Syiran stem cell transplantation group - SSCTG

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…

16/02/2025

A proportion of patients with early-stage Helicobacter pylori (HP)-positive gastric “pure” DLBCLs responded well to first-line antibiotics eradicating HP

doi.org/10.1002/ajh.27…

16/02/2025

What happens if allopurinol and azathioprine are used together?

The simple answer is that the patient incurs significant risk for potentially life threatening reductions in white blood cells (WBC).

This is especially true if the dose of azathioprine is not reduced.

16/02/2025

Spot on editorial by NicoGagelmann and Nicolaus Kröger on the role of TP53 in MPN, reflecting upon a recent important study in
doi.org/10.1002/ajh.27…