Daniela Hermelin, MD @HermelinMD Twitter profile

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Daniela Hermelin, MD

@HermelinMD

2 months

Blood is 35 languages. Can you find yours?

Daniela Hermelin, MD

@HermelinMD

2 months

I am creating a sweatshirt with the word 🩸𝔹𝕃𝕆𝕆𝔻 in every language. Could you please share how to write the word 🩸𝔹𝕃𝕆𝕆𝔻 in your native language? THANK YOU!

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Daniela Hermelin, MD

@HermelinMD

4 years

Every single peripheral smear I have viewed for an acute COVID-19 admission has #covicytes : large atypical lymphocytes w/ irregular nuclear borders and distinct deep, blue cytoplasm. In the background of lymphopenia, they are a striking cosmic orb. Do you see them also?

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Daniela Hermelin, MD

@HermelinMD

3 years

When I was a 1rst year resident, I gave birth to my 6th child on Sept 8. I planned to take 4 weeks off, but developed pneumonia & had to take an additional two weeks to recover. With all that, I was able to graduate on time, and today, my daughter started 2nd grade 🐦 #timeflies

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Daniela Hermelin, MD

@HermelinMD

4 years

“It’s a basophil.” Back to the hospital after dinner and joined by my 6-y/o daughter for a second opinion and basophil bonding. CML patient refusing treatment, WBC = 180K, PLT= 700K, basophilia

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Daniela Hermelin, MD

@HermelinMD

3 years

This is what a bag of granulocytes look like. They are transfused to patients with an ANC<500, evidence of an infection not responding to antibiotic therapy. Thank you to our amazing @WillYouGive donors who provide this precious product to our patients in need. #beyondgrateful

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Daniela Hermelin, MD

@HermelinMD

5 years

24 y/o w/ h/o of Crohn’s Disease presents w/ worsening fatigue, weakness & dizziness. He has mild abdominal pain, but no signs of bleeding. No transfusion history. Infliximab was discontinued for autoimmune hepatitis. Hb/Hct = 4.4/13.5. 👇🏽Check out his peripheral smear below.

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Daniela Hermelin, MD

@HermelinMD

3 years

This is the plasma of a patient w/ relapsed #TTP , who presented w/headaches. Notice how murky the plasma is. This happens when RBCs are hemolyzed (⬆️bilirubin). Platelet microthrombi accumulate like little rocks in a stream, occluding & shearing RBCs in the microvasculature.

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Daniela Hermelin, MD

@HermelinMD

5 years

A 23-year-old woman w/ a history of SLE was admitted to the hospital w/ abdominal pain & headache. Purpura is seen on her chest & thighs. Hb /Hct= 8.3,28.4, PLT= 7,000, LDH = 952, Hapto = <8, Ind Bili = 1.2, Cr = 1.2 PT/INR = 1.3. 👇🏼Take a look at her peripheral smear.

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Daniela Hermelin, MD

@HermelinMD

3 years

🪐Platelet satellitism in EDTA anticoagulated blood. EDTA chelates Ca2+, changes platelet membrane and unmasks antigens on platelet glycoproteins GPIIb/IIIa and neutrophils, IgG recognizes them forming a bridge between the two cells.

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Daniela Hermelin, MD

@HermelinMD

4 years

@DGlaucomflecken I’m crying laughing. This was hysterical. #basophilsRreal

Daniela Hermelin, MD

@HermelinMD

5 years

@hmgcoa2 @AkshaySharmaMD @satya_yadav @drzsicklecell @sicklecelldoc @nbhattmd @BldCancerDoc This video is dedicated to all those who ❤️love #basophils including my friend @DGlaucomflecken . 67 y/o man with Shingles. Presented to ER with abd pain secondary to opioid patch. Flagged for #lymphocytosis . Check out those 👀gorgeous basophils w/ coarse & dense granules.

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Daniela Hermelin, MD

@HermelinMD

5 years

⚡️ “ #Blooducation Tweetorials” Here is a running collection of my #Blooducation #Tweetorials covering topics in #TransfusionMedicine & #Apheresis Therapy including #TraumaResuscitation , delayed hemolytic transfusion reactions, #RhDisease & more 🅰️🅱️🆎🅾️

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Daniela Hermelin, MD

@HermelinMD

4 years

COVID19+ SCD patient in ICU asked me for a hug. Although, a little hard with my big visor, I gave a strong, firm hug. A reminder that we help treat patients beyond the physical.

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Daniela Hermelin, MD

@HermelinMD

4 years

This is a unit of COVID19 #convalescentplasma . Each unit has 200 ml & must be ABO-compatible. Once thawed, it has a 5-day expiration date. Remember to transfuse slowly (100 ml/hour) to prevent #TACO since many critically ill patients have underlying cardiac or renal disease.

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Daniela Hermelin, MD

@HermelinMD

3 years

☔️ Cytokine storm in acute Covid causing 🌊surge of myeloid cells to flood into the peripheral blood. Mimics CML 🥸 👇🏼Check out those basophils and covicytes.

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Daniela Hermelin, MD

@HermelinMD

4 years

As a clinical pathologist who reviews peripheral smears, I may not touch the patient, but I examine the patient. Under the microscope, a dynamic conversation occurs. Many times I am left in prayer, sending blessings of complete recovery, peace and comfort. #Blooducation

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Daniela Hermelin, MD

@HermelinMD

5 years

Married for 15 years today to an amazing man, who has relentlessly encouraged me to pursue my dreams through all of medical school, pregnancy (x6), raising children, residency, fellowship and life. The penultimate #heforshe

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Daniela Hermelin, MD

@HermelinMD

3 years

A 58-year-old man with a history of 🔮multiple myeloma has positive antibody screen. Check out his antibody identification panel. 👇🏽Notice it has a panagluttinin pattern, meaning every red cell tested against the patient's plasma is reactive or agglutinates🩸 #Blooducation

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Daniela Hermelin, MD

@HermelinMD

3 years

A 33 y/o physician just came back from a retreat in Sudan. She was interested in starting up her platelet donations but was feeling achy with abdominal pain + cyclical fevers. Take a look at her peripheral smear below 👇🏼 Notice the 💍trophozoites inside the RBCs.

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Daniela Hermelin, MD

@HermelinMD

2 years

What should be the interval between infusion of low dose Rituximab and PLEX for aTTP?

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Daniela Hermelin, MD

@HermelinMD

4 years

@DGlaucomflecken I really do serve hot cocoa or other hot sweet drinks in my office to all my guests. Is that a pathologist thing?

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Daniela Hermelin, MD

@HermelinMD

5 years

@hmgcoa2 @AkshaySharmaMD @satya_yadav @drzsicklecell @sicklecelldoc @nbhattmd @BldCancerDoc This video is dedicated to all those who ❤️love #basophils including my friend @DGlaucomflecken . 67 y/o man with Shingles. Presented to ER with abd pain secondary to opioid patch. Flagged for #lymphocytosis . Check out those 👀gorgeous basophils w/ coarse & dense granules.

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Daniela Hermelin, MD

@HermelinMD

2 years

🩸🤍With tremendous gratitude, I have accepted the CMO position at @impactlifeblood . Privileged to join a phenomenal team and donor community dedicated to gift of giving life. 🙏🏼Special thank you to Dr. Louis Katz. I have BIGGGGG shoes to fill 👟😁

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Daniela Hermelin, MD

@HermelinMD

3 years

😍What a treat to have my mother visit and tour the 🥼🔬Lab and Blood Bank. Here’s her advice for those pursuing medicine 💕🔬🩸🩺👩🏽‍⚕️👨‍⚕️ #Path2Path

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Daniela Hermelin, MD

@HermelinMD

5 years

🌨️It’s snowing outside, but it’s nice & warm in the Blood Bank. 23 y/o RhD-negative woman delivered an RhD-positive baby. Take a look at the positive👶🏼 #FetalScreen below. Notice the beautiful rosettes floating which look like ❄️snowflakes. #PathBoards #Blooducation

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Daniela Hermelin, MD

@HermelinMD

3 years

This is a synovial fluid smear from a 7 y/o boy who presented limping with a swollen left ankle, and fever for a week. 👇🏼Notice the intracellular cocci. Culture grew MRSA 🧫Wright stain.

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Daniela Hermelin, MD

@HermelinMD

6 years

1/8 62 y/o man presents to the ER with new onset shortness of breath 🤒 WBC = 225K, Hb/Hct = 12.8/39.3, PLT = 210K and the peripheral smear looks like this👇🏽 #PathTweetorial #Blooducation #Apheresis

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Daniela Hermelin, MD

@HermelinMD

3 years

👇🏼This is a gorgeous example of #rouleaux : the sticking of 4 or more RBC's that form a stacked coin 💰 appearance. This is due increased positive charged proteins such as immunoglobulins that change the zeta potential that repel RBCS. ❓Diagnosis 🥁🥁🥁 IgG kappa MM.

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Daniela Hermelin, MD

@HermelinMD

4 years

🙌🏼It’s new SARS-CoV2 IgG test validation time! Running known positive COVID-19 patient samples for presence of IgG antibody. How will this result impact our knowledge of disease prevalence and immunity? #LabMedicine #LabWeek2020 #Lab4Life 👊🏼 🧪🩸🧬🦠🧫🔬

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Daniela Hermelin, MD

@HermelinMD

4 years

Dedicating today's teaching & effort to my father, Ronald S. Wagner, MD, a"h, who passed away on 4-23-2014. One of the first HIV/AIDS physicians of S. Florida, he taught me how to truly care for the sickest. He always believed that "the world will always need good doctors."

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Daniela Hermelin, MD

@HermelinMD

3 years

🍼An 8-month old baby presented with lethargy and fever. Check out her peripheral smear below 👇🏼 ⁉️What do you think flow cytometry showed?

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Daniela Hermelin, MD

@HermelinMD

3 years

9 y/o boy presents to the ED with dark colored urine, fatigue. He is pale and slightly icteric. His Hb = 6.9, ⬆️LDH + Indirect Bili. Check out his urine in picture 👇🏼 📟Since you are the on-call Heme-Onc Fellow you are paged. ⁉️🩸What labs would you order and what is your DDX?

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Daniela Hermelin, MD

@HermelinMD

4 years

💫Unbelievable. Super cool. Outrageous. Amazing. Phenomenal. Fantastic. So incredible. Woo hoo. 🙏🏼Thank you @pathologistmag 🏆Congratulations to all the wonderful nominees dedicated to #pathology

The Pathologist

@pathologistmag

4 years

The Pathologist's 2020 Power List is now live! Will you appear in one of this year's four categories? Will your friends, colleagues, family? Find out now! #PathPower20

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Daniela Hermelin, MD

@HermelinMD

5 years

1/10 A 19 y/o # SickleCellDisease asplenic patient presents with fevers and signs of hemolytic anemia. Last week, he received a red blood cell exchange. Check out his 👇🏽 peripheral smear below. Notice the ⭕️ intraerythrocytic rings (blue arrows) #PathTweetorial #Blooducation

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Daniela Hermelin, MD

@HermelinMD

5 years

My final bow as the #TMfellow . Thank you Dr. Blackall for providing your incredible mentorship and training in #TransfusionMedicine . Thank you @aabb , #SLUPath , my colleagues and my friends for your encouragement. Thank you to my family for your endless love and support.

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Daniela Hermelin, MD

@HermelinMD

3 years

⁉️📟Are you a pathology resident taking call & handling Blood Banking and Transfusion Medicine topics? Here is a 10-step approach to consider when consulted for a Red Cell Exchange in the context of Sickle Cell Disease. 👇🏽Follow the #Tweetorial below. #BloodyOnCall

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Daniela Hermelin, MD

@HermelinMD

4 years

I'm really digging my new 🦠 #Coronavirus 👟 sneakers painted my daughter, 💘Talila. #6feet 😁

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Daniela Hermelin, MD

@HermelinMD

4 years

#CML in bloom.

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Daniela Hermelin, MD

@HermelinMD

10 months

👇🏼 Take a look at this very rare, frozen unit of Kpb-negative blood. Kpb is a member of the Kell blood antigen system and is present on 99% of all donors. Finding Kpb-negative blood is challenging. 🧊Rare red cell units can be frozen for up to 10 years in glycerol. When

Daniela Hermelin, MD

@HermelinMD

10 months

Blood Bank Mad Libs. ✍🏼Fill in the spaces. 68 y/o RhD-negative man with myelofibrosis and CKD is transfusion dependent. History of anti-C, anti-K antibodies. Now, our patient develops an anti- Kpb antibody. His Hb = 5.9 Oh ____. Finding compatible units will be ________.

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Daniela Hermelin, MD

@HermelinMD

3 years

This is a pedipack, a small unit of blood aliquoted from the “mother” bag and designated for a baby. Volumes for babies are determined by weight. ☢️Units are irradiated. If placed into a syringe, it becomes an open system and expires within 24 hours.

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Daniela Hermelin, MD

@HermelinMD

1 year

🤩Super proud of my daughter. Just turned 16. Today was her first whole blood donation 🩸💪🏽🅰️🅱️🆎🅾️ @impactlifeblood #BloodDrive STL

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Daniela Hermelin, MD

@HermelinMD

2 years

Who could have imagined? 7 years ago, 7 months pregnant w/ my 6th babe, I started my @SLUHospital AP/CP pathology residency. Boy was I excited! 🤩My dream was being realized. I even was assigned my own microscope. Could life get any better?

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Daniela Hermelin, MD

@HermelinMD

6 years

This is what a positive Direct Coombs’ otherwise known as a Direct Antiglobulin Test (DAT) looks like under the microscope. When Ab coats the RBC surface and a Coombs’ reagent (anti-IgG) is added, the cells will stick together, or agglutinate.

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Daniela Hermelin, MD

@HermelinMD

3 years

Cells don’t wear a name badge📛 To identify blasts ask the following questions: 1 Am I big? 2 Do I have a high N/C ratio? 3 Do I have fine nuclear chromatin? 4 Do I have a prominent nucleolus? ✅Then I’m a blast!

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Daniela Hermelin, MD

@HermelinMD

6 years

4 years ago, 6 mo. pregnant w/ my 6th, about to start my residency and closest friend diagnosed with triple - breast ca. Odds were against me to finish & my friend was told she would never have children after chemo. Yesterday, received diploma and today reveled in her son's bris

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Daniela Hermelin, MD

@HermelinMD

5 years

73 y/o man presents with weakness, SOB and poor appetite for 3 weeks. Physical exam reveals a large, firm prostate. PSA = 850 😱Admission labs show a Hb/Hct= 6.7/20.8, PLT =87, WBC = 5.29. Heme/Onc requests a #pathologist review on the peripheral smear below👇🏼

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Daniela Hermelin, MD

@HermelinMD

3 years

@Farzanarab Private message me when you have a chance so we can talk strategy 🥊

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Daniela Hermelin, MD

@HermelinMD

2 years

🎈Just E-published! We hope this Illustrated Review on Viscoelastic Testing will elucidate basic concepts while offering clinical applications for testing. Filled with evidence-based algorithms. 👏🏼Congrats to my co-authors @JanHartmannMD + @JerroldLevy .

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Daniela Hermelin, MD

@HermelinMD

4 years

📢Hey MS4s, getting ready to apply for #Pathology Residency in the virtual setting ⁉️ 🗓️Mark your calendars & join us Thurs Sept 24th at 9PM ET for a #Path2Path chat to get Tips and Tricks for the virtual interview & learn how to evaluate the fit of a program. 😎Bring a friend

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Daniela Hermelin, MD

@HermelinMD

3 years

To all my friends and colleagues around the world, wishing you #ShanahTovah blessings of sweetness, good health and happiness. May this year be one of togetherness, healing and growth filled with laughter, prosperity and collaborative success. W

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Daniela Hermelin, MD

@HermelinMD

3 years

👇🏼This is a great example of 𝐜𝐨𝐚𝐫𝐬𝐞 basophilic stippling Stippling is a type of RBC inclusion caused by precipitation of ribosomal RNA, a sign in a defect in erythrocytic maturation. They can be seen in nutritional deficiencies, MDS, metal toxicities, + hemoglobinopathies.

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Daniela Hermelin, MD

@HermelinMD

3 years

A 26-year-old female with a history of SLE and nephrolithiasis presented to the ED with hematuria and abdominal pain. 😨Admission Hb =5.3. A type and screen is ordered. 👇🏽Check out her antibody panel below. Notice it has a panagglutinin pattern = all reagent RBCs are reactive.

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Daniela Hermelin, MD

@HermelinMD

5 years

My 8-year-old daughter told me that her Mac&Cheese looked like DNA 🧬 Is this a sign of budding pathologist who associates the inner workings of the body with anything related to food? #pathologistfoodie #ImAPathologist

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Daniela Hermelin, MD

@HermelinMD

2 years

76 y/o male presented to ED with severe dyspnea. Hb= 5.5 Pretransfusion testing performed and found a panagluttin reactivity. 👇🏼Check out the peripheral smear below and notice the monomorphic lymphocyte population, smudge cells and rouleaux. ⁉️What’s causing the anemia?

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Daniela Hermelin, MD

@HermelinMD

4 years

🙌🏼Join us tomorrow as we launch the new #pathelective .com website filled with a ton of pathology lectures given by experts in the field, including topics in #TransfusionMedicine 🅰️🅱️☺️🅾️These lectures are geared towards med students and trainees and are 🤑FREE!!!!

Joe Chaffin, MD

@bloodbankguy

4 years

@cullen_lilley @KMirza @HermelinMD Cullen, I think having "made it" requires MUCH more than a shout out from dopey old me! Thanks for the kind words, though. @HermelinMD is the star 🌟, I'm just helping her out.

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Daniela Hermelin, MD

@HermelinMD

3 years

🤩Best part of my day? Teaching MS2’s topics in 🅰️🅱️🆎🅾️🩸Transfusion Medicine: pretransfusion testing, blood product transfusion criteria, + transfusion reactions. Energized by your questions and curiosity. #Blooducation

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Daniela Hermelin, MD

@HermelinMD

4 years

Critical green inclusions known as ☠️“death 💎crystals” are blue-green inclusions found in neutrophils. This finding is not to be used to predict mortality but are strongly associated with severe liver injury and lactic acidosis. Peripheral blood. Wright stain.

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Daniela Hermelin, MD

@HermelinMD

4 years

Day 1. Changing out of my clothes in the garage before I enter my house and wiping down my cell phone and pager with disinfectant wipes. Six excited kids on the other side of that door ready to jump all over me. Have to protect them from what I may have been exposed to today.

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Daniela Hermelin, MD

@HermelinMD

4 years

You know you are a #BloodBanker when your phone autocorrects for ADAMTS13 😁🅰️🅱️🆎🅾️ #ApheresisDay2020

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Daniela Hermelin, MD

@HermelinMD

3 years

New summer lipstick 💄 shade: carboxy hemoglobin red. Bad for masks, great for zoom!

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Daniela Hermelin, MD

@HermelinMD

6 years

72 y/o man with malaise, shortness of breath and fevers🤒 T wave depression on lateral EKG leads. This is what his peripheral smear looks like 👇🏼

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Daniela Hermelin, MD

@HermelinMD

1 year

Sometimes giving life to another, may save your own. Donor’s whole blood failed the leukofiltration step. Triggering a CBC which showed an elevated WBC with lymphocytosis. Contacted the donor and recommended a Heme/Onc referral. Low risk CLL diagnosis made. ☺️Proud

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Daniela Hermelin, MD

@HermelinMD

3 years

A baby underwent repair of multiple cardiac defects. Post ECMO, baby developed a left-side pleural effusion. Take a look at the pleural fluid that was collected. ⁉️What caused this and what do you think you will see under the microscope?

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Daniela Hermelin, MD

@HermelinMD

4 years

63 y/o female presented to ED with worsening lower back pain and generalized aches. Fevers and night sweats. She was exposed to a COVID-19 positive colleague at work, but tested negative. She was found to have a significant leukocytosis of 50K. Check out her smear below 👇🏼

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Daniela Hermelin, MD

@HermelinMD

9 months

It’s my birthday 🥳 What a blessing to be sharing and celebrating another year with my #Blooducation Family 🩵🅰️🅱️🆎🅾️🩸

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Daniela Hermelin, MD

@HermelinMD

3 years

No need to thaw. Plasma available now! Low Titer Group A Liquid Plasma for emergency released blood products in trauma resuscitation 🙌🏼 🔫🗡💣🏎🚓🧨🛡 26 Day expiration Not leukoreduced Stored in the refrigerator

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Daniela Hermelin, MD

@HermelinMD

6 years

🔬This is what a warm autoimmune hemolytic anemia looks like under the microscope. Notice the range in RBC sizes from spherocytes to polychromatophilic RBCS. 👇🏽 Also, check out the rouleaux and RBC agglutination! #Blooducation

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Daniela Hermelin, MD

@HermelinMD

5 years

❣️My Beloved #Blooducation Colleagues❣️ Red blood cells are red Platelets are blue Cryo is frozen Plasma is too Thank you for spreading the love for Transfusion Medicine, Blood Banking and every bloody thing in between 💟 🅰️🅱️🆎🅾️💟

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Daniela Hermelin, MD

@HermelinMD

6 years

62 y/o man, O positive with de novo AML undergoes workup for Hematopoietic Stem Cell Transplant (HSCT). 😃Good news: Sibling with 8/8 HLA match! 👎🏽Bad news: Sibling is A positive. Can this sibling be a donor? #Blooducation #PathTweetorial #HSCT

No way!

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Yes - go for it.

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Daniela Hermelin, MD

@HermelinMD

4 years

Macrophages are one of the first immune cells involved in responding to viral infections. They recognize proteins released by tissue injury & stimulate recruitment via signals (cytokines). Notice the monocyte below w/ toxic vacuolization, a common finding in #COVID19 patients.

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Daniela Hermelin, MD

@HermelinMD

4 years

I explained to my children the importance of vaccines and how they work to keep us safe. My 6 y/o followed our conversation with her own illustration of how the vaccine works against Covid-19. #GirlsInSTEM

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Daniela Hermelin, MD

@HermelinMD

3 years

#ApheresisChalkTalk . Today we discussed 🩸pretransfusion testing and why products need to be emergency released such as pRBCs in patients taking the drug #daratumumab . ⛑Keep Calm and Transfuse On #Blooducation

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Daniela Hermelin, MD

@HermelinMD

3 years

A 1 day y/o 👶🏽neonate, born at 40 weeks, was transferred to our NICU for anemia & hyperbilirubinemia. He is jaundice but has no signs of encephalopathy.🩸The antibody screen is positive. 👇🏽Check out his peripheral smear below and notice the increased number of nucleated RBCs.

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Daniela Hermelin, MD

@HermelinMD

4 years

Peripheral smear findings of COVID19 patient. Burst of #Inflammasomes leading to CML-like picture. Notice how all leukocytes have toxic cytoplasmic accumulation. They resemble painted warriors coming back from battle. Also #covicytes 🧿 present.

Prof. Akiko Iwasaki

@VirusesImmunity

4 years

Very excited to share this work by the heroic team - @carolilucas Pat Wong @sneakyvirus @tiago21bio et al on “Longitudinal analyses reveal immunological misfiring in severe COVID-19”. A thread on our findings. #COVID19 #Pathogenesis (1/n)

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Daniela Hermelin, MD

@HermelinMD

4 years

It’s 5:30 am and I’m waiting 🥶outside in line to vote. Proud to be standing among fellow Americans who make this the first priority of their day. #GoVote

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Daniela Hermelin, MD

@HermelinMD

2 years

💋🫂😘Kissing and hugging? Check out this 🎶🎧🔬peripheral smear below of a 4 y/o girl with EBV and the presence of reactive lymphocytes known as Downey cells which seem to kiss 💋 and hug 🫂 the red blood cells.

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Daniela Hermelin, MD

@HermelinMD

4 years

Getting started on the @aabb eCast covering the Kell and Kidd blood group antigens.

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Daniela Hermelin, MD

@HermelinMD

4 years

74-year-old man presents with SOB and found to have a paravertebral soft tissue mass. 👇🏼Pleural fluid smear below. Wright stain.

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Daniela Hermelin, MD

@HermelinMD

4 years

Giving baths while working on a presentation. I’m sometimes asked, how to balance work & parenting? Not a balance but a 🎠merry go round. Jump on, jump off, while it’s spinning of course. Often, the children & work are riding at the same time! Playground? #WomenInMedicine

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Daniela Hermelin, MD

@HermelinMD

4 years

This is AML with T(3:3). Hyperleukocytosis (WBC = 400K, 65% BIG, bulky blasts) presenting with symptoms of leukostasis. Check out the buffy coat 😱and the 1x slide.

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Daniela Hermelin, MD

@HermelinMD

6 years

1/9: 88 y/o woman with a history of hypothyroidism presents with a 3 day h/o abdominal pain and bloody diarrhea. Rising creatinine. Anemia with fall in platelet count. Peripheral smear shows the following 👇 #TMBlooducation #pathologytweetorial

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Daniela Hermelin, MD

@HermelinMD

3 years

This is a 43 y/o patient with ITP status post splenectomy. ⁉️Can you guess why he has a thrombocytosis? 👇🏼Check out this smear below and noticed the giant platelets and Howell Jolly bodies 🎶🎧

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Daniela Hermelin, MD

@HermelinMD

4 years

I’ve seen #hemophagocytosis in body cavity fluid smears, but never in the peripheral blood. What does this finding suggest if readily present on a peripheral smear? Is HLH a possibility in the right clinical scenario?

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Daniela Hermelin, MD

@HermelinMD

3 years

This is a target cell 🎯otherwise known as a codocyte (red arrow). They have an increased surface membrane to volume ratio leading to a central darker hemoglobinized region. ⁉️What conditions can you see them in?

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Daniela Hermelin, MD

@HermelinMD

2 years

I agree. The lab is in the dungeon (aka Lower Level) of the hospital. And we are thrilled to be recognized @DGlaucomflecken for the work we do. Meet Ron in the lab who agrees with the importance of a properly labeled specimen 🙌🏼 🧬🩸🧫🔬👩🏽‍🔬🧑‍🔬👨🏽‍🔬 stop by for a #hotcocoa

The Laborator-IAN

@iwallacemls

2 years

He’s done it! He’s freaking done it!!! Thanks @DGlaucomflecken !!! #lab4life

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9

105

Daniela Hermelin, MD

@HermelinMD

5 years

1/10 A 26-y/o man with HbS disease has recurrent episodes of priapism 😱 HbS is 51%. He has just arrived to the ER with another painful crisis. Take a look at this peripheral smear, notice the drepanocytes, or sickle-shaped cells in the peripheral smear below 👇🏽 #PathBoards

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Daniela Hermelin, MD

@HermelinMD

5 years

Today my daughter turned 5. When offered an aisle-long selection of Barbies, she choose one of color. I felt so proud. Of course, I wish the mermaid carried a stethoscope or microscope 🤣, but I don’t think mermaids get too sick.

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0

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Daniela Hermelin, MD

@HermelinMD

6 years

1/10 These are the lungs of a patient who died while receiving a PLT transfusion. He developed sudden respiratory distress and did not respond to O2 support. Lungs compressed by 3000 mL of transudative pleural fluid. Notice the increased neutrophils #PathTweetorial

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Daniela Hermelin, MD

@HermelinMD

3 years

Big, bulky, sticky blasts. 76 y/o presents w SOB and elevated troponins. 😲WBC = 256K with 97% blasts 👇🏼Check out the peripheral smear. These blasts can clog up the microvasculature & lead to symptoms of leukostasis. Urgent leukapheresis was iniated as hydroxyurea was started.

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Daniela Hermelin, MD

@HermelinMD

2 years

Curbside teaching moment in the 🩺🩸MICU resident training rooms. Called about a patient with decompensated liver cirrhosis presenting with bleeding. How to use TEG to treat this coaguloapthy? 👇🏼Check out TEG6S global hemostasis with lysis results below.

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Daniela Hermelin, MD

@HermelinMD

5 years

Every peripheral smear tells a story. What can you tell me about this patient? #CellMeAStory

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Daniela Hermelin, MD

@HermelinMD

5 years

A 54-year-old man with ETOH cirrhosis presents w/severe ascites, jaundice & fever. He is not bleeding. Diagnostic paracentesis is ordered. Labs are drawn. Hb 11.5, PLT 69K, INR 2.3. 📲The intern asks how much FFP to transfuse. 🗣️You respond: #PathTweetorial #Blooducation

Dude, therapeutic dose

45

Dude, 1 unit

46

Dude, he doesn't need FFP

934

Dude, I'm not sure

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Daniela Hermelin, MD

@HermelinMD

2 years

🫤Oh man. Kleihauer-Betke test is positive. Rh- negative mom, Rh-positive baby. Full term. Healthy with no signs of anemia. Before administering RhIG let’s think about what can cause a false positive KB and what further testing should be performed? #Blooducation

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Daniela Hermelin, MD

@HermelinMD

4 years

Unfortunately, cells don’t wear a name badge, but use this criteria to identify #blasts 1.) Am I big? 2.) Do I have a high N/C ratio? 3.) Do I have fine nuclear chromatin? 4.) Do I have a prominent nucleoli? If yes to all, then I’m a blast!

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Daniela Hermelin, MD

@HermelinMD

3 years

This is the pleural fluid smear of a 67-year-old man s/p autologous transplant for Multiple Myeloma who presented with shortness of breath due to a right-sided pleural effusion. 👇🏼🔬Check out the atypical plasma cell below. Wright stain.

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Daniela Hermelin, MD

@HermelinMD

4 years

68 y/o woman presents with worsening shortness of breath and bilateral leg swelling. Since you are the #LabMedicine resident covering the Heme Bench, you are called to review a critical smear. Take a look below 👇🏼

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Daniela Hermelin, MD

@HermelinMD

2 years

9 y/o with neuroblastoma presents with fever and cough😮‍💨 Influenza A positive. 👇🏼Take a look at this slide of the peripheral smear below and notice the large, reactive lymphocyte known as an immunoblast classically seen in viral infections. (Wright stain)

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Daniela Hermelin, MD

@HermelinMD

3 years

This is a peripheral smear of a patient with iron deficiency anemia. Check out the numerous #elliptocytes (orange arrow) also known as ✏️ pencil cells. In hereditary elliptocytosis, genetic mutations in RBC membrane cytoskeleton proteins lead to unstable & irreversible changes.

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Daniela Hermelin, MD

@HermelinMD

6 years

1/16) 29-y/o woman w/ h/o B-cell lymphoma presents with lethargy & fevers for 1 week. Hb = 4.2, LDH > 1000, haptoglobin <8, PLT = 69. Transferred for further treatment for suspected TTP 😱 Check out the peripheral blood smear below 👇🏼 #pathtweetorial #TMBlooducation

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Daniela Hermelin, MD

@HermelinMD

4 years

No school today because of a Covid outbreak. Instead my kids spent 3 hours making cookies which serves as baking, art, math and science.

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Daniela Hermelin, MD

@HermelinMD

10 months

This is a bag of cryoprecipitate (cryo). It is made from the plasma portion of whole blood and contains Factor VIII, VWFactor, fibronectin and FIBRINOGEN. ☃️It is stored in the blood bank freezer at ≤18°C and needs to be thawed before transfused. FIBRINOGEN, also known as

JAMA

@JAMA_current

10 months

Critical bleeding is associated with a high mortality rate in patients with trauma. JAMA Associate Editor @seymoc discuses the results of the CRYOSTAT-2 trial with Nicola Curry, MD, @OUHospitals , and Ross Davenport, PhD, Centre for Trauma Sciences, UK.

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Daniela Hermelin, MD

@HermelinMD

4 years

@kathryniveyy This is what acute leukemia looks like with a WBC count of 350K. Sadly the patient died within 48 hours. This was a recent case that made me 😱

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