Shematologist, MD

@acweyand

Pediatric hematologist/oncologist, faculty and APD PHO, mother, wife, daughter, sister, dreamer, pacifist. (she/her/hers) All opinions are my own.

Ann Arbor, MI
Vrijeme pridruživanja: siječanj 2017.

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  1. Prikvačeni tweet
    15. sij

    It's a new year, time for a new tweetorial! This one is for all of the amazing taking care of adolescent girls. 14yo female presents to primary care with a complaint of fatigue. Labs are ordered and hemoglobin is 6.0. She describes periods as "fine" 1/n

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  2. prije 18 sati

    Never underestimate Kansas City.

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  3. 2. velj

    Trying to clean up this morning and getting some sass from my 5yo. Me: don’t be cranky with me 3yo: yeah, just be cranky with yourself!

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  4. 1. velj
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  5. 1. velj

    Given this, and the fact that iron causes many side effects (mostly gastrointestinal), daily or QOD dosing is optimal. (My patients tend to end up confused and forgetting doses with QOD) Save your patients $ and side effects while improving efficacy! Win win! 9/fin

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  6. 1. velj

    Another study in Blood supports every other day dosing and lower daily doses (40-80 mg Fe) based on duration of hepcidin response and fractional absorption. 8/n

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  7. 1. velj

    This study in the Lancet demonstrated this in women, as those taking divided doses had increased hepcidin and decreased absorption. 7/n

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  8. 1. velj

    So back to deficiency and supplementation. Patients who are iron deficient have low hepcidin and are primed for absorption. However, giving large frequent doses of iron increases hepcidin so absorption decreases. 6/n

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  9. 1. velj

    Hepcidin is also inc in inflammation and infection. This is thought to be a host defense to limit iron availability to microorganisms. So all that is to say that our body has evolved an elegant system to avoid too much or too little iron and the accompanying problem. 5/n

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  10. 1. velj

    Hepcidin is homeostatically regulated by iron and erythropoietic activity. Iron excess ⬆️ hepcidin production which in turn inhibits further absorption. Iron deficiency ⬇️hepcidin leading fo improved absorption. 4/n

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  11. 1. velj

    And deficiency causes overload, as in hemochromatosis! These phenotypes occur bc hepcidin inhibits intestinal absorption and release of iron from macrophages recycling old RBCs. To understand why this matters for dosing we need to look at the regulators of the regulator. 3/n

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  12. 1. velj

    It all goes back to a little hormone called hepcidin, which is the primary regulator of iron absorption. Hepcidin is mainly produced in hepatocytes, encoded as a propeptide and following processing, circulates in plasma. Overexpression causes iron restricted anemia... 2/n

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  13. 1. velj

    Based on a recent tweet about iron dosing, I’ve had a few requests for a . Iron deficiency is relatively frequent and seen by all types of physicians. For years, iron supplements were given multiple times a day. So why the change? 1/n

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  14. proslijedio/la je Tweet
    30. sij

    Why do we have to pay to park at work? 😂 is this ‘normal’ for any other professions outside of academia? Asking for a friend. Me. I’m the friend.

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  15. 1. velj

    Me when I order a Diet Coke and am brought a Diet Pepsi.

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  16. 1. velj

    I don’t know who needs to hear this but there is no reason to ever dose iron more than once daily.

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  17. 31. sij
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  18. proslijedio/la je Tweet
    30. sij

    Thank you Dr Tyler Buckner for a great discussion on pain today for ’s upcoming ! Nice getting to hear how you think about and reflect on experiences with patients in pain. 🙏🏽

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  19. proslijedio/la je Tweet

    This from spoke to me. I never thought I would consider letting a 3 yo get a pedicure. But teaches, every day is precious. It's hard to shake it when you leave the hospital. Sometimes you just want to spoil them.

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  20. 25. sij

    Something that bothers me way more than it should: Restaurants that refill Heinz ketchup bottles with non Heinz ketchup. I mean really?

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  21. 25. sij

    Opening presents at Christmas in order of age. 5yo: I’m the youngest of the grown ups!

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