Dr Rajesh bollam DM medical oncology and hematology ( Cancer specialist Hyderabad )

  Bone marrow biopsy (BMB) FAQs! Ever wondered what it's all about? Keep reading... 👀 What makes up a BMB? Usually it includes 2 samples - the aspirate (liquid marrow 🩸) and the trephine (bone core 🦴) Why do we need 2 samples? The aspirate allows us to individually look at each BM cell under the microscope 🔬 (e.g. WBCs, RBCs) and classify them via flow cytometry (a method of identifying and measuring pathological cells using their surface markers e.g. CD19 for B-cells) The trephine lets us look at the way the BM is organised and assess for things like fibrosis and infiltration. We can also apply stains 🖌 (immunohistochemistry) to detect specific cells on the trephine How is it done? It is a quick (20-30 min) awake procedure using local anaesthetic. It does not require a theatre and is often done at the patient bedside. It is done aseptically using 2 separate needles 💉 (aspirate and trephine). Where do you take the samples from? Most times we manage to get samples from the pos...

  Updated Recommendations for Breast Cancer Surveillance in Young Female Cancer Survivors William J. Gradishar, MD reviewing Mulder RL et al. J Clin Oncol 2020 Dec 10 Surveillance is now strongly recommended for survivors treated with ≥10 Gy chest radiation — a change from ≥20 Gy. In 2013 the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) published evidence-based recommendations for surveillance of female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with radiation to fields that potentially involved breast tissue on the chest wall. Based on new evidence, IGHG has updated its breast cancer surveillance recommendations. BOOK APPOINTMENT Modified recommendations include the following: Mammography and breast MRI should be performed at least annually up to age 60 for survivors treated with ≥10 Gy chest radiation (strong recommendation) and for those treated with upper abdominal radiation that exposed breast tiss...

  #hemophilia Blood needs to clot. It needs to plug the hole so it doesn’t leak out of the hose! When endothelial injury occurs this activates the clotting cascade (extrinsic and intrinsic) Think of the extrinsic pathway as the “quick fix”, like putting duct tape on the hole. It occurs faster, but is less stable. This is fibrin mesh formation and platelet aggregation. You still need the intrinsic pathway to keep going in order to form the more robust clot that will permanently plug that hole. Clotting factors help support the plug. When clot formation is working the way it is supposed to, we form an immediate plug, followed by a delayed more secure clot. BOOK APPOINTMENT Both of them lead to activation of factor X (the common pathway) The intrinsic pathway has a bunch of clotting factors, one activates the other, like dominoes falling. If one of the Domino pieces are missing, the cascade can’t go on, and no “robust” clot will form. Intrinsic pathway deficiencies If factor VIII is ...