POPULARITY
7 episodes with Thrombocytopenia
7 episodes with Thrombocytopenia
4 episodes with Thrombocytopenia
4 episodes with Thrombocytopenia
4 episodes with Thrombocytopenia
3 episodes with Thrombocytopenia
3 episodes with Thrombocytopenia
3 episodes with Thrombocytopenia
2 episodes with Thrombocytopenia
What happens when a sharp-eyed cruise ship doctor spots a hantavirus amid a sea of hangovers and flu symptoms? In this high-stakes episode of the Prolonged Field Care Podcast, Dennis sits down with Dr. Ryan Maves — combat-experienced infectious disease expert and military medicine veteran — to break down the shocking recent Andes virus outbreak.Far from the next global pandemic, hantaviruses are a real, rodent-borne threat that has hit soldiers before (Korean War, anyone?) and can strike deployed units in austere environments. Ryan delivers hard-hitting insights on rapid diagnosis, the “off-script” decompensation that screams hantavirus, supportive care when there's no magic antiviral, and — most importantly — prevention strategies that actually work in the field.If you operate in rodent-infested buildings, set up in abandoned structures, or just want to trust your gut when a patient goes south fast, this episode is required listening. Real talk from the A-team who are currently managing these patients stateside.Key TakeawaysClassic presentation: Flu-like prodrome (fever, fatigue, myalgias, GI upset) for a few days followed by sudden shock, respiratory failure, and decompensation.Bedside diagnostic gold: Thrombocytopenia (low platelets) + hemoconcentration (elevated hematocrit) in a previously healthy patient = major red flag.Treatment reality: Purely supportive — fluids, pressors, oxygen, renal support. No silver-bullet antiviral; ribavirin has limited data at best.Prevention beats everything: Humans are dead-end hosts. Avoid aerosolizing rodent urine/feces/droppings (no dry sweeping!). Use bleach, N95 (or equivalent), gloves, and gown.Human-to-human spread: Extremely rare except with Andes virus (this outbreak strain). Still, treat unknowns with respect.Military relevance: Endemic in deployment zones worldwide; occupying previously rat-infested buildings is a classic risk. History tied directly to U.S. troops in Korea.Mindset: When things go “off script,” trust your clinical instincts over machines. The best tool in the field is still an experienced medic's gut.Chapters00:00 – Welcome back to the PFC Podcast00:26 – Introducing Dr. Ryan Maves & the cruise ship outbreak00:55 – Why this isn't the next pandemic… but still matters03:04 – Military relevance: hantaviruses in deployment zones03:51 – How the cruise ship doc nailed the diagnosis05:27 – Clinical syndrome & the “virus-y” prodrome07:04 – Key labs: thrombocytopenia + hemoconcentration explained09:42 – Disease progression and why young healthy people can still crash10:50 – History of hantaviruses (Korean War → Sin Nombre → Andes)12:21 – Who actually dies and why14:50 – Biocontainment units and the military experts on the case17:35 – Treatment in the field: supportive care only19:35 – Shock management: distributive + capillary leak20:55 – Prevention is king: rodent control & PPE tactics24:22 – Human-to-human transmission (Andes virus exception)27:31 – Infection control, differential diagnosis, and real-world precautions30:08 – Final thoughts: clinical acumen, zoonoses, and trusting your instincts32:32 – Closing & where to find more PFC contentGrab your N95 and hit playFor more content, go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
In this week's episode, Blood editor Dr. Laurie Sehn interviews Drs. Shengwen Calvin Li and Hrishi Krishna Srinagesh on their latest articles published in Blood. Dr. Li discusses "Single-cell profiling of ANKRD26 thrombocytopenia reveals progenitor expansion and polyploid apoptosis via JUNB-p21". The study identifies reproducible abnormalities in progenitor expansion and increased apoptosis of polyploid megakaryocytes, and they propose a novel mechanism in which centrosomal over-expression of ANKRD26 drives polyploid megakaryocyte apoptosis through JUNB-mediated induction of p21 transcription. Dr. Srinagesh discusses "Blinatumomab nonresponse correlates with poor survival after brexucabtagene autoleucel in B-cell ALL" in which data collected by the Real-World Outcomes Collaborative of CAR-T in Adult ALL consortium showed that prior nonresponse to blinatumomab was associated with inferior survival after brexucabtagene in comparison to blinatumomab-naïve patients. Early CAR-T responses were uniformly high regardless of prior exposure or response. This highlights that resistance to blinatumomab may identify patients at higher risk of post–CAR T relapse despite excellent initial responses.
Broadcast from KSQD, Santa Cruz on 4-09-2026: Dr. Dawn shares a follow-up from an emailer in Switzerland providing seven functional medicine practitioner addresses near Zurich and Aargau, noting that Switzerland uses different terminology but is actually an "epicenter of functional medicine." Dr. Dawn calls for support of the bipartisan Break Up Big Medicine Act, modeled on Glass-Steagall, which would prohibit common ownership of medical providers with insurers, pharmacy benefit managers, or drug wholesalers. She explains how vertical integration by companies like UnitedHealth, CVS/Aetna, and Cigna allows them to game medical loss ratio requirements through self-dealing while driving up costs. A European clinical trial implanted 2mm x 2mm light sensors beneath the retinas of 38 people with advanced macular degeneration, with 80% gaining clinically meaningful improvement (two lines on the vision chart) after one year. The device bypasses damaged rods and cones, sending camera images from glasses directly to the optic nerve. Dr. Dawn explains that air temperature warnings are measured in shade, but direct sunlight can add 20°C to heat exposure. Heat stroke triggers gut permeability, releasing lipopolysaccharides that cause cytokine storms and organ failure. She advises fans over air conditioning when possible, shade, hydration, and loose natural-fabric clothing. An emailer asks if low-dose oral strontium supplementation has the same problem as pharmaceutical strontium. Dr. Dawn confirms it improves bone density scores without reducing fracture risk, and recommends telopeptide testing to monitor actual bone loss after discontinuing. An emailer's doctor wants to prescribe high-dose dexamethasone for low platelets. Dr. Dawn advises against rushing to steroids since platelets of 40 are adequate for clotting, recommending a hematology consultation and repeat testing with citrated blood. Dr. Dawn reviews fiber types: wheat dextrin (Benefiber) is fermentable but technically gluten-free; guar fiber (Sunfiber) ferments slowly and works for low-FODMAP diets; inulin feeds bifidobacteria and produces anti-inflammatory short-chain fatty acids; methylcellulose (Citrucel) is non-fermentable; and psyllium (Metamucil) is facing a class action lawsuit over undisclosed lead contamination. An emailer with varicose veins reports recurring superficial blood clots. Dr. Dawn explains these don't travel to lungs like deep vein clots, but repeated clotting suggests possible thrombophilia requiring workup. She recommends consulting a vascular surgeon about superficial venous ligation under local anesthesia. Analysis of 25,000 wearable users found that three daily "exercise snacks" of just 1-2 minutes of vigorous activity (stairs, running for a bus) reduced all-cause mortality by 38-40%. Benefits plateau around 7,500 steps daily, and simply standing up every couple of hours dramatically reduces sedentary risks.
Suzy talks to Elina Vlachodimitropoulou, consultant obstetrician, and Mike Desborough, consultant haematologist, about FNAIT
Host: Prof. Jens Meier (Austria)Speaker: Dr Tina Tomić Mahečić (Croatia)In this episode of the ESAIC Podcast, our experts explore the complexities of thrombocytopenia beyond clinical guidelines. They discuss why platelet counts alone can be misleading, the impact of severe anaemia on haemostasis, and the risks of platelet transfusion in conditions such as TTP and HIT. A valuable listen for clinicians seeking a more nuanced approach to platelet management.
In the February 2026 episode of Critical Decisions in Emergency Medicine, Drs. Danya Khoujah and Wendy Chang discuss high-risk otologic infections and thrombocytopenia. As always, you'll also hear about the hot topics covered in the regular features, including a man with chest pain and palpitations in The Critical ECG, a child with chronic constipation in Clinical Pediatrics, elbow fracture-dislocation in Critical Cases in Orthopedics and Trauma, ultrasound-guided calcific tendinitis barbotage and lavage in The Critical Procedure, ACOG 2024 guidelines on Rh D immune globulin prophylaxis in The Literature Review, a young man with numbness and falls in The Critical Image, eptinezumab for migraine prevention in adults in The Drug Box, and metformin toxicity in The Tox Box.
Featuring an interview with Dr Hanny Al-Samkari, including the following topics: Case: A man in his early 40s with chronic immune thrombocytopenia (ITP) receives romiplostim with rituximab — Bhavana (Tina) Bhatnagar, DO (0:00) Case: A woman in her early 80s with metastatic adenocarcinoma of the lung responds to carboplatin/pemetrexed/pembrolizumab but after 14 months of maintenance pembrolizumab presents with ITP — Susmitha Apuri, MD (6:48) Case: A man in his late 70s with a 30-year history of chronic ITP who received corticosteroids and rituximab now receives avatrombopag — Sunil Gandhi, MD (12:06) Case: A woman in her early 80s with multiple comorbidities and a long history of ITP presents with confusion and fluid retention due to exacerbated congestive heart failure and receives fostamatinib — Dr Bhatnagar (19:26) CME information and select publications
Dr Hanny Al-Samkari from Massachusetts General Hospital in Boston discusses recent developments from the ASH 2025 Annual Meeting involving the use of Bruton tyrosine kinase inhibitors and BAFF-R antagonists in the treatment of immune thrombocytopenia.CME information and select publications here.
This episode covers immune thrombocytopenia.Notes: https://zerotofinals.com/paediatrics/haematology/itp/Questions: https://members.zerotofinals.com/Books: https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.
Featuring an interview with Dr Hanny Al-Samkari, including the following topics: Case: A woman in her early 70s incidentally diagnosed with immune thrombocytopenia (ITP) experiences a suboptimal response to prednisone and IVIG — Bhavana (Tina) Bhatnagar, DO (0:00) Case: A man in his early 50s with a long history of ITP undergoes splenectomy — Neil Morganstein, MD (5:06) Case: A woman in her mid 50s with symptomatic iron-deficiency anemia who was found to have ITP has received corticosteroids, rituximab and IVIG — Jennifer Yannucci, MD (12:25) Case: A woman in her early 30s who previously received ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine) and autologous stem cell transplant for Hodgkin lymphoma is diagnosed with ITP 5 years later that is refractory to high-dose prednisone, IVIG and rituximab, then romiplostim — Priya Rudolph, MD, PhD (18:19) CME information and select publications
Dr Hanny Al-Samkari from Massachusetts General Hospital in Boston discusses recent developments from the ASH 2025 Annual Meeting involving the use of Bruton tyrosine kinase inhibitors and BAFF-R antagonists in the treatment of immune thrombocytopenia.CME information and select publications here.
In this week's episode of the Blood podcast, editor Dr. James Griffin interviews Drs. Christian Gorzelanny and Rebecca Leaf on their latest articles published in this week's issue of Blood. Dr. Gorzelanny discusses compelling evidence for a new mechanism that amplifies their proinflammatory actions in "Lipid nanotubes unmask neutrophils for complement attack", demonstrating the pathological role of this process in a range of inflammatory disorders in order to stimulate intense study of how to regulate nanotube formation for therapeutic benefit. In "Immune thrombocytopenia in patients treated with immune checkpoint inhibitors" Dr. Leaf and colleagues define the incidence, clinical features, and outcomes of ICI-induced immune thrombocytopenia. Showing that ICI-induced immune thrombocytopenia is associated with excess mortality, these data should provide an impetus to greater recognition and to protocolization of effective interventions.
Featuring an interview with Dr Hanny Al-Samkari, including the following topics: VAYHIT1: A multicenter randomized, double-blind, Phase III trial evaluating ianalumab versus placebo in addition to first-line corticosteroids for patients with primary immune thrombocytopenia (ITP) (0:00) Secondary analysis results from VAYHIT3, a Phase II study of ianalumab for patients with primary ITP previously treated with at least 2 lines of therapy (8:15) Improved health-related quality of life and bleeding scores with the oral Bruton tyrosine kinase inhibitor rilzabrutinib in the open-label period of the multicenter Phase III LUNA 3 study for adults with ITP (12:23) Romiplostim for chemotherapy-induced thrombocytopenia in patients with colorectal, gastroesophageal and pancreatic cancer: A global Phase III randomized, placebo-controlled trial (16:01) CME information and select publications
Dr Hanny Al-Samkari from Massachusetts General Hospital in Boston discusses recent developments from the ASH 2025 Annual Meeting involving the use of Bruton tyrosine kinase inhibitors and BAFF-R antagonists in the treatment of immune thrombocytopenia.CME information and select publications here.
Dr Hanny Al-Samkari from Massachusetts General Hospital in Boston discusses recent developments from the ASH 2025 Annual Meeting involving the use of Bruton tyrosine kinase inhibitors and BAFF-R antagonists in the treatment of immune thrombocytopenia.CME information and select publications here.
Featuring an interview with Dr Hanny Al-Samkari, including the following topics: Mechanism of action and toxicity of the monoclonal antibody ianalumab (0:00) Primary results from VAYHIT2, a randomized, double-blind Phase III trial of ianalumab with eltrombopag for patients with primary immune thrombocytopenia (ITP) after failure of first-line corticosteroid treatment (7:32) Mechanism of action and toxicity of the Bruton tyrosine kinase inhibitor rilzabrutinib (11:52) Reduction in corticosteroid use with rilzabrutinib and sustained response in adults with persistent or chronic ITP in the long-term extension period of the Phase III LUNA3 study (18:46) CME information and select publications
Featuring perspectives from Dr Hanny Al-Samkari, Dr Cindy Neunert and Prof Francesco Zaja, including the following topics: Introduction (0:00) Case: A woman in her early 30s with chronic relapsing immune thrombocytopenia (ITP) receives eltrombopag with ongoing stabilization of platelet counts — Neil Morganstein, MD (2:03) Case: A woman in her late 60s with a long history of ITP controlled by eltrombopag experiences acute exacerbations — Bhavana (Tina) Bhatnagar, DO (6:42) Clinical Manifestations and Initial Management of ITP — Dr Neunert (18:07) Case: A woman in her early 80s with metastatic adenocarcinoma of the lung who responded to carboplatin/pemetrexed/pembrolizumab presents with ITP after 14 months of maintenance pembrolizumab — Susmitha Apuri, MD (33:14) Incorporation of Thrombopoietin Receptor Agonists and Other Second-Line Therapies into ITP Management — Prof Zaja (40:19) Case: A woman in her late 60s with stress cardiomyopathy and corticosteroid-refractory ITP receives rituximab followed by eltrombopag — Eric Fox, DO (1:00:44) Current and Future Role of Novel Therapies in ITP — Dr Al-Samkari (1:03:47) CME information and select publications
Dr Hanny Al-Samkari from Massachusetts General Hospital in Boston, Dr Cindy Neunert from Columbia University Irving Medical Center in New York and Prof Francesco Zaja from ASUGI in Trieste, Italy discuss cases of immune thrombocytopenia and recent findings from the 2025 ASH Annual Meeting.CME information and select publications here.
In this episode, we review the high-yield topic of Immune Thrombocytopenia (ITP) from the Hematology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
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Welcome to the Oncology Brothers podcast! In this Challenging Cases episode, we take a deep dive into thrombocytopenia management—a common yet often perplexing topic in everyday hematology and oncology practice. We are joined by Dr. Ronak Mistry, hematologist at the University of Pennsylvania and co‑host of Fellows on Call, to walk through real‑world cases spanning ITP, anticoagulation with low platelets, and HIT. We covered essential topics such as: • Workup of thrombocytopenia and confirming the diagnosis of ITP • First‑ and second‑line ITP therapy—steroids, IVIG, TPO receptor agonists, and splenectomy • Managing anticoagulation in thrombocytopenic patients with cirrhosis and DVT • Step‑by‑step approach to suspected HIT in the inpatient setting • Rapid‑fire tips—transfusion thresholds, chemo‑related thrombocytopenia, and medication culprits Whether you're a hematologist, oncologist, or internal medicine resident, this episode is packed with case‑based teaching points, practical pearls, and the latest guidance from ASH and NCCN for non‑malignant hematology. Follow us on social media: • X/Twitter: https://twitter.com/oncbrothers • Instagram: https://www.instagram.com/oncbrothers • Website: https://oncbrothers.com/ Don't forget to like, subscribe, and tune in for more challenging case discussions, treatment strategies, and expert insights from the world of hematology and oncology! #Thrombocytopenia #HematologyPodcast #ITP #HIT #OncologyBrothers
This week's episode will be focusing on Immune Thrombocytopenia Purpura ( ITP). We will go all the important details on causes, mechanism, diagnosis and treatment. The last time we covered this topic was in Sept 2022, and this comes up ALL the time in heme consults, and there will definitely be board review questions. It may also be tested on IM boards.
On tonight's show, we recognize National Immune Thrombocytopenia Awareness Month with Dr. Amit Mehta, hematologist and medical oncologist at Premier Hematology & Oncology in Cary, North Carolina. Dr. Mehta will share what immune thrombocytopenia is, how it impacts patients and families, and details about a new FDA approved treatment now available for adults living with this rare blood disorder.
On this Make A Difference Minute, Dr. Amit Mehta, hematologist and medical oncologist at Premier Hematology & Oncology in Cary, North Carolina, shares what to look for when it comes to immune thrombocytopenia (ITP), a rare blood disorder that can cause serious bruising and bleeding. Sponsor: Bankston Motor Homes BankstonMotorHomes.com
This accredited CME program highlights the latest clinical research about immune thrombocytopenia (ITP), a rare thrombotic disorder. Led by Shruti Chaturvedi, MD, this program provides a summary of clinically relevant data presented at the International Society of Thrombosis and Haemostatis Congress (ISTH 2025) that can enhance the care of patients with ITP. This program is supported by an educational grant from Sanofi.To receive CME credit, go to https://checkrare.com/learning/p-isth2025-module2-immune-thrombocytopenia-clinical-research-highlights/Target AudienceThis activity has been designed to meet the educational needs of physicians specializing in ITP. Other members of the care team may also participate.Learning ObjectivesAfter participating in the activity, learners should be better able to:Describe the latest research being presented to better manage individuals with ITP and its clinical relevance.FacultyShruti Chaturvedi, MDAssistant Professor of Medicine,Johns Hopkins Disclosure StatementAccording to the disclosure policy of the Academy, all faculty, planning committee members, editors, managers and other individuals who are in a position to control content are required to disclose any relationships with any ineligible company(ies). The existence of these relationships is not viewed as implying bias or decreasing the value of the activity. Clinical content has been reviewed for fair balance and scientific objectivity, and all of the relevant financial relationships listed for these individuals have been mitigated. Disclosure of relevant financial relationships are as follows:Faculty Educator/PlannerDr. Chaturvedi discloses the following relevant financial relationships with ineligible companies:Scientific Advisory Board/Consultant: Sanofi, Takeda, Sobi, argenx, Star Pharma, RallyBio, Novartis, AlexionGrant/Research Support: Sanofi, Sobi, argenx Other Planners for this activity have no relevant financial relationships with any ineligible companies. This activity will review off-label or investigational information. The opinions expressed in this educational activity are those of the faculty, and do not represent those of the Academy or CheckRare CE. This activity is intended as a supplement to existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically, and draw conclusions only after careful consideration of all available scientific information.Accreditation and Credit DesignationIn support of improving patient care, this activity has been planned and implemented by American Academy of CME, Inc. and CheckRare CE. American Academy of CME, Inc. is Jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.PhysiciansAmerican Academy of CME, Inc., designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other HCPsOther members of the care team will receive a certificate of participation. There are no fees to participate in the activity. Participants must review the activity information including the learning objectives and disclosure statements, as well as the content of the activity. To receive CME credit for your participation, please complete the pre and post-program assessments. Your certificate will be emailed to you within 30 days. PrivacyFor more information about the American Academy of CME privacy policy, please access http://www.academycme.org/privacy.htm For more information about CheckRare's privacy policy, please access https://checkrare.com/privacy/ContactFor any questions, please contact: CEServices@academycme.orgCopyright© 2025. This CME-certified activity is held as copyrighted © by American Academy of CME and CheckRare CE. Through this notice, the Academy and CheckRare CE grant permission of its use for educational purposes only. These materials may not be used, in whole or in part, for any commercial purposes without prior permission in writing from the copyright owner(s).
In this week's episode, we'll learn more about how exogenous CD19 stimulation affects CAR T-cell persistence in B-cell acute lymphoblastic leukemia treated with CD19 CAR T-cell therapy; new algorithms that incorporate sequential rapid immune-assays, intended to improve diagnosis of heparin-induced thrombocytopenia, and resource-adaptive survival prediction models to help guide management of patients with chronic myelomonocytic leukemia.Featured Articles:Outcomes of PLAT-02 and PLAT-03: evaluating CD19 CAR T-cell therapy and CD19-expressing T-APC support in pediatric B-ALLSequential combinations of rapid immunoassays for prompt recognition of heparin-induced thrombocytopeniaBLAST: a globally applicable and molecularly versatile survival model for chronic myelomonocytic leukemia
In this episode, Dr. Sergio Zanotti discusses clinical guidelines for the transfusion of platelets and fresh frozen plasma (FFP) in critically ill patients. He is joined by Dr. Angel Coz Yataco, a practicing pulmonary critical care physician. Dr Coz Yataco is on the faculty of the Cleaveland Clinic Main Campus. He is also the lead author of the recently published American College of Chest Physicians Clinical Practice Guidelines on “Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults.” Additional resources: American College of Chest Physicians Clinical Practice Guidelines on Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults. Coz Yataco a, et al. CHEST 2025: https://pubmed.ncbi.nlm.nih.gov/40074060/ Platelet Transfusion 2025 AAB and ICTMG International Clinical Practice Guidelines. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/40440268/ Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. Van Baarle LF, et al. New Eng J of Med 2023: https://www.nejm.org/doi/full/10.1056/NEJMoa2214322 Books mentioned in this episode: Think Again: The Power of Knowing What You Don't Know. By Adam Grant: https://bit.ly/404783f
In today's episode, supported by Camber Pharmaceuticals, we spoke with Kanwarpal S. Kahlon, MD, an associate clinical professor of medicine at the UCLA School of Medicine. In our exclusive interview, Dr Kahlon discussed the significance of the commercial availability of the generic, AB-rated formulations of eltrombopag (Promacta), a bioequivalent medication for the treatment of select patients with severe aplastic anemia and immune thrombocytopenia. He noted how the biosimilar is expected to reduce costs and improve the accessibility of this treatment, potentially enhancing patient adherence. He also explained how it is available in both oral suspension and tablet formulations and that it is well tolerated, with a safety profile similar to that of the original drug.
We dive into the recognition and management of blast crisis. Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Blast_Crisis.mp3 Download Leave a Comment Tags: Hematology, Oncology Show Notes Topic Overview Blast crisis is an oncologic emergency, most commonly seen in chronic myeloid leukemia (CML). Defined by: >20% blasts in peripheral blood or bone marrow. May include extramedullary blast proliferation. Without treatment, median survival is only 3–6 months. Pathophysiology & Associated Conditions Usually occurs in CML, but also in: Myeloproliferative neoplasms (MPNs) Myelodysplastic syndromes (MDS) Transition from chronic to blast phase often reflects disease progression or treatment resistance. Risk Factors 10% of CML patients progress to blast crisis. Risk increased in: Patients refractory to tyrosine kinase inhibitors (e.g., imatinib). Those with Philadelphia chromosome abnormalities. WBC >100,000, which increases risk for leukostasis. Clinical Presentation Symptoms often stem from pancytopenia and leukostasis: Anemia: fatigue, malaise. Functional neutropenia: high WBC count, but increased infection/sepsis risk. Thrombocytopenia: bleeding, bruising. Leukostasis/hyperviscosity effects by system: Neurologic: confusion, visual changes, stroke-like symptoms. Cardiopulmonary: ARDS, myocardial injury. Others: priapism, limb ischemia, bowel infarction.
Featuring slide presentations and related discussion from Dr Hanny Al-Samkari, Dr James B Bussel and Prof Nichola Cooper, including the following topics: Introduction (0:00) Clinical Manifestations and Initial Management of Immune Thrombocytopenia (ITP) — Dr Al-Samkari (10:24) Second- and Later-Line Therapies for ITP — Dr Bussel (1:00:51) Tolerability and Other Practical Considerations with Available Treatment Strategies for Persistent/Chronic ITP — Prof Cooper (1:28:08) CME information and select publications
Dr Hanny Al-Samkari from Massachusetts General Hospital in Boston, Dr James B Bussel from Weill Cornell School of Medicine in New York, New York, and Prof Nichola Cooper from Hammersmith Hospital Campus in London, United Kingdom, share expert perspectives on the diagnosis of and optimal management strategies for immune thrombocytopenia. CME information and select publications here.
Enrico Lopriore, MD, PhD - Are You Managing Pregnant Individuals? Then You Need to Know About Fetal-Neonatal Alloimmune Thrombocytopenia (FNAIT)
Enrico Lopriore, MD, PhD - Are You Managing Pregnant Individuals? Then You Need to Know About Fetal-Neonatal Alloimmune Thrombocytopenia (FNAIT)
Enrico Lopriore, MD, PhD - Are You Managing Pregnant Individuals? Then You Need to Know About Fetal-Neonatal Alloimmune Thrombocytopenia (FNAIT)
Enrico Lopriore, MD, PhD - Are You Managing Pregnant Individuals? Then You Need to Know About Fetal-Neonatal Alloimmune Thrombocytopenia (FNAIT)
Send us a textEffects of pregnancy-induced hypertension on early-onset neonatal thrombocytopenia. Ye M, Zhou C, Li L, Wang L, Zhang M.BMC Pregnancy Childbirth. 2025 Jan 24;25(1):67. doi: 10.1186/s12884-025-07193-z.PMID: 39856602 Free PMC article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
In this episode, we review the high-yield topic of Heparin-Induced Thrombocytopenia (HIT) from the Hematology section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets
Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions: Audrey: Hello! Appreciate all of your insight - you are a wealth of knowledge! I'm a 32 year old that has had idiopathic thrombocytopenia since I had my child 5 years ago. Just wondering what labs you recommend for this and how to improve the numbers. Thanks! Kaylee: Hi Dr. Cabral. I appreciate everything that you do. I'm reaching out because I am at a loss for what to do next. I have dealt with chronic constipation and bloating my entire life. A year ago I cut out all dairy from my diet and started working with an IHP. She was phenomenal and for a while, constipation, gas, and bloating had subsided while working with her. Through working together I am now able to have a bowel movement every morning. However, the intense bloating, gas and belching has returned. From the moment I wake up until I go to bed, my stomach gets more and more distended as the day goes on. I prioritize Whole Foods, still don't eat dairy, exercise five days a week, prioritize 7 to 8 hours of sleep at night and live a healthier life than a lot of my peers. What should I do? Kelsey: How does glutamate affect methylation? Frances: Hi doctor Cabral, First off, I just want to say how amazing you are at breaking down complex health topics and offering practical solutions on your podcast. It's been incredibly helpful, and I truly appreciate it. I have a question about raw vs. cooked vegetables. Traditional Chinese Medicine and Ayurveda often recommend eating cooked vegetables to aid digestion and other bodily processes. Does this also apply to veggies we add to smoothies? I frequently use raw spinach, kale, and cauliflower in mine. Should I be cooking them first, or does blending them make them easier to digest? Thanks so much for your answer. Frances Lauren: Hi Dr. Cabral, a close friend is suffering from Morton's Neuroma in both her feet. She has had cortisone injections, tried rest & really can't find much in terms of natural remedies. Are you able to make any suggestions? Sometimes surgery is the only option but I would appreciate your expertise/guidance on possible healing modalities? Thank you! Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community's questions! - - - Show Notes and Resources: StephenCabral.com/3228 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!
Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks… Erica: Hi Dr. Cabral. I wanted to ask about hair loss. I have a female friend in her 30s who is starting to wake up with a lot of hair on her pillow and on her bed after sleeping. Where would you start to look for the underlying root causes of this? Thank you. Patrick: Hey dr. Huge fan thanks so much for all you and your team do. I have another elbow question for you I went And got an X-ray and it showed some ostiophytes and I have snapping elbow which is affecting my rom Ofcorse all they said was cortisone shot and pills . I'm very active and enjoy exercising so I'd love to know the best therapy and supplements to do. Thanks Montas: Hi Dr Cabral, Thank so much for this life saving information you provide in order to take our health. For the past 5 years, I have been suffering a lot with back pain, joint pain, and all part of my body. I went from doctor to doctor, they can't really help me and it's obvious because they didn't train to go to the root cause of a symptomatic disease. I have been diagnosed with TB and spent 6 months for the treatment but after 1 year this left me with more diseases. I sweat a lot night and day, I have noise in my stomach eating or not, I strangely lose pounds instead of gaining. What's the first lab test you would recommend me to do to? I can't afford big 5. Thank you! Lara: Hi, dr. Cabral.. I'm wondering if any of the following contradicting information is true: you have to be taking Mg and Zn together for better absorption and the other is, don't take them together because Zn can block Mg absorption.. I found the same for Iron and Calcium - that they should be taken 4h away from Mg so they don't block its absorption.. please clarify, so we know how to properly take these supplements.. thank you so much! happy healing, everyone! An: hi Dr. Cabral thank you for all you do. I have a quick question now that I'm 70 I have bunions that are starting to bother me. I've had them for years but now that I'm heavy into pickleball they're starting to hurt. I see noninvasive bunion fixes and I'm just wondering what your thoughts are on those are they worth it or is that just a scam? Audrey: Hello! Appreciate all of your insight - you are a wealth of knowledge! I'm a 32 year old that has had idiopathic thrombocytopenia since I had my child 5 years ago. Just wondering what labs you recommend for this and how to improve the numbers. Thanks! Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes and Resources: StephenCabral.com/3222 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!
Send us a textMost major bleeds in preterm infants occur in the absence of severe thrombocytopenia: an observational cohort study. van der Staaij H, Hooiveld NMA, Caram-Deelder C, Fustolo-Gunnink SF, Fijnvandraat K, Steggerda SJ, de Vries LS, van der Bom JG, Lopriore E.Arch Dis Child Fetal Neonatal Ed. 2024 Jul 15:fetalneonatal-2024-326959. doi: 10.1136/archdischild-2024-326959. Online ahead of print.PMID: 39009429As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!
In this episode, we review the high-yield topic of Heparin-Induced Thrombocytopenia (HIT) from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets
Beyond the Pearls: Cases for Med School, Residency and Beyond (An InsideTheBoards Podcast)
Today's Episode Charlee reviews chapter 16 from the Pediatric Morning Report book. An 11-year-old male presents with scattered petechiae and increased bruising over 3 weeks, first on his legs, then spreading to his abdomen and arms. He cannot recall any trauma preceding the bruising but does report fever, cough, rhinorrhea, and headache 6 weeks prior that resolved over several days. He had a deciduous (baby) tooth fall out (shed) 3 days prior to presentation, without excess bleeding. He does not have gingival bleeding, nose bleeds, or joint swelling. Today's Host Charlee Quarless is a 3rd year medical student at Ross University. About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj www.BeyondThePearls.net The Dr. Raj Podcast Dr. Raj on Twitter Dr. Raj on Instagram Want more board review content? USMLE Step 1 Ad-Free Bundle Crush Step 1 Step 2 Secrets Beyond the Pearls The Dr. Raj Podcast Beyond the Pearls Premium USMLE Step 3 Review MedPrepTGo Step 1 Questions Learn more about your ad choices. Visit megaphone.fm/adchoices
Hannah is a VBAC mom and doula with Ebb and Flow Birth Co. located in Indiana. Hannah's first labor began very intensely. Her platelet levels were high enough for her to be able to get an epidural which she requested right away. She dilated to complete quickly, but after about 4 hours of pushing, baby just kept coming down and going back up with no progress. Hannah was exhausted and consented to a Cesarean. Unfortunately, her very effective epidural was not as effective during her surgery. It was painful. She required higher doses of medicine, hemorrhaged, and was so out of it that she remembers very little about her baby's actual birth.After the birth of her son, Hannah researched birth options and did all she could do ensure she'd never have another Cesarean. Her VBAC pregnancy included thrombocytopenia again, partial placenta previa (which completely resolved!), marginal cord insertion, and she was GBS+. With a great team and supportive provider, Hannah was able to stay focused on her VBAC goal even with the curveballs thrown at her. She went into labor spontaneously, progressed quickly, and though her pushing stage mimicked the same patterns, with the help of her doula's tips and freedom to move without an epidural, baby was able to descend and come right out!Hannah's Doula WebsiteWhat is Thrombocytopenia? ACH PublicationsPlatelet Transfusions ArticleNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Welcome, welcome. I hope you guys are having an incredible day. We have a guest today who has a VBAC story with a whole bunch of different things added to her journey. She has thrombocytopenia. Thrombocytopenia, I always say that wrong, which means low platelet count. That is definitely something that is more unique. It's a little bit more rare, but if you've ever been told that you have low platelet counts or thrombocytopenia, this is definitely going to be an episode for you to listen to. She also had partial placenta previa and even marginal cord insertion. I am so excited for her to be sharing her story today. We do have a Review of the Week so I'm going to dive right into that and then we are going to get into her beautiful story. This review was just left on Apple Podcasts recently and it said, “I recently discovered this amazing VBAC podcast and I'm absolutely hooked. The host is incredibly knowledgeable and passionate about all things related to pregnancy, childbirth, and postpartum care. Each episode is packed with insightful information, personal stories, and practical tips for expectant mothers and families. I love how they bring on guests and experts to cover a wide range of topics making each episode engaging and informative. Whether you're a first-time mom or a seasoned parent, this podcast is a valuable resource and empowers and educates. I highly recommend tuning in and soaking up all the wisdom shared on The VBAC Link Podcast.” I love this review and as always, I love them all. I love every single review, you guys. It is so amazing to get a notification in our inbox that a review has been left, so if you haven't had a chance yet, please do so. Please leave us a review. Tell us what you think about The VBAC Link Podcast. You can do it on Apple Podcasts. You can rate us on Spotify or really wherever you listen to your podcasts. Or even Google– you can Google “The VBAC Link” and leave us a review there. As I always say, these reviews truly warm my heart but they actually really help your community and these other Women of Strength find this podcast and these stories. I encourage you to leave a review and tell us what you think so someone else can find this episode as well. Meagan: Well, welcome Hannah. Thank you so much for joining us. Seriously, you guys, I can't tell you guys enough. Every time I have someone recording, I'm like, “Thank you for being here with me” because it takes a village and without all of your guys' stories, this podcast wouldn't be a thing. So thank you for being here, Hannah, and yeah. Feel free to share your stories. Tell the world what you feel like they need to know. Hannah: Yeah. Thank you so much for having me. I really appreciate the opportunity to share my story because both stories, I could talk about all day but also, I listened to your podcast consistently, constantly throughout the postpartum after I had my C-section and also during my VBAC pregnancy. With our first, I didn't really have a different plan other than what my friends and family had done. I had planned to go to the highly recommended hospital in my area with a random OB that I just chose. The only real decision I knew I wanted specifically was that I knew I wanted to go unmedicated for my birth but I didn't do anything other than general childbirth classes to actually prepare to birth unmedicated. I just assumed, “I'm going to go in and have a baby unmedicated and everything will be fine.” I didn't do anything to prepare for that and my pregnancy was pretty uneventful. I was sick the entire time. I had borderline hyperemesis– not officially diagnosed, but I was very, very sick. The only other weird thing I guess that I wasn't aware of before pregnancy was I had gestational thrombocytopenia where your blood platelet count gets lower. Meagan: Yes. We just heard about this on a recent story and I had never even heard of that before. Hannah: Yeah, I've had it with both of my pregnancies so I think my body just does that when I'm pregnant. The only thing that they had mentioned about that was there was a potential that you won't be able to get an epidural if your platelets fall too low. I had wanted to go without an epidural anyway so I wasn't really concerned about that, but again, I didn't do much to prepare. At the end of my third trimester, around that 36-week mark, they had brought up, “Well, your baby is measuring potentially big.” They estimated him weighing 11 pounds. They were like, “If you want to schedule an induction at 39 weeks, you can. If not, that's fine. It's up to you.” My OB was really great about just presenting options and not forcing things to happen. She did say, “You can schedule one of you want to but you don't have to.” I did schedule an induction for 39+5 or something like that. At 38 weeks and 39 weeks, I decided to get membrane sweeps. I got one at 38 weeks exactly and 39 weeks exactly. The day after I got my membrane sweep at 39 weeks, at 39+1, I went into labor. This was before my induction. I didn't have to end up being induced, but my contractions that morning had started so fast and so hard that I was really thrown off. I was shocked because when I had talked to people, they said, “They'll gradually build and they'll gradually get closer together and stronger in intensity over a few days or whatever it may be.”Mine started. It just hit me like a train. It was really bad so I called my husband. He was already at work that morning and I said, “We need to go to the hospital now. I need to get an epidural right away.” Because they were so intense, I just thought, I'm really far into labor, clearly. We got to the hospital and we got into triage. They checked me and they were like, “Well, you're about 3 centimeters.” I was just so annoyed. I was like, Okay. I'm only 3 centimeters. Whatever. We can stay because I'm obviously not coping well. I got an epidural right away as soon as we got back to be admitted. Thankfully my platelets were within range to get the epidural. Meagan: That's awesome. Did you get platelet transfusions at all during pregnancy? Hannah: Nope. They just monitored them. They continued to decrease, but they didn't drop below that epidural safety level but they were continually decreasing throughout my whole pregnancy. Meagan: Got it. I was curious. I'm always wondering what people with low platelets do if they do transfusions or not. Do you remember what the low number was, like the safety number?Hannah: Yeah, it kind of depends on the anesthesiologist, but for epidural specifically, they said anything below 100. I don't remember the units. It's like 100 something per milliliter or something like that. Anything below 100 would be considered not okay to have an epidural. Anything below 70 or 80 would risk people out of home birth which is another thing to consider. But yeah. Mine didn't drop below that level. It was 105 when I checked into the hospital. Meagan: Awesome. What's crazy is that less than 1% of people even have this condition. Hannah: Yeah, it's very rare. Meagan: Yeah. Yeah. Well, good. So you're 105. You're getting good. You're clear to get an epidural. Hannah: Yep. I get my epidural right away when we get back there and essentially, I just nap. My husband was really confused. He was like, “Well, I thought I was going to be doing more. I'm just sitting here,” because I just napped with a peanut ball between my legs. I progressed very, very quickly especially for a first-time mom and around 9 centimeters, I had been stuck at 9 centimeters basically not really long, but longer than I was for how fast I was progressing. When my OB came in, she said, “If you want, we can break your water just to get you to that complete state so we can start pushing.” I was like, “Yeah, fine.” I didn't really know a difference so she broke my water and then I got to 10 really, really quickly but I labored down for quite a while just because my OB was back and forth between seeing patients in clinic and then coming to see me because she comes to your birth whether she's on call or not which is nice. I labored down for a while and then started doing practice pushes or whatever with the nurse. My epidural was so strong. I felt absolutely nothing. I didn't feel a sensation to push, an urge to push. I didn't feel pressure– absolutely nothing. Me trying to push was not effective whatsoever. I pushed for about 4 hours before we ended up opting for a C-section because my son was just coming down and then going back up, coming down and going back up and of course, I was in that semi-reclined, pretty much on my back position so gravity wasn't really helping me at all. He just was not coming out. The nurse and my doctor had mentioned, “We think he's asynclitic,” where his head was tilted to the side and he just wasn't coming out. I was just exhausted and annoyed so we opted to have the C-section. That was really shocking to me. I was a little thrown off because C-section was never on my radar. It's not something I really prepared for or thought about. I just thought, C-sections happen in emergencies. I was fine. My baby was fine. We were both stable and had no problems. It was just that I had been pushing for a long time so I felt really confused on why it was happening. But the hard part for me was once the C-section started is when things really took a bad turn for me emotionally and physically. My epidural like I mentioned was super, super strong, but when the C-section started, I could feel a lot. I felt a lot of pain, not just the pressure they had mentioned. I was really, really in pain. I had told my husband, “There's something wrong. I can feel way more than I believe I should be feeling.” He told the anesthesiologist and they gave me some additional medication. I don't know exactly what it was, but whatever they gave me, I fell asleep for a little bit. I wasn't under general but I dozed off. Meagan: Yeah, it made you sleepy. Hannah: Yeah. I don't remember when my son was born or meeting him or hearing him cry because I was just so out of it. When I woke up however long that was, time was just not in my mind at that moment, but I remember my husband saying, “Babe, it's a boy,” because we didn't know if we were having a boy or a girl. That's all I really remember from the OR itself. Then in recovery, in the recovery room, my blood pressure dropped. I was going hypotensive. I apparently had hemorrhaged more than they would have liked for a C-section which is understandable with low platelet counts so they were trying to get me stable because I was essentially on the verge of passing out. Everything was blurry and my main concern while all of this was happening was having my son breastfeed. I told my husband, “They're going to work on me. Just get him to nurse,” so he was holding my son to my chest so he could nurse while they were trying to stabilize me. It took them quite a while to get my blood pressure back up and to get everything fine, but thankfully, I didn't need any transfusions or anything like that. The whole postpartum experience, everything from C-section on was just really difficult to deal with and process at that point but that's kind of how everything ended up with that one. Then I knew from then on if I had any other kids, this can't happen again. I have to do something different. Meagan: Did they talk to you about anything like, “Okay, for your next birth, if you choose to have one, you can have a VBAC”? Did they counsel you at all after that? I'm always curious if providers do. Hannah: Yeah, so my OB specifically– I told her, I was like, “If I have more kids–”, because I had never heard the term VBAC. I didn't know that was a thing. I just thought, Oh, you can have a C-section but you can go on to have kids vaginally later. I didn't realize it was such a big deal until I started looking into it and asking around about it. At my postpartum appointment, I talked to my OB about it and she was like, “Well, yeah. That's fine. There are no issues with that. You would be a great candidate for it.” It was like, okay. That's what's going to happen if I have more kids. From postpartum on, I started researching. Meagan: Awesome. So what did you find in your research? Hannah: The first thing I did was look up obviously what VBAC was. I didn't really know then I started listening to podcasts and reading and reading book and listening to stories. I came across your guys' podcast which I honestly don't know how I found it. It was 5 weeks postpartum and I had never really listened to podcasts before. I found it and I found several others and started listening. Then one of the big things I looked at was, okay. What happened in my birth that potentially contributed to this? How can I avoid this in the future or make it a better experience? One of the big things was that I got my hospital notes and my op report and everything from when we were in the hospital just to understand fully what happened because they don't explain every single detail of what's happening to you unfortunately in most circumstances. So I wanted to see all of the notes and everything that happened down to the minute that was in my chart which really helped me understand what happened, process it, and heal that. Then for me, when I was looking at why I had my C-section and all of that, when I was looking at things about VBAC, it was like if these things happen to you like a failure to progress or the baby wouldn't come out like CPD, the cephalic pelvis disproportion, then the chance of you having a VBAC are not great. I was like, Well, that's discouraging. Then the more I got to the research, the more I realized that my birth specifically was likely a cascade of interventions starting with my epidural for me. That's how I personally feel. Some people would say that's not the case but that's how I personally feel. I knew going into my next pregnancy that I would do things drastically differently to set myself up for the best possible chances of having that VBAC. Meagan: Yeah. I love that. It sounds like you were starting in all of the right places. Hannah: Yep. Meagan: So baby number two– Hannah: Yeah. We decided. 8 months postpartum, I was like, “Let's have another baby.” I feel like with both my pregnancies and both my postpartum, around that time, I just get baby fever and then I am thankful that I don't get pregnant at that time. We got pregnant with my daughter about 20ish months after I had my son. That wasn't specifically chosen for VBAC intervals or anything like that. We just weren't ready to have another kid yet. So I got pregnant with her and I had interviewed doulas before we even conceived because in my area, they book up really, really fast, especially the more experienced ones. I specifically looked for a doula who had a lot of experience supporting VBAC. Then I also looked into different birth location options. I had first looked into a birth center and out-of-hospital birth center, but where I am in Indiana, it's illegal and against the law to have a VBAC in a free-standing birth center. I was upset about that at first, but then I looked into some home birth midwives as well as hospital providers. Home birth midwives– the only one I could find in my general close area was about two hours away and the ones who were closer to me wouldn't support a primary VBAC so if you had never had a vaginal birth either before your C-section or had a VBAC before, they wouldn't support you which was really discouraging. With how fast my labor progressed the first time around, I just didn't want to travel that far for appointments or having my midwife have to travel that far for the birth because you just never know how fast it's going to be. The thing about my first birth, my OB was amazing. She was not the type of OB who would try to coerce you to do anything. She was always very supportive of whatever I decided to do. She was very supportive of VBAC but I did also interview some hospital providers, some midwives, some other OBs and ultimately, I decided to stay with my OB because I felt really comfortable with her. I felt confident in her. She had no stipulations surrounding VBAC at all. The only other OB I did interview was an OB who would do vaginal breech birth because that's one thing my OB would not do and I was like, If I have a breech baby, I'm not having a C-section so I'll go to this other OB if that ends up being the case. Meagan: Okay, you're in Indiana.Hannah: The Indianapolis area. Meagan: Did you find it hard to find that provider? Hannah: Yes and no. Yes because he's the only one in our area who supports vaginal breech and no because my doula and a network of doulas who I converse with now all recommended him because they know that he's the only one in the area who would do it. Meagan: Do you care to share his name just in case we have someone breech listening? Hannah: Yes, so his name is Dr. James Webb and he's on the verge of retiring. Meagan: No! That's the problem. Hannah: Yeah. He is very particular about what hospitals he'll deliver at and all of that, but he is the only one currently in our area who will do it so if he doesn't happen to be retired at the time of this episode coming out, you can look into him as an option. Meagan: Yeah, awesome. That is the hardest part is we are seeing so many people who do supportive breech VBAC or just breech in general are retiring. They are closing doors and that's the hardest part. Okay, sorry. So you did an interview with him. Hannah: Yes. I had him as a backup just in case baby did end up being breech. Then my pregnancy again in general was fine. I had gestational thrombocytopenia again. I was not as sick the second time around which I was very, very thankful for. The only other weird things that came up were I was GBS+. I was negative for my first pregnancy and then I had a partial placenta previa at one point which at first concerned me but then once I realized that they usually resolve as your uterus grows, then I wasn't too concerned about ending up with another C-section because of that. I also, my baby was breech at one point. Meagan: Oh my goodness. Hannah: I know. I was like, All of the things that could happen did happen. But I didn't let it discourage me. I just kept going on and doing what I needed to do. The big difference in my preparation that I did the second time around because I knew for my VBAC I wanted to be as low intervention as possible. I knew I wanted to go unmedicated. I had my doula so I took a program called HypnoBabies which is a type of hypnobirth for those who may not know. It's a medical-grade hypnosis so I consistently practiced with that throughout my whole pregnancy. I did some breathwork and progressive relaxation videos and stuff like that to make sure I was really mentally prepared to go unmedicated because I feel like that aspect of birth is so much more mental than it is physical. That's where I really wanted to be prepared for that part. Meagan: Mhmm, nice job. Hypnobirthing is really common here in Utah. I wouldn't even say common but a favorite education course and we actually have a blog about it because so many people love it. It really can put you in such a great head space. Hannah: Yeah. I know it doesn't work for everyone, but what was more beneficial for me was that I didn't just go through the course in the last 6 weeks of pregnancy or something like that. I consistently practiced throughout my entire pregnancy to make sure it became a habit or something that I was normally used to doing. I did that primarily to prepare for birthing unmedicated and then I also did pelvic floor therapy to help with my C-section scar and my ability to push because pushing was such a difficult time for me the first time around. I really wanted to know what muscles to use and how to actively engage and push if I needed to. Meagan: Awesome. Hannah: I did a lot of different things to prepare the second time around. But then at the end of pregnancy, I did not get any cervical checks. I didn't get any sweeps because I knew it would just mess with my head space. It would discourage me if I was dilated or wasn't dilated and I knew that my dilation wouldn't determine when I was going into labor. I didn't schedule an induction either. I was just going to wait for my baby to come when they wanted to come and my OB was fine with that which was great. The only thing I did do was– I didn't have to end up doing this, but if I went past 41 weeks, I was going to get non-stress tests. But we were find waiting for things to happen. I went into labor spontaneously at 40+2 and– oh, I forgot to mention. Sorry, I'll back up. I did have a marginal cord insertion with this baby too so all of the things where the cord was on the side of the placenta instead of the center. The issue there could potentially be a lack of blood and nutrient flow to the baby which could cause growth issues. Meagan: IUGR, yeah. Hannah: We did monitor that a little bit more, but there were no issues with her growth or her percentile or anything like that so that was never a concern of her being too small or too big or anything like that. But I went into labor the morning of 40+2 and it didn't start how I expected or anything like my first labor. I had excessive bleeding and no contractions. I was really confused. I was like, Why am I bleeding so much? It was more blood than I felt comfortable with. A lot of times you have a bloody show or something like that with your mucus plug, but this was filling pads. I called my doula. I called my doctor and they were both like, “Yes, just go in.” My plan was to labor at home as long as possible, but because it started that way, I was like, Okay, I'm going to the hospital. Meagan: Mhmm, and the previa had completely resolved? Hannah: Yes. Yes. It was still low-lying, but it wasn't covering the cervix at all. With the amount of blood, I was like, Well, this is a little concerning. I did go into the hospital right away and went to triage because their main concern was a placental abruption with how much I was bleeding. Meagan: That's one of the things I was thinking too. Could it be a placenta thing? Hannah: They put the monitors on us. They checked everything and we were both fine. There were no issues. The bleeding ended up resolving and they couldn't exactly tell where it was coming from. At the time, I was about 4 centimeters dilated when we got to triage and I had planned because we were both fine, I was like, Well, I'm going to go back home then, but we had to stay to be monitored for about an hour just to make sure nothing else came up or things didn't take a turn or something like that. Within that hour, I had already began to dilate more. I was already 5 centimeters and at that time, I started feeling contractions so I decided, Okay, we'll just stay. We're already here. With the bleeding, I felt a little bit more concerned so we just stayed. I told my doula I would just text her and keep her updated. We got back to be admitted and because I was GBS+, I did choose to get the antibiotics. I got that round of antibiotics and then had them unhook the IV because I wanted to be as mobile and as free as possible. Thankfully, my hospital had wireless monitors so I was able to move around. I didn't have to tote around a monitor or be stuck to the bed or anything like that. After the antibiotics went through, I was going to lay down and listen to my Hypnobabies tracks and just rest because my contractions weren't intense or anything like that. I was super, super uncomfortable laying down. I needed to be up and moving. I tried and I was just annoyed with my headphones and annoyed with the tracks and everything. I was like, I need to be up and moving. At that point, I was getting ready to get up and my water broke on its own which was different for me because it did not break on its own with my previous birth. My water broke and again, I was around 5 or 6 centimeters at this time. It was definitely my water and they made sure. It was gushing out so it was definitely my water. After that point, I just felt like I needed to be on the toilet. I went to the bathroom and sat on the toilet and my husband got me cool washcloths and was wrapping my shoulders. I was just swaying back and forth on the toilet. Quickly, within 30 minutes, I was getting hot and sweaty. I was shaking. I was doing the horse-lip breathing and my doula wasn't there yet. I had texted her right before I went to the bathroom to tell her, “Things are getting more intense. You should probably head this way.” I hadn't been there more than 2 hours so she was like, “Okay, yes. Okay, things are picking up. I'll be on my way.” When I was on the toilet and I was starting to sweat and shake, I was clearly in transition. I knew that in my mind. My nurse knew that. My husband realized that. At that time, I was like, “I need an epidural.” I told my husband that and he was like, “But you're doing so well. Let's wait for Julie (my doula) to get there and see what she suggests.” I just felt like I couldn't do it. Then my nurse was really great about just leaving us alone and letting us do our thing. She came into the bathroom to check on us like I said about 30 minutes later. I told her, “I think I need an epidural.” At this time, I did not have an IV hooked up. She had mentioned, “Well, it's at least going to take 20 minutes to get the fluids in you to even be able to do an epidural.” She knew and she was clearly trying to stall me. Meagan: Yeah, I was going to say, I think that nurse knew something you didn't know. Hannah: Yes. Looking back in my mind, I knew but I was just in denial. I didn't really want the epidural but at that moment when you are in transition, you're just like, I can't do this. Two minutes later, my doula walks in and I told her the same thing, “I think I need the epidural.” She was like, “How long have you been on the toilet? Have you switched positions lately?” I said, “Well, now I've been here about 30-45 minutes.” She said, “Let's try getting in the shower and see if that just helps things ease up or change or whatever.” I was so reluctant to get off the toilet because I was so comfortable and in my zone but I did. I got in the shower and as soon as I stood up and got in the shower, I was bearing down and pushing. I was hanging onto my husband's neck and my doula was putting water on my back and the nurse heard me grunting and bearing down and she came in and was like, “Are you complete? We need to make sure you're complete just to make sure you're not pushing against a not complete cervix.” That was one of my concerns too. I was unmedicated so I felt the urge to push obviously, but I didn't want to be in that case where my cervix would swell or something like that. But I was complete and I had just a slight lip or whatever. My doula just suggested maybe we get on hands and knees to help relieve that lip or get in a different position to even everything out. I got on the bed and got on hands and knees. At this point, I'm just pushing. My body is pushing. I have no control over it. It's happening regardless of whether my cervix is complete or not. I was on hands and knees sitting on the back of the bed. My husband was cooling me down with washcloths and rubbing my back. My doula was doing the same and taking pictures and watching me push to see how baby's movement was. I pushed on hands and knees for about 10 minutes and again, my baby was coming down and coming back up and coming down and coming back up which was discouraging because that's what happened the last time. Then my doula said, “How about we try a squat to see if that helps with gravity working in getting your baby out?” I was so tired at this time. I was like, “There's no way I can hold myself up in a squat. This is not going to happen.” But we got the squat bar. I got in the squat. My doula and my husband were both supporting me. Within 5 minutes, probably two or three pushes, my baby was out. We didn't know again if it was a girl or a boy. She came out so fast and my doula was trying to get me to do the blow breathing to control and slow the pushing but I was not. I was like, “Get this baby out,” because I knew pushing was going to be the hard part for me to get past because it was four hours with my C-section baby. My doula knew that as well so she was trying to give me that extra support to make pushing a good experience. I let it fly and I was like, “Nope. This baby is coming out now. I don't care how fast she comes out. I don't care if I tear or whatever. I just need to get her out.” So she did. She came out and it was so funny because I had the squat bar and I was trying to pull her to my chest. My doula had even mentioned this in our prenatal prep. If you use the squat bar, the umbilical cord is still going to be attached so go under the bar and not over the bar. I tried to go over the bar of course. They were trying to get me all untangled and stuff but I was so happy she had come out that I didn't even look to see if she was a boy or a girl. I just forgot to check. She was a girl and we were so, so happy and so excited. I was just in disbelief that I had done it. It happened so fast that I didn't really have time to process what was happening. It was 4.5 hours total. Meagan: Oh my gosh. Hannah: Yeah. From the first contraction I felt– so not when the bleeding started, but from the first contractions I felt to when she was born was 4.5 hours. Meagan: Holy smokes. Hannah: Yeah, that's almost a precipitous birth and I don't know what just happened. It was just a rollercoaster and intense with no breaks whatsoever. But we were so excited. So excited. Meagan: I bet. Oh my gosh. When you said almost precipitous labor, to me, that is still very precipitous. 4 hours really from the start to the end, that is so fast. I have had a couple of clients like that. Sometimes I'm just like, “How does your cervix just do that?” Because from a mom who had a 42-hour long labor, it's like, what? We envy a lot of you precipitous birthers, however, I will point out that when precipitous birth happens, it's typically super intense. Hannah: Yes and you don't have a break. It's just constant intensity. Meagan: Yes. It's so hard because people have said, “Oh, I'd rather have a fast labor than a long labor.” It goes both ways. They want a fast labor, but I'm like, you have to know that it is very, very, very intense. It usually starts right out of the gate. When I say right out of the gate, I can picture a rodeo with a cowboy on a bull and the second the gate opens, the bull is just bucking, right? Hannah: Yes, because as soon as–Meagan: That is what reminds me of precipitous labor. Hannah: As soon as I felt contractions, I went from feeling nothing that morning to feeling like my whole body was contracting. It was just very intense so I don't know. I think both have their pros and cons, long labors and short labors. Meagan: Absolutely. Absolutely. Yeah. I'm glad. Precipitous labor for a first baby is common from what I have seen in the doula world of supporting hundreds of babies and lots of moms with precipitous labor. It is common to happen the next time. So even if you didn't have bleeding, you probably would have gone in sooner rather than later too. Hannah: Or I would have ended up with a car baby because if I hadn't been bleeding, I would not have gone to the hospital. I would have been fine. My plan was to labor at home as long as possible. Meagan: So you could have had a car baby or a front door baby. Hannah: Yeah, or just somewhere that is not in the hospital baby because it was too fast. Meagan: Yes. Oh my gosh. You are amazing and it is interesting. I'm so curious. Did the doctors say why they think that you developed low platelets? Do you have that normally? Hannah: No, I don't. Meagan: You said gestational so I'm like, She must be meaning just during pregnancy. Hannah: Yes. Some people have it in general without being pregnant. Other people develop it just when they are pregnant. They don't really know exactly why. I think there are things you can do to help that and help increase those platelet levels other than getting transfusions or whatever, but they didn't really know why. I mean, I'll be interested to see if I have a third to see if I have it again, but I think it's just what my body chooses to do. Meagan: Yeah. Interesting. Well, I'm so happy for you. Huge congratulations. Hannah: Thank you. Meagan: I don't know if you're going to have a third, but I assume you'll probably have a wild ride as well and you'll have to let us know how it goes if you decide in the future to have one. Hannah: Yeah. It will probably be the wildcard. Meagan: I know. You know, that does happen. I swear baby number three– in fact actually, it was my very first doula client that I attended. I was shadowing a birth doula because I was brand new and this mom had precipitous labors and baby number three took 15 hours. She was like, “No. No. No. Why is this happening? What is going on here? No.” The whole labor, she was like, “I don't like this. This keeps going.” So you never know. Baby number three also could be a labor wildcard. You never know. Well, thank you so much for sharing your story today. Hannah: Yes. Thank you so much for having me. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands
In this episode, we review the high-yield topic of Immune Thrombocytopenia (ITP) from the Heme section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets
Thrombocytopenia is a puzzling, yet common problem in the ambulatory setting, on the wards and certainly in critically ill patients! Having an understanding of why it matters, why it can happen and what we should do about it, is of paramount importance to you if you are committed to excellent patient care.Given that patient care is first and foremost for us at Critical Care Time, we've teamed up - once again - with hematologist extraordinaire Matthew Rendo (X: RendOncology) to help us develop a pragmatic approach to managing the patient with thrombocytopenia. Please give it a listen and let us know what you think! Hosted on Acast. See acast.com/privacy for more information.
Hudi Arieh was born with TAR syndrome, also known as, Thrombocytopenia. But she is not letting that stop her. In this episode, Hudi shares her incredible life story, the mindset that has enabled her to overcome incredible odds, and her amazing faith and Emunah.
HOST: Andy Herber, P.A.-C. GUEST: Ronald S. Go, M.D. Join our host, Andy J. Herber, P.A.-C., as he discusses the complete blood count (CBC), which is one of the most ordered laboratory tests in the primary care setting. Providers are frequently tasked with evaluating all aspects of the CBC. A keen understanding of this laboratory test is essential to providing quality care for patients. Ronald S. Go, M.D. returns as a guest to discuss abnormal platelet test results and its implication on patient management. Learn more about our Lab Medicine Edition here Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
On this episode, we finish the discussion about the challenges and issues involving documenting elective surgeries in order to improve care and maximize reimbursement. Moderator: Tomas Villanueva, DO, MBA, FACPE, SFHM Senior Principal, Performance Improvement Consulting Vizient Guests: Rachel Mack, MSN, RN, CCDS, CDIP, CCS, CRC Consulting Director, Clinical Documentation Improvement Vizient Show Notes: [00:37] Anticoagulation – often overlooked in documentation [01:30] PSI 9 [02:20] Thrombocytopenia [03:57] Antiplatelets and elective surgeries [05:56] Every PSI reported means money lost to the practice Links | Resources: To contact Modern Practice: modernpracticepodcast@vizientinc.com Rachel Mack's email: rachel.mack@vizientinc.com “Costs of Postoperative Sepsis: The Business Case for Quality Improvement to Reduce Postoperative Sepsis in Veterans Affairs Hospitals” (JAMA): Click Here Subscribe Today! Apple Podcasts Amazon Podcasts Android Google Podcasts Spotify RSS Feed
This week the boys chat with their guest, James, about living with Immune Thrombocytopenia (ITP). James shares his journey of having a WILD rare disease with hidden symptoms. A case of feeling perfectly fine, yet being on medication that makes you feel worse. Black dots in the mouth? Google might say it'll clear up on it's own. But sometimes it really really doesn't. James recounts the jaw-dropping reaction of doctors and nurses to his rapidly dropping platelet count. A not so fun adventure of the uncertainty of constant blood tests and the emotional rollercoaster they bring. James's story reveals the unpredictability of ITP, leading to two intense emergency room visits and a life lived in fear of the next clinic summons. Join the post-episode conversation over on Discord! https://discord.gg/expeUDN
Please Subscribe and Review: Apple Podcasts | RSS Submit your questions for the podcast here News Topic: Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis Show Notes: Association of Immune Thrombocytopenia and Celiac Disease in Children: A Retrospective Case Control Study Questions: Diet and Digestion Andrew writes: Hi Robb! I'm loving the podcast! Just started listening and got your information from the lady who started the Debug Your Health blog which goes over diet and parasite elimination. She recommended for diet just doing grass fed meat and veggies. I did that for a few days but had severe leg cramps and sleep disturbances. Also, I've been constipated for awhile now and just can't seem to find the right diet for addressing this issue. I will go to the bathroom once every three days and my gut just doesn't feel right whatsoever. Also, I have A- blood type so I should be having more frequent bowel movements but that is not the case. I am only 21 years old and want to live my life. My suspicion is that it may be related to parasites, heavy metals, and maybe nutritional deficiencies. Any suggestions on how to get rid of this constipation with diet, parasite cleansing, or even enemas? Keep up the great work and I am excited to hear your response! Immune thrombocytopenia ITP Allen writes: Hello, My wife has an immune system disorder called Immune thrombocytopenia ITP. It is triggered by pregnancy. Her platelet count drops, which means she is at greater risk for hemorrhaging. The underlying cause of ITP is unknown according to our doctors and what I've read. For her first pregnancy, the doctors prescribed two treatments to ameliorate the platelet count: prednisone and IVG (this is standard treatment AFAICT) but these treatments had minimal/no effect. As the disease is evidently related to immune system health, I wondered if there are any dietary or environmental things we might look at which could help. Any advice getting pointed in the right direction would be much appreciated. Thank you! eGFR results while on a high protein diet Richard writes: I went to the doctor for a full feeling in my throat that was affecting my voice. Nothing was found but some of the bloodwork results have me a little worried.Creatinine 1.3, Total bilirubin 2.1, GFR 60. Should I be concerned with high meat intake? I follow a ketovore diet that averages less than 20g of carbs per day. Protein falls between 150 and 250 per day. The day of the test I had about a pound of meat for breakfast 6:00AM and nothing else before the bloodwork at 2:00PM. The doctor didn't express any concern over the results but a GFR of 60 is kidney disease according to all the charts on the web. I'm going to get retested but I'm wondering if my diet makes these tests unreliable. How would you prepare for the second test to insure that the results are accurate? Sponsor: The Healthy Rebellion Radio is sponsored by our electrolyte company, LMNT. Proper hydration is more than just drinking water. You need electrolytes too! Check out The Healthy Rebellion Radio sponsor LMNT for grab-and-go electrolyte packets to keep you at your peak! They give you all the electrolytes want, none of the stuff you don't. Click here to get your LMNT electrolytes Transcript: Coming soon at Robbwolf.com
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