Implementation matters! A guideline-driven VTE prevention program (Vermont Model) led to ~60% of high-risk cancer patients receiving prophylactic anticoagulation—resulting in a 60% reduction in VTE and 56% reduction in death. #ISTH2025 #VTEprevention 🩸📉

The Vermont Model to prevent VTE in cancer pts. Results in high risk pts: ♥️ all pts starting cancer Rx screened for VTE risk 💙 59% of high risk pts rec’d prophylactic anticoagulation ♥️ VTE rate: 60% ⬇️ with AC 💙 Death rate: 56% ⬇️ with AC #ISTH2025 UVM Cancer Center

Dr Warkentin says his approach is plasma exchange + a few doses of IVIg —> straight to OR

2/2 One study showed that > 45% of patients with IDA and the majority of those with non-anemic ID can have a normal MCV. Another study showed similar results in pregnancy. Take home (and hopefully stating the obvious): do not rely solely on MCV to diagnose ID

RIETE registry data demonstrating that patients who retain their IVC filters have globally worse outcomes regardless of anticoagulation status; but were enriched for cancer. Please take the filter out when it’s no longer needed ❗️ #ISTH2025 THANZ

1/2 Duffy-Associated Neutrophil Count (DANC) I recently posted a poll asking what you would do with a person, otherwise well, who presented with chronic mild neutropenia and a Duffy-null phenotype (Fy[a–b–]). Diagnosis was DANC. Most answered correctly, namely reassurance.

What a week at #ISTH2025 for AHNIMres + Classical Heme at AHN! 🚀 4 posters by our PGY1 power duo @srinishantR & Kalaivani Babu 💪 Oral presentation on 11-year NIS study in acquired hemophilia A by PGY2 superstar Kriti Dhamija 🎤 Proud of this incredible team!

Half of young women with Heavy Menstrual Bleeding have iron deficiency. In women < 25years with onset of HMB from the start with a history of nose bleeds or their mother had HMB or bleeding then there may well be an underlying problem with how their blood clots (Von Willebrand's)

3/3 ✅ This means as long as you absorb ~1 mg/day, and losses aren’t excessive, the body can sustain erythropoiesis even in the absence of iron stores These patients are riding the edge of balance, thanks to gut absorption + iron recycling Low stores ≠ low Hb.

The American Gastroenterological Association (AGA)'s 2020 guidelines increased the diagnostic serum ferritin threshold from 15 ng/mL to 45 ng/mL, raising the estimated prevalence of iron deficiency #anemia among US adults by 3.3 million. ja.ma/476kBMk figure 1

Should aspirin be added to full-intensity anticoagulation in patients with stable coronary disease? jwat.ch/41NcXTH NEJM #CardioTwitter Behnood Bikdeli

1/2 EXPLAINING THALASSEMIA TRAIT Drafting new patient info on thalassemia trait for our The Blood Project module. A common condition, but often misunderstood by physicians and carriers alike. Hoping this will be a practical resource.

2/2 Feedback welcome!

3/3 Why do such patients develop symptoms? Erythroid precursors outcompete other tissues for iron thanks to massive transferrin receptor density. Evolution favors oxygen delivery > hair, nails, brain. Result: Hb steady, ferritin low, systemic effects possible.

3/3 That’s why for the same level of renal function (e.g., same estimated GFR), patients with predominant interstitial lesions generally have lower hemoglobin than those with isolated glomerular pathology. It’s about the compartment.

1/4 MILD, MODERATE, SEVERE... ACCORDING TO WHO? I often notice MDs describing cytopenias as “mild,” “moderate,” or “severe” without reference to standard definitions. The problem? Severity is in the eye of the beholder. Without shared definitions, these terms lose precision.

1/4 What happens to hemoglobin after RBCs rupture? When red cells rupture, hemoglobin (Hb) is released into plasma. Hb tetramers fall apart into αβ dimers, which are unstable and potentially toxic. What happens next?

Obesity can cause persistent mild leukocytosis 🔹 WBC 10–14 ×10⁹/L 🔹 Often neutrophilia (± lymphs/monos) 🔹 Hb & platelets normal 🔹 CRP may be normal Mechanism: low-grade inflammation Usually benign, but marker of cardiometabolic risk. Reviewed in PMID: 33270290

IV IRON AND FERRITIN 1/8 I recently posted a question about the spike in serum ferritin after IV iron. It can shoot from <10 to >1000, yet transferrin saturation (TSAT) only rises to normal — it barely moves. What’s going on? This is macrophage physiology in action 👇

2 trials reinforce less is more with anti-platelet & DOACs: 1. AQUATIC (NEJM): Adding ASA to DOACs in chronic coronary syndrome = ↑ death + bleeding 2. ATIS‑NVAF (JAMA): Adding ASA to DOACs after stroke w/ concurrent Afib+ASCVD = no benefit + ⬆️ 🩸 #HemeTwitter #MedTwitter