RND

[flora peyvandi @flora_peyvandi]

Give megs a break: minor DNA stress, platelets in excess . Direct #DNA damage can influence #megakaryocyte biology. https://t.co/jSyqjsb5dZ

[William Aird @WilliamAird4]

I asked for 2–3 causes of an isolated prolonged aPTT with normal intrinsic factor activities. The key differential includes lupus anticoagulant (LA), heparin effect, and contact factor deficiency. Many of you nailed it! 👋

In this case, testing revealed lupus anticoagulant!

[Dr. Chokri Ben Lamine @abouabdrahman0]

High Lactate in Hematology — Full Differential (DD) for Heme Fellows 🩸

🧪 Basics
•Lactate = marker of anaerobic metabolism OR impaired clearance
•Not all high lactate = sepsis ❗
•Always classify: Type A vs Type B

⸻

🔴 Type A Lactic Acidosis (Hypoxia / Hypoperfusion)

🫀 Shock states
•🦠 Septic shock (neutropenic sepsis, post-SCT)
•❤️ Cardiogenic shock
•🩸 Hemorrhagic shock (GI bleed, DIC)
•🫁 Massive PE

🩸 Severe anemia
•Hb very low → ↓ O₂ delivery despite normal BP
•Seen in:
•Acute leukemia
•Aplastic crisis
•Massive hemolysis

🫁 Respiratory failure
•ARDS (post-chemo, infection, TRALI)

⸻

🔵 Type B Lactic Acidosis (No Hypoxia)

⚠️ Very important in hematology

⸻

🧬 Malignancy-Related (Classic Boards & Real Life)

🔥 Warburg effect
•Tumor cells use aerobic glycolysis
•Seen in:
•Aggressive lymphomas (DLBCL, Burkitt)
•Acute leukemias (AML, ALL)
•Lactate can be very high, pH low, BP normal

🚩 Clues:
•Massive tumor burden
•High LDH
•Normal oxygenation
•Refractory to fluids/antibiotics

➡️ Definitive treatment = chemotherapy

⸻

🧫 Liver Involvement
•Hepatic infiltration by lymphoma/leukemia
•Acute liver failure → ↓ lactate clearance
•Even moderate lactate can be ominous

⸻

🧪 Drug-Induced (Very High-Yield)

💊 Metformin
•Especially with AKI, sepsis

💉 Linezolid
•Mitochondrial toxicity

🧬 NRTIs
•(HIV patients with hematologic malignancies)

💊 Propofol
•ICU patients (PRIS)

💉 Catecholamines
•Epinephrine → ↑ glycolysis

⸻

🧠 Thiamine Deficiency
•Post-HSCT
•Malnutrition
•Chronic TPN

➡️ Always give IV thiamine if unexplained lactate

⸻

🩸 Hematologic Emergencies

🔥 Tumor Lysis Syndrome
•Indirect contributor
•AKI + metabolic chaos

🧬 HLH
•Severe inflammation
•Liver dysfunction
•High lactate without shock

🩸 DIC
•Microcirculatory failure

⸻

🦠 Infections (Beyond Typical Sepsis)

🦠 Invasive fungal infections
🦠 CMV, EBV post-transplant
🦠 Severe viral reactivation

⸻

🧠 Approach for Heme Fellows

🧭 Stepwise thinking:
1️⃣ Hypotension/hypoxia? → Type A
2️⃣ Stable vitals + cancer burden? → Think Warburg
3️⃣ Liver involved? → clearance problem
4️⃣ Drugs? → check list
5️⃣ Give thiamine early (low risk, high gain)

⸻

🚩 Red Flags
•High lactate + normal BP
•Lactate not improving with fluids
•High LDH + bulky disease
➡️ Call hematology early → urgent cytoreduction

⸻

📚 Key References
•Ruiz JP et al. Type B lactic acidosis in hematologic malignancies.
https://t.co/Vpz4bzV71O
•Friedenberg AS et al. Lactic acidosis in lymphoma.
https://t.co/xMUKwJIY1G
•Andersen LW et al. Clinical significance of lactate.
https://t.co/wk1sNNhIg9
•UpToDate: Lactic acidosis in cancer patients
https://t.co/r9QwqzArqY

#Hematology #LacticAcidosis #WarburgEffect #Lymphoma #Leukemia #TumorLysis #HLH #Sepsis #ICUHematology #HemeFellows

[Zhuoer (Zoey) Xie, MD, MSCR @ZhuoerXie]

Thank you for this!
my snapshot comparing #AML #MRD 2021 vs. 2025
more details in the paper👇

[Aravind Palraj @Rheumat_Aravind]

ANA positivity ≠ autoimmune disease.

Low titre? Elderly? Isolated DFS70 pattern?
Often incidental.

Pattern + clinical phenotype > titre alone.

Treat the patient, not the ANA report.

#Rheumatology #InternalMedicine @DrAkhilX @IhabFathiSulima @Janetbirdope #MedicalEducation #Autoimmune #BedsideMedicine

[Brian O Mahony @Brianhemophilia]

I believe it will be an individual choice. Very physically active people may prefer twice per week with 2 peaks, especially if playing sports or training

[Brian O Mahony @Brianhemophilia]

Nice summary of the paper by @RKaczmarekDr

[William Aird @WilliamAird4]

1/5

SPLENOMEGALY/HYPERSPLENISM

Mechanisms of splenomegaly:
• Congestive
• Work hypertrophy
• Infiltrative

What enlarges?
• Red pulp: macrophages, sinusoids, blood
• White pulp: lymphocytes, plasma cells
• Infiltrative: tumor, storage cells, granulomas, amyloid

#MedEd

[Haematologica @Haematologica]

How many platelets do I need to perform a safe lumbar puncture in patients with hematologic malignancies? 40 is the new 50!
https://t.co/HTyfWXTcPR

[Benlazar S M A @smbenlazar]

New release from Springer Nature Link : Diseases of Blood and Skin https://t.co/jvYT7gZaQ2

[William Aird @WilliamAird4]

RBC as Factory Analogy

A red blood cell is like a stripped-down factory: no power plant (mitochondria) and no blueprint office (nucleus) to store DNA and send out RNA instructions to repair or make new machines. Just the machines on the floor, running until they wear out.

[Pip Nicolson @PipNicolson]

Pleased to be able to share the #VITT consortium's comprehensive final report which sheds light on rare blood clotting syndrome linked to COVID-19 vaccines https://t.co/aP8Dm8Cqg8 Main findings🧵

[NEJM @NEJM]

MASLD has become the most common chronic liver disease worldwide. Giovanni Targher, MD, Luca Valenti, MD (@lucavalenti75), and Christopher D. Byrne, MB, ChB, review the features of the disease as well as pharmacotherapies targeting the associated liver and cardiovascular–renal–metabolic issues.

Learn more in the Review Article “Metabolic Dysfunction–Associated Steatotic Liver Disease” from @univerona, IRCCS Sacro Cuore Don Calabria Hospital, and elsewhere: https://t.co/EJhFlIcXOp