Jonathan Liles

Enjoyed presenting our research at the annual Stewart Wolf Research Day @ResearchOU @RyanNipp

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

🧠🔍 Journal Club Recap! This Monday we discussed the OPTIMISE Trial — de-escalation of antihypertensive meds in adults >80 yrs. 👨‍⚕️ Moderators: Dr @RyanNipp and Dr @RMAtkinsMD 🔗: #google_vignette" target="_blank" rel="nofollow noopener">jamanetwork.com/journals/jama/…

Very proud to present our research at #ASCO2025. Keep a lookout for the upcoming manuscript. Special thanks to @RyanNipp and @anhbl9 for all the support