Cat got your tongue? Or in this case - mucositis? Does converting the acute allogeneic transplant patient who can no longer eat's medications to IV fill you with dread? In this practical for once episode join consultant haematologist Dr Alison Chandler as well as haematology pharmacists Andriana Colic & Ariana McCauley as they take us through the how to of this challenging, but very common, clinical scenario. 

Timestamps

0:58 - Nick's literal nightmare
2:18 - Today's outline
3:38 - Let's meet the A-team!
11:14 - What do you wish the haem doctors knew?
13:38 - Introducing the NBM transplant patient
15:18 - Tacrolimus
17:37 - Mycophenolate
19:51 - Ciclosporine (or cyclosporine or CsA or CyA, whatevs)
22:20 - Hot tip on TDM
23:47 - Antifungals
24:23 - Posaconazole
26:06 - Voriconazole
27:29 - Isavuconazole
28:45 - Echinocandins - mica/anidula
30:52 - Antivirals
33:27 - CMV treatment
37:41 - Antibacterials - PJP prophylaxis
39:22 - The NBM APML patient 
43:35 - Antiepileptics
46:24 - TLS prophylaxis
47:53 - Wrap up time!
50:18 - Episode summary

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Was episode 79 too light on MDS for you? “Amateurs” you said, adjusting your sellotaped glasses. If so, you’re in the right place today as we prepare to look at classification, risk stratification and treatment of myelodysplastic syndrome. You also should seek out psychiatric attention, or perhaps just go outside. But in the meantime, enjoy this episode where we’ll dig deeper into the nitty gritty of MDS! We’ve got a lot to cover so we float about between intermediate and advanced for this episode.

TIMESTAMPS

1:11 - A Very Unhinged Intro  
3:34 - Actual Content Starts Here  
5:52 - Differentials for dysplasia  
7:54 - Presentations of MDS  
12:36 - MDS Subtypes  
14:23 - MDS with del(5q)  
18:29 - Lenalidomide in del(5q)  
25:03 - MDS with SF3B1  
29:05 - MDS with biallelic TP53 inactivation  
30:26 - Bonus cytogenetic abnormalities that pop up  
31:43 - Germline mutations that predispose to MDS and AML  
37:14 - MDS with low blasts  
38:08 - Ogata Score  
39:26 - Hypoplastic MDS  
44:03 - MDS with increased blasts  
44:58 - MDS with increased blasts and fibrosis  
46:22 - Breaking News - Blasts Should Now Be Counted By Flow  
48:30 - Prognostic models for MDS  
53:36 - Treatments for MDS  
1:04:39 - Take Home Messages

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What if the prequel had a prequel? Join Bashar, Nick and Cale as they attempt to unpack the newfangled world of clonal haematopoeisis. Find out how CHIPs can kill and no, it’s not due to eating too many of them too fast. Though that might do it too. We’ve had one spectrum, but what about a second. We need to go deeper. 

TIMESTAMPS

0:56 - A classic chippy mixup  
2:56 - Episode overview  
3:54 - Where CHIP sits in haem  
5:15 - Clonal haematopoiesis  
11:21 - What genes acquire CH?  
13:42 - CHIP  
20:09 - Clinical implications of CHIP  
24:24 - Increased mortality in CHIP  
28:54 - ICUS  
32:40 - CCUS  
35:42 - Take home messages  

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 If we’re going to truly understand myeloid disease, we must dispense with the ward and journey to the dystopian heart that beats at the centre of each dysplastic cell. Learn what is valid and in-valid as we swim across an ocean of concepts - past the basic principles of DNA and RNA, Polymerase Chain Reaction and its many many variants, Fragment Analysis and Next Generation Sequencing. Just save a little something for the swim back to clinic next week.

PS The Extra T is for TYOTT 

Timestamps

0:55 - Back in the lab, baby!
2:08 - Today's outline
6:24 - What IS molecular testing?
8:13 - The central dogma of molecular biology
14:46 - Types of genetic mutations
20:05 - Nomenclature for gene variants (advanced)
23:52 - Samples for testing
27:42 - What comes after DNA extraction
30:11 - What is PCR and how did we discover it? 
38:45 - What we do post PCR
41:27 - Quantitative and RT-PCR 
46:54 - Asking the RIGHT question
48:55 - Digital droplet PCR
50:44 - Electrophoresis
52:35 - Fragment analysis and melt curve analysis
54:33 - NGS
1:00:02 - What is a VAF?
1:05:23 - Lab governance (for haem ATs)
1:09:32 - Take home messages

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Happy marrows are all alike; every unhappy marrow is unhappy in its own way.  When haematopoiesis behaves itself, it’s frankly quite boring. When it goes rogue, it can get very creative. Join Cale, Bash and Nick as they attempt to walk through how this process goes off the rails, how MDS and AML are best understood and how dysplasia, cytopenias, blasts and clones all fit together.

TIMESTAMPS

0:55 - Our serious introduction to counterbalance last week 
1:58 - Episode overview 
2:50 - Introducing MDS 
7:12 - Risk factors for MDS 
8:53 - MDS progression 
11:13 - Complications of MDS 
13:10 - Leukaemic transformation 
15:37 - MDS epidemiology 
16:27 - Diagnosing MDS 
21:19 - What is dysplasia? 
26:44 - What we test on marrow 
35:13 - Clonality assessment in MDS 
42:29 - Caveats in diagnosing MDS 
43:18 - MDS summary (finally) 
44:09 - MDS treatment in brief 
45:37 - Intro to AML 
51:32 - Episode summary 

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What’s a CHIP and why is it so delicious? Why do we still abbreviate myeodysplastic neoplasm to MDS? How did Bashar get his hands on the Necronomicon? These are questions that every budding haematologist asks themselves at some point and we will answer at least some of them here! Join us today for a birds-eye overview of the myeloid family of disorders before we dig into them more over the coming weeks. 

TIMESTAMPS

0:57 - Does anyone know a good priest?  
3:17 - Myeloid conditions in bucket form  
5:30 - Acute vs chronic in haematological diseases  
7:35 - Myeloid precursor lesions  
10:33 - Myeloproliferative neoplasms  
15:23 - Myelodysplastic syndromes  
18:50 - MDS/MPN Overlap Syndromes  
22:29 - Mastocytosis  
26:02 - Acute myeloid leukaemia  
28:23 - (Acute promyelocytic leukaemia)  
29:36 - Histiocytic/dendritic cell disorders  
31:14 - Take Home Messages

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Hi-ho, Hi-ho, it's off the myeloid factory we go. Grab your fastest belt, a spare inserter and all the iron plates you can get your hands on as the Bloody Minded Crew embark on their nerdiest references yet and learn all about the basic science behind myelopoiesis. You’d better hop on a train, because the only main bus here goes straight from the marrow out to the periphery carrying all sorts of myeloid cells. And some blue circuits. 

0:52 - New year same us
2:44 - Season overview: myeloid time, baby!
5:15 - What is the myeloid compartment?
7:29 - Myelopoiesis
12:49 - Stem cell destiny... does free will exist?
14:28 - The myeloid progenitor
16:30 - Red cells and platelets
17:46 - White cell maturation
19:34 - Hormonal control of myelopoiesis
21:25 - Historical diversion into GCSF
23:19 - Clinical use of stimulating factors
26:39 - GCSF Bone Pain
28:15 - Emergency Myelopoiesis
30:08 - Wrap Up

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So you’ve been asked to start a DOAC? How is that different from a NOAC? Is there a difference? Which one should you start? Is warfarin a WOAC? How do I initiate these drugs? Why is the dose weird at the beginning? Do I need to check my dose is appropriate? 

If oral anticoagulation has you discombobulated you are in the right place!! In part II on the practical management of anticoagulation we are here to clarify all your questions on the most common types of oral anticoagulation you will come across as a junior doctor on the wards.

Timestamps
1:44 - Part I Recap and Part II Introduction
3:44 - History of Warfarin
8:37 - Mechanism of Warfarin
13:01 - Monitoring Warfarin
16:52 - Why Warfarin? and warfarin tips
21:40 - Warfarin reversal
31:05 - Warfarin Skin Necrosis & Drug Interactions
36:08 - Warfarin in Special Circumstances
40:25 - DOACs Intro
41:12 - Dabigatran
48:25 - Anti-Xa Agents (Rivaroxaban / Apixaban)
52:38 - Anti-Xa Monitoring (or not)
59:28 - DOACS - Special Circumstances
1:05:58 - Wrapup

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Does my blood look fat in this?

Does the idea of heparin being a fraction make you wish you listened harder in maths? What is unfractionated heparin? Why are haematologists so judgmental and prefer their anticoagulation low molecular weight? Why does haematology frown when you use the term “blood thinners” ?!?!

If injectable or parenteral anticoagulation feels confusing you have come to the right place! Today we look at unfractionated heparin and low molecular weight heparin,  practical things to think about and how to manage these drugs safely on the wards and beyond 

NB We’re going to leave the advanced injectables like Fonda/Danaparoid/Bivalirudin to a dedicated alternative, probably HITTS themed episode if you’re looking for these drugs

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Twas the night before Christmas, and all through the house, not a creature was stirring, particularly not a missing coagulation factor. Welcome to a very special present all wrapped and delivered by Santa and his Christmas elves and stuffed in your podcast queue in time to drive off for the holidays. Join Cale, a very dusty Bashar, Nick and Santa as we learn a little bit about Christmas Disease. We swear his jacket was that colour before we messed with his haemostatic pathways… CONTENT WARNING: Singing

TIMESTAMPS

00:55 - Pure unbridled musical talent 
03:34 - Intro to Christmas Disease/Haemophilia B
04:58 - History of Haemophilia B
14:01 - Presentation of Haemophilia B
18:25 - Haemophilia B Leyden
22:49 - Coagulation studies in Haemophilia B
26:20 - Treating Haemophilia B
28:12 - Where does factor replacement come from?
31:57 - Inhibitors
33:48 - Gene therapy
37:27 - Take home messages

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Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au