Syiran stem cell transplantation group - SSCTG

25/11/2025

p53: A Central Regulator in Cancer Biology👇

✅p53 stands at the center of a vast network of molecular interactions that influence key cellular processes involved in cancer.

✅Around p53, multiple functional groups appear, each representing a major biological pathway such as DNA damage response, cell fate decisions, apoptosis, autophagy, and ROS control.

✅Additional clusters include regulators of proliferation, metabolism, the cell cycle, pluripotency, EMT and invasion, ncRNA activity, translation, and inflammation within the tumor microenvironment.

✅Both positive and negative regulators of p53 are arranged in organized groups, reflecting the tight control exerted over its activity in healthy and cancerous cells.

✅Stress-response proteins, epigenetic factors, and core family members further highlight the diversity of mechanisms that modulate p53-dependent outcomes.

✅This network underscores how p53 coordinates context-dependent anti-proliferative programs, explaining its central role as the most frequently mutated gene in human cancers.
💡 Image:

The most frequently mutated gene in human cancer, p53, governs a complex anti-proliferative program that in turn impacts an array of biological responses in a context-specific manner.

19/11/2025

22/10/2025

Hympavzi (marstacimab-hncq) is a tissue factor pathway inhibitor (TFPI) antagonist used for the treatment of adults and adolescents with hemophilia A or B without inhibitors.

13/07/2025

13/07/2025

🌼 Easy-to-Remember Tips for MCV 🌼

✨ MCV ⬇️ (MCV < 80 fL) (Microcytic Anemia)
🔸think of "Iron deficiency" or "Thalassemia."
🔸Memory Trick: " TAILS "
* T: Thalassemia
* A: Anemia of chronic disease (sometimes microcytic)
* I : Iron deficiency anemia
* L: Lead poisoning
* S: Sideroblastic anemia

✨ MCV ↔️ (MCV 80-100 fL) (Normocytic Anemia)
🔸think of "Blood loss," "Red blood cell destruction," or
"Bone marrow failure."
🔸Memory Trick: " HAM "
* H:Hemolysis (red blood cell destruction)
* A : Acute blood loss
* M :Marrow failure (aplastic anemia)

✨ MCV ⬆️ (MCV > 100 fL) (Macrocytic Anemia)
🔸think of "B12/Folate deficiency," "Liver disease," "Alcoholism," or certain "Genetic disorders."
🔸Memory Trick: " BIG FAT RBC "
* B : B12 deficiency
* I : Increased reticulocytes (e.g., in hemolysis or blood loss recovery)
* G : GI malabsorption (leading to B12/folate deficiency)
* F : Folate deficiency
* A : Alcoholism
* T : Thyroid disease (hypothyroidism)
* R : Reticulocytosis
* B : Bone marrow disorders (myelodysplastic syndromes)
* C : Cirrhosis (liver disease)

07/07/2025

🔄 Anticoagulant Conversion Guide

🌐 General Principles

🔸 Monitor overlapping periods to avoid 🩸 bleeding or 🧱 clotting.
🔸 Consider the half-life and ⚙️ mechanism of action of each drug.
🔸 Assess renal function 🧪 (especially for DOACs).
🔸 Check for drug interactions and lab parameters like INR, aPTT.

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1️⃣ Warfarin ➡️ DOACs (Apixaban, Rivaroxaban, Dabigatran, Edoxaban)

📌 Switch when INR reaches the following thresholds:

🟢 Apixaban: Start when INR < 2.0
🟡 Rivaroxaban: Start when INR < 3.0
🔴 Dabigatran: Start when INR < 2.0
🟣 Edoxaban: Start when INR ≤ 2.5

⚠️ Note: Always verify renal function before starting Dabigatran (avoid if CrCl < 30 mL/min).

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2️⃣ DOACs ➡️ Warfarin

🔁 Overlap Required!
Because DOACs wear off quickly and warfarin takes days to reach effect.

✅ Steps:

1. Start warfarin while continuing the DOAC.

2. Measure INR just before the next DOAC dose.

3. When INR is therapeutic (usually 2.0–3.0), stop the DOAC.

🔧 Target INR thresholds to stop DOAC:

Apixaban: Stop when INR ≥ 2.0

Rivaroxaban: Stop when INR ≥ 2.5

Dabigatran: Stop when INR ≥ 2.0 (check after 1–3 days off)

Edoxaban: Reduce edoxaban by 50% when starting warfarin; stop when INR ≥ 2.0

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3️⃣ DOAC ➡️ DOAC

✅ Simple Switch!
No overlap, no washout required.

🔄 Example:
Stop rivaroxaban at 6 PM → Start apixaban at the same time the next day.

ALGrawany
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4️⃣ Warfarin ➡️ Parenteral (LMWH, UFH)

🛑 Stop warfarin.
✅ Start LMWH/UFH when INR < 2.0.

💡 Emergency reversal: Consider Vitamin K or PCC.

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5️⃣ Parenteral ➡️ Warfarin

🔁 Overlap for at least 5 days AND INR ≥ 2.0 for 24+ hours

🩺 Details:

Continue LMWH or UFH with warfarin until INR target is met.

LMWH: Dosed every 12–24 hours.

UFH: Continuous IV infusion, titrated by aPTT.

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6️⃣ Parenteral ➡️ DOAC

⏱ Timing of switch:

From LMWH: Start DOAC when next LMWH dose is due

From UFH IV: Start DOAC 4–6 hours after stopping infusion

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7️⃣ DOAC ➡️ Parenteral

🕒 Timing based on DOAC half-life:

Dabigatran: Start LMWH/UFH 12–24 hours after last dose (longer if CrCl ↓)

Apixaban/Rivaroxaban/Edoxaban: Start parenteral ~24 hours after last dose

ALGrawany

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8️⃣ Bridging Around Surgery

🔪 Hold Before Surgery:

Warfarin: ❌ 5 days

Dabigatran: ❌ 1–2 days (CrCl ≥ 50), ❌ 3–5 days (CrCl < 50)

Rivaroxaban/Apixaban/Edoxaban: ❌ 24–48 hours

🩹 Resume After Surgery:

When hemostasis secured

Usually after 24–72 hours, depending on bleeding risk

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🔬 Monitoring Overview

📊 Lab Considerations:

Warfarin: Monitor INR

UFH: Monitor aPTT or anti-Xa

LMWH: Usually no monitoring; check anti-Xa in renal impairment or pregnancy

DOACs: No routine labs; use drug-specific tests if needed

ALGrawany

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🧠 Quick Summary

✅ Warfarin → DOAC: Start DOAC when INR is below target
✅ DOAC → Warfarin: Overlap and monitor INR
✅ DOAC → DOAC: Simple switch
✅ Parenteral → Warfarin: Overlap ≥5 days + INR ≥2.0
✅ Parenteral → DOAC: Start DOAC at time of next dose or after stopping UFH
✅ DOAC → Parenteral: Start parenteral when DOAC wears off

ALGrawany

28/02/2025

Etiology of venous thromboembolism – Virchow’s triad.

pathophys.org

27/02/2025

Differential Diagnosis for a Prolonged PT and aPTT

🔸If the PT and the aPTT are both prolonged, there could be multiple factors affected in the intrinsic and extrinsic pathways or a single factor deficiency in the common pathway: FX, FV, Fll or severe fibrinogen deficiency.

24/02/2025

Algorithm showing screening, diagnosing, treating and monitoring for iron deficiency in patients with HF

mdpi.com/2077-0383/11/1…

21/02/2025

Rnf111 as a novel regulator of hematopoietic stem and progenitor cell development, providing the first elaborate characterization of the role of Rnf111 in hematopoiesis.
haematologica.org/article/view/h…

21/02/2025

Blastic plasmacytoid dendritic cell neoplasm is a rare hematologic malignancy. It was initially regarded as a form of lymphocyte-derived cutaneous lymphoma and alternatively named CD4+CD56+ hematodermic tumor, blastic NK cell lymphoma, and agranular CD4+ NK cell leukemia.

20/02/2025

Kidney involvement in Monoclonal gammopathy of renal significance
kireportscommunity.org/post/monoclona…