Avinash Kumar Singh

Clinical hematologist Hemato oncologist Stem cell transplant physician Bihar Heartfulness Meditator

Serving hands should reach last in the queue

[Sahaj Marg @sahajmarg_srcm]

“I have now come to the conclusion that suffering and disease are the boons of Nature in disguise which helps deliverance from the effects of samskaras.” - Babuji

[Benlazar S M A @smbenlazar]

Prognostic Impact of FLT3-ITD Allelic Ratio in #AML Patients Treated With High-Dose Anthracycline and a #FLT3 Inhibitor https://t.co/Ljxvd7FqdM #leusm

[Harsh Goenka @hvgoenka]

The colleague who succeeds may have done years of preparation . The person who seems difficult may be fighting battles we know nothing about. So look closer. Understand the context. Have empathy. The whole story is often invisible.

[Avinash Kumar Singh @Pmchsingh]

Good morning everyone

[Benlazar S M A @smbenlazar]

Novel treatment strategies in acute myeloid leukemia https://t.co/50jM9kN7sw #leusm

[Dalai Lama @DalaiLama]

I believe the purpose of life is to be happy. Happiness is not guaranteed, we have to work for it. The most important way to do this is to cultivate concern for others. That’s how to take a wise approach to our natural self-interest.

[Harsh Goenka @hvgoenka]

Stop auditioning for people who aren’t even watching your life. Chase your dreams, celebrate your wins, and stop seeking validation from people who aren’t even interested in your journey.

[Avinash Kumar Singh @Pmchsingh]

Good morning everyone

[Avinash Kumar Singh @Pmchsingh]

Good morning everyone

[Daaji - Kamlesh Patel @kamleshdaaji]

We are not the owners of this Earth; we are its stewards. Our responsibility is to care for it, protect its resources, and preserve the delicate balance of nature.

When we recognise that we belong to the Earth, rather than the Earth belonging to us, our relationship with nature changes. We begin to live with greater awareness, humility, and responsibility towards all life.

Let us leave behind a planet that future generations can thrive on.

#DaajiQuotes #Earth #Environment #Nature

[Avinash Kumar Singh @Pmchsingh]

Good morning everyone

[Avinash Kumar Singh @Pmchsingh]

World Amyloidosis day

[𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 MD, DM @nihardesai89]

Oncology is making incredible progress, yet we continue to lose far too many lives to infectious diseases 😭

TUBERCULOSIS remains a BIG, BIG problem in many parts of the world 😭😭

[Dr. Chokri Ben Lamine @abouabdrahman0]

🩸🏥 Acute GVHD after allo-SCT: inpatient or outpatient?

🎯 Disposition depends on organ severity, clinical stability, oral absorption & access to urgent transplant care. Practical triage requires transplant-team judgment; grade alone is insufficient.

🏠 OUTPATIENT may be appropriate
🟢 Grade I: skin-only rash <50% body surface area → topical corticosteroids.
🟡 Selected grade II: stable, mild symptoms; adequate hydration, nutrition & oral medication tolerance.
✅ Reliable caregiver, close follow-up & rapid hospital access.

🏥 ADMIT / low threshold for admission
🔴 Grade III–IV or rapidly progressive disease.
💩 High-output diarrhea, dehydration, AKI or electrolyte disturbances.
🤮 Persistent vomiting, poor intake or unreliable drug absorption.
🩸 GI bleeding, severe abdominal pain or ileus.
🟨 Rapidly rising bilirubin/significant hepatic dysfunction.
🌡️ Fever, suspected infection or hemodynamic instability.
🚫 Inadequate home support or monitoring.

💊 Treatment
• Grade II–IV generally requires systemic corticosteroids.
• Severe GI disease/poor absorption → IV therapy.
• Monitor stool output, rash extent, bilirubin, renal function, electrolytes & immunosuppressant levels.

🔬 Investigate infectious/drug mimics; obtain biopsy when feasible without delaying treatment in severe suspected GVHD.

💡 Discharge when improving, oral intake/medications are reliable, losses are manageable & close transplant follow-up is arranged.

📚 EBMT Handbook⁠ | Oxford acute GVHD protocol⁠

[Ahmed Kotb @AhmedKo45911157]

🩸Autoimmune Neutropenia in Adults |Blood2026
🔹Diagnosis: Exclude drugs, infections, autoimmune disorders
🔹Treatment:Most patients require observation only
🔹G-CSF: First-line for clinically infections
🔹Refractory:Consider B-or T-cell-directed therapy
🎯Treat patient not count

[Dr. Chokri Ben Lamine @abouabdrahman0]

🩸 LPL vs IgM MGUS vs WM vs IgM MYELOMA—board essentials!

🔵 1️⃣ LPL = histological diagnosis
🔬 Lymphoplasmacytic lymphoma: clonal small B lymphocytes, plasmacytoid lymphocytes & plasma cells.
🧬 MYD88 L265P is common.
🧪 Usually secretes IgM, but rare IgG/IgA or nonsecretory cases occur.
🎯 B-cell component: CD19+/CD20+; plasma-cell component: CD38+/CD138+.

🟣 2️⃣ WM = marrow LPL + monoclonal serum IgM
✅ Waldenström macroglobulinemia is the IgM-associated clinicopathological form of LPL.
⚠️ IgM paraprotein alone ≠ WM.
🧬 MYD88 mutation in >90%; CXCR4 mutations in a subset.
🩺 May cause anemia, adenopathy, splenomegaly, hyperviscosity, neuropathy or cryoglobulinemia.
💤 Asymptomatic WM → observation.
💊 Symptomatic WM → treatment according to attributable clinical indications. (https://t.co/QYofrB0ll5⁠)

🟢 3️⃣ IgM MGUS = precursor state
🧪 Monoclonal IgM without diagnostic overt lymphoma/myeloma or attributable organ injury.
📏 Conventional criteria: IgM <3 g/dL & marrow involvement <10%.
⚠️ Classification trap: IWWM/ICC emphasize diagnostic marrow morphology; unequivocal LPL can be diagnosed below 10%. Avoid applying the cutoff in isolation. (https://t.co/KRH3g0QJSE⁠, https://t.co/6vysOyPRrJ⁠)

🧬 Two biological pathways
▪️ IgM MGUS-NOS: often a B-cell clone; MYD88 may be mutated → potential progression to WM/other B-cell lymphoma.
▪️ IgM MGUS, plasma-cell type: plasma-cell clone without a B-cell component; MYD88 wild-type; may carry t(11;14) → potential progression to IgM myeloma. (https://t.co/sdKAcTc4L2⁠)

🔴 4️⃣ IgM MULTIPLE MYELOMA = plasma-cell malignancy
🔬 Clonal plasma cells ≥10% or biopsy-proven plasmacytoma plus a myeloma-defining event: SLiM-CRAB.
🦴 Lytic lesions strongly favor myeloma over WM.
🧬 MYD88 usually wild-type; t(11;14)/cyclin D1 positivity supports IgM myeloma but is not required.
🎯 CD138+/CD38 bright; CD19 usually absent; CD20 can be positive.
💊 Treat through the myeloma pathway—CD20 positivity alone does not make rituximab standard therapy.

🚨 EXAM TRAPS
❌ MYD88+ does not distinguish WM from IgM MGUS.
❌ MYD88 wild-type does not exclude WM.
❌ t(11;14)+ requires lineage confirmation—also consider mantle cell lymphoma.
❌ A small clone causing IgM-mediated injury may represent IgM-related disease/MGCS, requiring treatment despite low tumor burden.

🧠 Mnemonic
LPL = tissue • WM = marrow LPL + IgM • MGUS = precursor • IgM MM = plasma cells + myeloma-defining event

📚 European WM diagnostic consensus⁠ | IWWM-11 diagnostic consensus⁠ | IgM MGUS classification⁠

[Dr. Chokri Ben Lamine @abouabdrahman0]

🦠💊 IDSA 2026: Antimicrobial-resistant Gram-negative infections—high-yield pearls for hematology & HSCT!

🧬 Identify the resistance mechanism + confirm susceptibility: “CRE” alone does not identify the optimal antibiotic.

1️⃣ Invasive ESBL infections
💊 Carbapenems preferred.
🚨 In critical illness/hypoalbuminemia, favor meropenem or imipenem–cilastatin over ertapenem.

2️⃣ Inducible AmpC
🦠 Enterobacter cloacae complex, Klebsiella aerogenes & Citrobacter freundii.
✅ Cefepime is suggested.
⚠️ Avoid ceftriaxone for invasive infections due to resistance emergence.

3️⃣ KPC-producing Enterobacterales
✅ Meropenem–vaborbactam, ceftazidime–avibactam or imipenem–relebactam.
📌 Panel slightly favors meropenem–vaborbactam.

4️⃣ NDM-producing Enterobacterales
✅ Aztreonam–avibactam OR cefiderocol.
🔄 If aztreonam–avibactam unavailable: ceftazidime–avibactam + aztreonam.
🚫 Ceftazidime–avibactam alone does not cover NDM!

5️⃣ OXA-48-like Enterobacterales
✅ Ceftazidime–avibactam preferred.

6️⃣ Difficult-to-treat Pseudomonas
✅ Ceftolozane–tazobactam, ceftazidime–avibactam or imipenem–relebactam for infections outside the urinary tract.
🫁 Ceftolozane–tazobactam favored for pneumonia.

7️⃣ Carbapenem-resistant Acinetobacter
✅ Sulbactam–durlobactam + imipenem or meropenem preferred for invasive infection.

8️⃣ Invasive Stenotrophomonas—key pearl!
✅ Cefiderocol monotherapy is preferred in this document.
🔬 Preference rests largely on neutropenic animal models; clinical outcome evidence remains limited.
🔄 TMP–SMX, levofloxacin or minocycline: alternatives as components of combination therapy.
🚫 Ceftazidime is not suggested.

🩸 Hematology takeaways
🔍 Distinguish colonization from infection.
📋 Review prior cultures, recent antibiotics & local resistance patterns.
🎯 Optimize source control, renal dosing & infusion strategy.
⏳ Resistance alone does not mandate longer treatment; consider immune status, source control & response.

📚 US-focused expert guidance; evidence current to 1 March 2026.
🔗 https://t.co/vPiaAUxa3B

[Vala Afshar @ValaAfshar]

Do not take yourself too seriously. Laugh loudly.

Stay optimistic, accept rejection, learn from mistakes, work hard, forgive first, show up on time, fight against sense of entitlement, hold doors open a bit longer, and travel light without carrying resentment or bitterness.

[Harsh Goenka @hvgoenka]

Rampal, a 50-year-old visually impaired sculptor from Uttar Pradesh, creates lifelike idols of Lord Ganesha and Maa Durga using nothing but his sense of touch.
When the eyes cannot see, the hands create magic. A beautiful reminder that true vision comes from within…