Deep Shah
804 posts
@deepshah88
Classical Hematologist @AHNtoday Associate Program director @AHNhemeonc Fellowship Program Reviewer HemeOncBuddy App https://t.co/qhYLggSVLg
Paradigm shifting OCEANIC-STROKE results just in: #FXI inhibitor asundexian + AP superior to #antiplatelet therapy alone for secondary #stroke prevention, without elev #bleed risk. Dual pathway inhibition key @Vasculearn @AnticoagForum @canvector @ThrombosisUK @ThrombosisCan
🚨 FELLOWSHIP MATCH ALERT! 🚨 Our residents absolutely crushed the 2025 match: ❤️ Cardiology 🩸 Heme/Onc 🫁 Pulm/CCM 🦠 ID 🧪 Endocrinology 💩 GI 🤲 Rheumatology 🌟 And more - at some of the most prestigious programs nationwide. So proud. So grateful. So inspired. Let’s GO! 💥
My 12-Step Thrombocytopenia Workup 🧵 (Not Medical Advice) 1. Review baseline counts first. Rule out pseudothrombocytopenia. 2. Evaluate for critical conditions: TTP, HIT, or DIC? • Assess heparin exposure - Calculate 4T score. • Peripheral smear for schistocytes. • Check LDH/Haptoglobin/Bilirubin, PT/aPTT/Fibrinogen. 3. Assess for acute leukemia or bone marrow involvement? • Examine peripheral smear for abnormal/neoplastic cells. • Consider imaging if clinically indicated. • Do we need a bone marrow exam? 4. Active life-threatening bleeding? Do we need a platelet transfusion? 5. Review drug-induced thrombocytopenia. Always consult latest literature for implicated medications. 6. Investigate secondary causes: • Nutritional deficiencies: B12, Folate, Copper, Zinc. • Infections: HIV, Hepatitis, CMV, EBV, HSV (clinically guided). • Sepsis leading to DIC. • Endocrine disorders: TSH, Free T4. 7. Review imaging for cirrhosis/splenomegaly. If inconclusive, obtain abdominal ultrasound. 8. Consider mechanical causes: Dialysis/ECMO/IABP/cardiopulmonary bypass/artificial heart valve? 9. Evaluate pregnancy-related disorders: HELLP, AFLP, gestational thrombocytopenia. 10. Assess for autoimmune conditions if clinically warranted. Consider SLE and other rheumatological diseases. 11. Consider rare but serious differentials: • CAPS, other TMA causes, PNH • Post-transfusion purpura, HLH • Pursue only with appropriate clinical suspicion 12. If no clear etiology identified, consider ITP as diagnosis of exclusion. 📋 Key Clinical Considerations: • Critically ill patients frequently have multifactorial thrombocytopenia [A combination of some of the above]. • Primary HLH presenting de novo in adults is exceedingly rare. • Thrombocytopenia with thrombosis: Consider DIC, TTP, HIT, PNH, or VITT. [Image AI Generated] #Hematology #MedTwitter
