Bárbara Araújo Milward Azevedo @milwardbe on GrepMed

Lymphomas and Lymphoproliferative Disorders - Differential Diagnosis Algorithm Hodgkin Lymphoma ~40% - Characteristic For Reed-Sternberg (RS) Cells - usually at a single site in lymphatic system (node) with progression contiguously with lymphatic system. - Bimodal Age Distribution - better prognosis • Nodular Lymphocyte - 5% RS cells absent, lymphocyte predominant (LP) tumour B cells are present • Classic - Nodular Sclerosis, Mixed Cellularity, Lymphocyte Rich, Lymphocyte Depletion Non-Hodgkin lymphomas (NHL) ~60% - lymphadenopathy more diffuse, can have extra nodal involvement, irregular pattern of spread, B symptoms not as common - T Cell ~10% - B-Cell ~90% • Low Grade - Slow growing, Poorly Responsive to Treatment • Aggressive/ Intermediate - Faster growing Potential For Cure, Most common, Wide age range • High Grade - Very Lethal if untreated, Behave and Treated Like Acute Leukemias, very high mitotic rate correlated with rapid growth, response to treatment and relapse - Amy Chung, MD, MSc @AmyChung #Lymphomas #Lymphoproliferative #Disorders #Classification #pathophysiology #Hematology #Diagnosis #NonHodgkin #differential #algorithm

An algorithm created for classifying MDS according to the new 2017 WHO Classification. - Kyle Bradley, MD @KyleBradleyMD #Diagnosis #Hemepath #HOnc #MDS #Myelodysplastic #Syndrome #Classification #Algorithm #WHO2017

THROMBOELASTOGRAPHY (TEG) General Principle • A small cuvette is rotated to simulate sluggish venous flow and stimulate clot formation. • The resistance to rotation due to the mass of the clot is measured, which allows the kinetics of clot formation to be assessed. • This provides information about clot formation and breakdown, and also reflects problems with coagulation cascade and platelet function. • This is displayed graphically as time (min) versus thromboelasticity (in mm). Explaining the numbers • R - reaction time - latency until clot formation begins as defined by an amplitude of 2 mm • K - K value - time from the end of R until the clot reaches 20mm – reflects speed of initial clot formation • α - alpha angle - the angle tangent to the curve at K • MA - maximum amplitude - reflects total clot strength • Lysis time (LY30) - % lysis after 30 min - reflects the fibrinolysis stage of clot development Nick Mark MD @nickmmark #TEG #Thromboelastogram #Thromboelastography #Diagnosis #Management #CriticalCare #Hematology #Interpretation

Multiple Myeloma and Monoclonal Gammopathies C - HyperCalcemia- calcium > 11 mg/dL / >1 mg/dL the ULN R - Renal disease - Cr >2 mg/dL or CC < 40 ml/min A - Anemia- Hemoglobin < 10 g/dL or <2 g/dl LLN B - Bony lesions +1 or more: • Clonal bone marrow plasma cell percentage ≥60% • Involved: uninvolved serum free light chain ratio ≥100 • >1 focal lesions on MRI studies Look for gamma gap (total protein - albumin) ≥ 4 to identify hypergammaglobulinemia; SPEP determines if this is is monoclonal or polyclonal. Causes of false- negative SPEP: • Non-secretory MM (1-2% of MM), light chain deposition disease, and amyloidosis Other causes of a monoclonal M spike: • CML, B and T cell lymphoproliferative diseases, CML, amyloidosis, solitary plasmacytoma, POEMs syndrome, Castleman's, Waldenström's macroglobulinemia, and autoimmune diseases. Dr. Ann Marie Kumfer @AnnKumfer #MultipleMyeloma #Monoclonal #Gammopathies #MGUS #diagnosis #hematology #oncology

REBEL Review 54: Thromboelastogram (TEG) Interpretation R Time - Time to start forming clot K Time - Time until clot reaches a fixed strength Alpha angle - Speed of fibrin accumulation Maximum Amplitude (MA) - Highest vertical amplitude of the TEG Lysis at 30 Minutes (LY30) - Percentage of amplitude reduction 30 minutes after maximum amplitude #thromboelastogram #TEG #hematology #interpretation #diagnosis #components #thromboelastography #anticoagulation