EvelioClaros_hematologo

Marvin Evelio Claros.
Hematólogo / Salvadoreño 🇸🇻

[Oliverio @LuisOliverio]

Preeclampsia, la última revisión en The Lancet (2026). Puntos importantes:

🔴 La proteinuria dejó de ser obligatoria para el diagnóstico. Preeclampsia = hipertensión después de las 20 SDG + disfunción de órgano blanco (neurológica, renal, hepática, hematológica) o uteroplacentaria.

🔴 Olviden la hipertensión permisiva: trata toda hipertensión del embarazo, meta <140/90 (diastólica 85), CHIPS y CHAP Trial. Labetalol, nifedipino o metildopa. IECA/ARA contraindicados por fetotoxicidad.

🔴Prevención con Aspirina 150 mg por la noche, antes de las 16 SDG, y se suspende a las 36. El calcio ya no se recomienda.

🔴 El único tratamiento sigue siendo el parto. El sulfato de magnesio no es profilaxis universal — es para preeclampsia con datos de gravedad y eclampsia.

🔴 En el puerperio, la presión arterial alcanza su pico los días 3 a 6 (monitorea en casa). Asociado a más: hipertensión, enfermedad renal crónica, diabetes, riesgo cardiovascular. Revisión médica anual recomendada.

Ya actualizamos las apps.

[Dr.Mukesh , MD , DM @dr_immuno29]

🩸 OBSTETRIC APS | 2026 UPDATE

OAPS ≠ just placental thrombosis.
Think immunothrombosis → complement + NETs + trophoblast/placental injury.

💊 Treatment
• Criteria OAPS → LDA + prophylactic LMWH
• Prior thrombosis → LDA + therapeutic LMWH
• High-risk → LA+, triple-aPL, prior severe PE/FGR
• Refractory → consider HCQ ± LMWH escalation; IVIG in selected cases

⚠️ Important nuance
LMWH works best-established for classic OAPS/pregnancy loss.
For preventing recurrent PE/FGR/placental insufficiency, RCT evidence is surprisingly thin → only 53 randomized women in a 2026 systematic review.

🔥 What’s new?
IMPACT: certolizumab + LDA/LMWH in high-risk LA+ APS → placenta-mediated adverse outcomes 20% vs ~40% historical expectation. Promising, but single-arm → not standard care yet.

HCQ → growing observational/meta-analytic evidence for ↑ live birth.
Pravastatin → experimental for refractory PE/FGR; not routine.

🎯 2026 shift:
“Anticoagulate everyone” → phenotype + risk-stratified therapy targeting thrombosis AND inflammation.

📚 DOI:
10.1016/j.rpth.2026.103396
10.1016/j.autrev.2026.104013
10.1097/BOR.0000000000001152
10.1136/rmdopen-2025-005825

#ObstetricAPS #APS #Rheumatology #Pregnancy #Autoimmunity

[Papa Heme @Papa_Heme]

Therapeutic Apheresis Mathematics!

Total Blood Volume =
70 ml/kg for males
65 ml/kg for females

Total plasma volume = TBV x [1-Hct]

As the Hct decreases the TPV increases!

[R3 | Rheumatology Rapid Review @BodhibrataB]

⭐ Management of Lupus Nephritis : Practical Points From ACR 2024 &amp; EULAR 2025

[Dr.Mukesh , MD , DM @dr_immuno29]

ANTIPHOSPHOLIPID SYNDROME | 2026 UPDATE

APS is no longer simply “aPL + thrombosis.”
Think phenotype + antibody profile + thrombotic risk.

🔹 CLASSIFICATION ≠ DIAGNOSIS
2023 ACR/EULAR criteria: ~99% specificity, ~74% sensitivity.
Obstetric APS: sensitivity only ~20–31%.
→ Don’t rule out APS by the score alone.

🔹 LOOK BEYOND THROMBOSIS
Microvascular disease • valve disease • thrombocytopenia • renal/neurological involvement = important APS phenotypes.

🔹 IDENTIFY HIGH-RISK APS
🚩 Lupus anticoagulant
🚩 Double/triple positivity
🚩 Arterial/microvascular disease
→ VKA remains the anchor.

🔹 DOACs? THINK TWICE.
❌ Avoid rivaroxaban in triple-positive APS.
For most thrombotic APS—particularly high-risk disease—VKA remains preferred.

🔹 RECURRENT THROMBOSIS?
Before intensifying therapy:
Adherence → INR/TTR → provoking factors → APS risk profile.
Then consider LDA / intensified VKA / LMWH in selected patients.

🔹 OBSTETRIC APS
LDA + heparin/LMWH remains the foundation.
Refractory disease → specialist-directed escalation; HCQ remains an emerging option.

🔹 HCQ: PROMISING, NOT PRACTICE-CHANGING—YET
2026 data suggest fewer recurrent thrombotic events, but evidence remains small & heterogeneous.

PRACTICAL TAKE-HOME

Suspect clinically → confirm persistent aPL → phenotype/risk-stratify → choose anticoagulation accordingly.

High-risk APS? → VKA.
Triple-positive? → Avoid rivaroxaban.
Recurrent event? → Investigate before simply escalating.
Obstetric APS? → LDA + heparin/LMWH.

The future: precision APS care—not one-size-fits-all anticoagulation.

#APS #Rheumatology #AntiphospholipidSyndrome #Medtwitter

References

Barbhaiya M, et al. Ann Rheum Dis. 2023;82:1258–1270.
Fujieda Y, et al. Curr Opin Immunol. 2026. doi:10.1016/j.coi.2026.102775.
Riancho-Zarrabeitia L, Riancho JA. Rheumatology. 2026. doi:10.1093/rheumatology/keag434.
de Carvalho JF, et al. Rheumatol Ther. 2026. doi:10.1007/s40744-026-00858-x.

[Gabriel Puche, MD/PhD @gabi_puchepalao]

🚨 CAMBIO DEFINICIÓN DE INFARTO

5ª Definición Universal elimina clásicos tipos 1–5 y pasa a 3 categorías fisiopatológicas:

🔴 IM primario
🟠 IM secundario
🔵 IM relacionado procedimientos

🔑 Troponina ↑ = lesión miocárdica
⚡ Lesión + isquemia = INFARTO

#ESCCongress2026

[Henry C Fung| MM, lymphoma, leukemia & CART @HenrychihangFu1]

Remember STI571?

Hagop Kantarjian MD at MD Anderson used to joke:

STI = “Stop Transplant Immediately.” 😎

And for chronic-phase CML, history largely proved the point.

Now, from MD Anderson again:

PON + BLIN for Ph+ ALL.

Is this STI571 all over again?

Maybe. I hope so. But not yet.

The results are remarkable. But MRD− does not automatically mean no transplant, particularly when the evidence in high-risk biology remains limited.

Which MRD? Which specimen? When? How deep? How durable?

And what about IKZF1-plus, complex cytogenetics, very high WBC, CNS disease, slow molecular response and TKI resistance?

Even ALL2820 incorporated biology and persistent MRD into transplant allocation.

We should absolutely transplant fewer patients if we can.

But before we “Stop Transplant Immediately,” we need to know whom it is safe to stop transplanting.

🧬 MRD measures response. Biology still matters.

In Biology We Trust.
Dr Fun + G

#AcuteLeukemia #ALL #Medtwitter

[Mauricio Ambriz @AmbrizMau]

Hipercalcemia asociada a cáncer.

N Engl J Med 2022;386:1443-51.

[Hemostasis Today @HemostasisToday]

Avatrombopag in Hematology – Dosing and Monitoring - @abouabdrahman0

https://t.co/pee8m05BfC

#HemostasisToday

[Ravi Kumar @RheumattDoc]

🧪 Anti-Cardiolipin Antibodies: Beyond a Positive Test

Anti-cardiolipin (aCL) antibodies are one of the three major laboratory antibodies tested in antiphospholipid syndrome (APS).

But what does a positive aCL actually mean? Here are the key clinical points.

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[Dr. Carlos Arnaud @carlos_arnaud]

Siempre considera la #Desvenlafaxina cuando tengas como paciente a una mujer con síntomas de perimenopausia, con #SíntomasVasomotores y #SíntomasAfectivos

Una excelente opción clínica

No aumenta de peso
Ayuda a #Bochornos
No afecta función sexual
100 mg
Siempre en la mañana

[CardiovascularCorner @TrackYourHeart]

How long should anticoagulants be withheld before elective surgery?

◻️Apixaban: 1 day (low/moderate bleeding risk), 2 days (high risk)
◻️Rivaroxaban: 1 day (low/moderate), 2 days (high)
◻️Edoxaban: 1 day (low/moderate), 2 days (high)
◻️Dabigatran: 1-4 days depending on bleeding risk & renal function
◻️ Fondaparinux: 36-42 hours
◻️ LMWH: 12 h (prophylactic), 24 h (therapeutic)
◻️ UFH: IV 4-6 h; SC 12–24 h
◻️ Warfarin: Stop 5 days before surgery; confirm INR before the procedure.

Adjust timing for renal impairment, neuraxial anesthesia, and individual patient risk. Bridging is reserved for selected high-thrombotic-risk patients.

Reference: 2024 AHA/ACC Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery, Table 13.

[Jose Luis Del Pozo @jdelpoleo]

SEPSIS 2026: Consenso internacional multidisciplinario, con 164 expertos de 22 países, establece 40 recomendaciones en siete áreas fundamentales del manejo de la sepsis. 🩺 https://t.co/VTSsEl6o1z @ClinicaNavarra

[Ravi Kumar @RheumattDoc]

🧪 Lupus Anticoagulant: The Test That Prolongs Clotting Time but Predicts Clots

Lupus anticoagulant (LA) is one of the most misunderstood tests in rheumatology.

Despite its name, it is associated with thrombosis - not bleeding.

Here’s what every clinician should know.
👇

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #LupusAnticoagulant #APS #AntiphospholipidSyndrome #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[PleuralPOCUS | Dr. Jaime Sánchez @PleuralPOCUS]

En 1949 un médico inglés publicó 700 palabras en The Lancet que deberían leerse en voz alta cada vez que entra una generación nueva a un hospital.

Casi nadie las lee.

Los siete pecados de la medicina. 🧵

[Leonardo Santos @Leo_Santo5]

🩸 Urgencias en Hematología

🔴Hipercalcemia
⚪Hiperleucocitosis/Leucostasis
💥Síndrome de lisis tumoral
🏥Coagulación intravascular diseminada
🧬Crisis Falciforme
⚠️Reacciones transfusionales

🔰📚J. Clin. Med. 2024

Artículo Completo👇🏻🆓✅
https://t.co/FGRn4Nm2BR

[Ravi Kumar @RheumattDoc]

🧵 Antiphospholipid Antibodies: From Test to Diagnosis

A positive antiphospholipid antibody does not automatically mean antiphospholipid syndrome (APS).

The key is knowing who to test, which antibodies matter, and how to interpret the results. 👇

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[Rhenals acuña @RhenalsMedint]

Hoy me preguntaron "cuantos neutrofilos eran desviacion a la izquierda en un hemograma?" y me acordé de esta foto que siempre he subido aqui.

La DESVIACION A LA IZQUIERDA NO ES NEUTROFILIA, es la aparición en sangre periferica de formas INMADURAS de los granulocitos.

[Daniel Montero @ndanmontero]

Los ahora Profesores aprendimos Medicina de una forma pero debemos ejercerla y enseñarla de otra manera.
Acá @JAMA_current enfocando lo tradicional respecto a lo necesario.

https://t.co/NXUEUrm4Sg

[Benlazar S M A @smbenlazar]

B ALL subtypes and its diagnosis