Bloody Minded

After our initial intro to AML back in ep 79, we are back to dig deeper into AML this week, from pathophysiology through to treatment overview. The boys are joined by final year registrar Dr Georgina Calov who is here to cut through our nonsense and deliver some actual high yield content. And thank goodness for that, otherwise it'd be an hour of us making bad April Fool's day jokes.Timestamps2:09 - Introducing Dr Georgina Calov3:34 - AML Refresher7:12 - AML defined by recurrent genetic abnormalities15:39 - AML defined by differentiation (aka whats with the M numbers)18:14 - MN-pCT19:03 - Prognostication - ELN Classification21:58 - Diagnosing AML - Clinical24:16 - Diagnosing AML - Lab31:39 - New AML Workup35:50 - Intro to Treatment - Induction in "Fit" patients41:40 - Treatment - Consolidation & MRD45:15 - Treatment - "Unfit"48:02 - Treatment - Supportive50:16 - Treatment - Relapse/Refractory55:19 - SummarySupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Ariana McCauley, senior cancer care haematology pharmacist specialising in medication management for haematology patients, and Andriana Colic, senior haematology/BMT pharmacist who leads bone marrow transplant pharmacy services, walk through converting nil-by-mouth transplant drugs to IV. They cover immunosuppressant IV conversions, TDM pitfalls with lines, antifungal/antiviral IV choices, CMV and PJP IV strategies, antiepileptic swaps and practical ward tips.

Deep dive into classification, risk stratification and treatments for myelodysplastic syndromes. Discussion of key genetic subtypes like del(5q), SF3B1 and biallelic TP53 and their clinical patterns. Coverage of diagnostic pitfalls, flow tools and germline predispositions. Practical treatment topics include lenalidomide, azacitidine, oral decitabine/cedazuridine, luspatercept and transplantation options.

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.

Clear walkthrough of DNA, RNA and the central dogma. A tour of PCR variants, from endpoint to quantitative and digital droplet PCR. Explanations of fragment analysis, melt curves, Sanger and next generation sequencing. Discussion of variant allele frequency, sample handling and lab governance for molecular haematology.

They explore how bone marrow goes from normal factory work to creative failure, focusing on myelodysplastic syndromes and their causes. The conversation covers clonal evolution, cytopenias and how dysplasia is recognised on films and marrow. They also outline what tests (flow, cytogenetics, molecular) reveal and give a brief look at acute myeloid leukaemia and how it relates to MDS.

A lively birds-eye tour of the myeloid family of disorders using a seven-bucket framework. They map clonal haematopoiesis, precursor lesions and terminology like CHIP, CCUS and ICUS. Major groups covered include myeloproliferative neoplasms, myelodysplastic neoplasms and their overlaps, mastocytosis, acute myeloid leukaemia and rare histiocytic/dendritic disorders.

A nerdy tour through how the body's myeloid factory makes red cells, platelets and a flood of white cells. They map stem cell branching and the key progenitors that set cell fates. Growth factors like EPO, TPO and GCSF get spotlighted, including clinical uses and side effects. The crew also explain emergency myelopoiesis and how marrow reprioritizes during stress.

A focused walkthrough of oral anticoagulants, covering warfarin history, mechanism and practical dosing tips. Clear guidance on monitoring, reversal strategies and tricky interactions. Deep dive into DOACs: dabigatran, rivaroxaban and apixaban dosing, monitoring limits and reversal options. Special circumstances like renal failure, pregnancy, obesity and perioperative management are highlighted.

Join haematologist Alison Chandler, a clinician-educator specializing in anticoagulation, as she unravels the mysteries of injectable anticoagulants. Discover why heparin can make your blood feel 'fat' and why the term 'blood thinners' is frowned upon. Alison explains unfractionated heparin’s mechanisms, monitoring challenges, and practical use on the wards. Plus, learn about low molecular weight heparin's advantages and dosing nuances in special populations, like during pregnancy. Get ready for a fascinating dive into the world of anticoagulation!