Deep Shah

805 posts

Deep Shah

Deep Shah

@deepshah88

Classical Hematologist @AHNtoday Associate Program director @AHNhemeonc Fellowship Program Reviewer HemeOncBuddy App https://t.co/qhYLggSVLg

Pittsburgh, PA Entrou em Mayıs 2010
385 Seguindo309 Seguidores
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Bloodman
Bloodman@Bloodman·
Nice review on why one should not take oral iron with tea or coffee
William A. Wallace, Ph.D.@WilliamWallace

Coffee and tea contain polyphenols that bind non-heme iron in the gut and form insoluble complexes that pass through unabsorbed. Hurrell and colleagues (1999, Br J Nutr) tested this directly using radio-labeled iron in adult humans eating a standardized bread meal with different beverages. Absorption was quantified by erythrocyte incorporation of the tracer. Compared to water, beverages containing 20 to 50 mg of polyphenols per serving reduced iron absorption by 50 to 70%. At 100 to 400 mg, the reduction was 60 to 90%. Black tea: 79 to 94%. Peppermint tea: 84%. Cocoa: 71%. Chamomile: 47%. Adding milk did not meaningfully change the effect. The mechanism is specific to galloyl structure, not total phenolic content. Brune, Rossander, and Hallberg (1989, Eur J Clin Nutr) showed that tannic acid inhibits in a dose-dependent manner that tracks galloyl content: 5 mg cut absorption 20%, 25 mg cut it 67%, and 100 mg cut it 88%. Gallic acid inhibited equivalently per mol of galloyl groups. Catechin, which lacks the galloyl ester, showed no inhibition. Chlorogenic acid, the dominant polyphenol in coffee, inhibits but less potently than tannins. Heme iron behaves differently. It is absorbed through a separate brush-border pathway that is still incompletely characterized, likely involving receptor-mediated endocytosis. Iron is liberated from the porphyrin ring inside the enterocyte by heme oxygenase 1. Because the iron stays shielded inside the porphyrin until intracellular release, polyphenols in the gut lumen don't reach it. Heme iron from meat is largely protected. Non-heme iron from plants, eggs, and fortified foods is the vulnerable pool. Vitamin C counteracts the interaction by reducing Fe³⁺ to Fe²⁺ and forming a soluble ascorbate-iron complex that resists polyphenol binding. Hallberg, Brune, and Rossander (1986, Hum Nutr Appl Nutr) measured the dose-response directly. Hallberg and Hulthén's later absorption algorithm (2000, Am J Clin Nutr) integrated those data and predicts that 50 mg of ascorbate added to an inhibitor-rich meal increases non-heme iron absorption roughly 3 to 6-fold. For anyone with borderline iron status, menstruation-related losses, a plant-based diet, or pregnancy, timing matters. A two-hour gap between the beverage and iron-rich foods, or pairing the meal with vitamin C, is the simplest fix. The mechanism has been in the literature for three decades. It's rarely in standard dietary counseling, rarely on any bottle, and almost never mentioned by the industry selling iron. pubmed.ncbi.nlm.nih.gov/10999016/ pubmed.ncbi.nlm.nih.gov/2598894/ pubmed.ncbi.nlm.nih.gov/3700141/ pubmed.ncbi.nlm.nih.gov/10799377/

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Deep Shah
Deep Shah@deepshah88·
I’m thrilled to share that I have been selected for the @ASCO Leadership Development Program: Education Scholars! I’m excited to collaborate with inspiring colleagues and continue growing in medical education, mentorship, and educational research. connection.asco.org/do/asco-announ…
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Marc Carrier
Marc Carrier@MarcCarrier1·
Guideline-based VTE prevention works in real life. In high-risk ambulatory cancer pts: ✅ VTE ↓ (3.2% vs 7.7%) ✅ Mortality ↓ (16.8% vs 31.3%) ➡️ OR VTE 0.36 | OR death 0.46 Time to close the gap between evidence & practice. ascopubs.org/doi/pdf/10.120… #JCOOP #ASCO
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William Aird
William Aird@WilliamAird4·
Iron deficiency symptoms precede anemia because the body prioritizes red cell production — other tissues become iron-deficient first.
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William Aird
William Aird@WilliamAird4·
Common misconception: “You can’t give iron to someone with hemochromatosis. Reality: if ferritin is low, they need iron. Hemochromatosis doesn’t cause harm without excess iron stores. The risk is ferritin, not the diagnosis.
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Saarang Deshpande, MD
Saarang Deshpande, MD@SR_DeshpandeMD·
🩸2025 wrapped for classical hematology!🩸 What a year for advancements in the field and what a field to be in! 🧵Thread of my favorite studies: 1/
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Srinishant Rajarajan
Srinishant Rajarajan@SrinishantR·
Amazing #ASH25 with amazing #Mentors! So grateful to be surrounded by mentors who truly care. Thank you, Dr. Shah, Dr. Bhagavatula & Dr. Mewawalla, for your continued guidance and support! ✨
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Tas Kapetanos MD
Tas Kapetanos MD@TKapetanos·
Incredibly proud of our residents and everyone who helped propel them to this moment! 🙌 A special shout-out to the PDs and faculty who believed in them and opened doors to their next destination. 🎓✨ They are motivated. They are strong. They are READY. 💪🔥 #TheAlleghenyWay
AHNIMres@AHNIMres

🚨 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! 💥

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AHNIMres
AHNIMres@AHNIMres·
🚨 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! 💥
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Deep Shah
Deep Shah@deepshah88·
Nishant Rajendra Tiwari@Nischistocyte

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

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William Aird
William Aird@WilliamAird4·
DID YOU KNOW ... that leukocytosis can take years to resolve after smoking cessation? Why? Because smoking reprograms hematopoietic stem cells toward myeloid output. Those epigenetic changes wash out slowly as new stem-cell generations replace the old.
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William Aird
William Aird@WilliamAird4·
Name the condition
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William Aird
William Aird@WilliamAird4·
One word to explain: 1. Low RBC count 2. Elevated MCH 3. Elevated RDW-SD with normal RDW-CV (labeled just DRW in results)
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William Aird
William Aird@WilliamAird4·
One 325-mg ferrous sulfate tablet ≈ 13 mg absorbed iron. To match that with diet alone, you’d need: 🥩 3.3 lb steak 🥬 18 lb spinach (Steak assumes ~25% heme absorption; spinach ~5% non-heme) Food is important, but for iron deficiency, tablets are doing a very different job
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sganguly
sganguly@bmtdoc63·
Prolonged PT/PTT in cyanotic heart disease often calls for a heme consult. However, it is important to recognize that due to high hematocrit, often above 65% leads to less plasma in the tube causing altered plasma-anticoagulant ratio in the blue top tube and falsely high PT/PTT.
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