Bloody Minded Episode 81 - In the Beginning... | Myeloid Precursor Conditions (CHIP, ICUS, CCUS)
Mar 10, 2026
A lively dive into clonal haematopoiesis and its precursor conditions. They map CHIP, ICUS, and CCUS and where each sits on the disease spectrum. Key genes and how ageing and sequencing affect detection get playful but precise treatment. Risks like progression to blood cancer and links to cardiovascular mortality are highlighted without clinical deep dives.
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How Clonal Hematopoiesis Actually Works
- Clonal hematopoiesis arises when a somatic mutation gives one hematopoietic stem cell a fitness advantage, producing a disproportionate share of blood cells.
- Bashar likens it to putting food colouring at a stream source so many downstream cells inherit the change.
DNMT3A And TET2 Dominate Clonal Mutations
- DNMT3A and TET2 loss‑of‑function mutations account for over 60% of detectable clonal hematopoiesis.
- The DNMT3AR882H variant is the single most common mutation listed as a trivia-worthy dominant clone.
Only Call It CHIP If Blood Counts And Marrow Are Normal
- Do not label someone with CHIP if they have cytopenias, dysplasia, or a hematological cancer because those findings exclude the diagnosis.
- Use WHO cytopenia cutoffs (Hb, neutrophils, platelets) when assessing eligibility.