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Profil korisnika/ce acweyand
Shematologist, MD
Shematologist, MD
Shematologist, MD
@acweyand

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Shematologist, MD

@acweyand

Pediatric hematologist/oncologist, faculty and APD @umich 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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    Shematologist, MD‏ @acweyand 15. sij
    • Prijavi Tweet

    It's a new year, time for a new tweetorial! This one is for all of the amazing #tweetiatricians 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

    15:07 - 15. sij 2020.
    • 146 proslijeđenih tweetova
    • 441 oznaka „sviđa mi se”
    • Mat Wenger Stephen Hines Kathy AM SCARE Kim Letendre Ben RN Angela M Tant Ify Osunkwo MD Jorge Cortés
    26 replies 146 proslijeđenih tweetova 441 korisnik označava da mu se sviđa
      1. Novi razgovor
      2. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        But how can that be? You decide to delve a little deeper and ask some details. Turns out her "fine" periods last 3-4 weeks, and she requires pad or tampon changes between every class. *key point* many adolescent girls DO NOT KNOW what a normal period should be like. 2/n

        7 proslijeđenih tweetova 150 korisnika označava da im se sviđa
        Prikaži ovu nit
      3. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        So what is a normal period? Bleeding for < or = 7 days Cycles between 21-45 days Should be able to go at least a few hours without changing products Product use should be 3-6 regular/day 3/n

        1 reply 9 proslijeđenih tweetova 97 korisnika označava da im se sviđa
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      4. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        Heavy menstrual bleeding is common, occurring in up to 37% of adolescents. Other red flags: large clots, "gushing sensation", accidents, needing to change overnight, and development of iron deficiency 4/n

        4 proslijeđena tweeta 68 korisnika označava da im se sviđa
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      5. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        As you sit in amazement wondering how she can consider those periods to be "fine", her mother pipes up that hers were the same way. This is something I commonly see. Horrific periods are normalized when multiple family members are affected. 5/n

        1 reply 4 proslijeđena tweeta 139 korisnika označava da im se sviđa
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      6. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        Often mom is the only one who knows how heavy an adolescent's periods are because she is the one buying the menstrual products, and washing out the menstrual stains. So why are her periods so heavy? The differential diagnosis for HMB is broad and includes.. 6/n

        1 reply 2 proslijeđena tweeta 55 korisnika označava da im se sviđa
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      7. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        Anovulatory cycles (by far the most common), coagulopathies (such as VWD), STIs, iatrogenic causes, pregnancy, and structural causes (very rare in adolescents). So what next? 7/n

        2 proslijeđena tweeta 59 korisnika označava da im se sviđa
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      8. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        History should focus on bleeding (epistaxis, oral bleeding, abnormal bruising, surgeries, etc), medical hx, and family hx. Lack of a bleeding hx does not r/o a coagulopathy as HMB can be the 1st presentation. Sadly, the 1st patient to be described with VWD died from HMB. 8/n

        1 reply 2 proslijeđena tweeta 51 korisnik označava da mu se sviđa
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      9. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        It has historically been taught that hypothyroidism can cause HMB. We published a retrospective review in J Peds last year (https://www.jpeds.com/article/S0022-3476(19)30534-7/fulltext …) of 427 adolescent females with HMB and actually found lower rates of hypothyroid than that seen in the general population! 9/n

        4 proslijeđena tweeta 65 korisnika označava da im se sviđa
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      10. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        Lab eval depends on hx, but all patients should have a CBC, ferritin, and pregnancy test. Hemostatic testing can be performed if the hx suggests but ideally under the guidance of a hematologist as testing can be affected by testing location, sample processing, etc. 10/n

        1 reply 1 proslijeđeni tweet 42 korisnika označavaju da im se sviđa
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      11. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        Management of HMB depends on severity and complications. Iron deficiency can be treated with oral iron (if tolerated) which should be given once daily or every other day for better absorption (no more 3x a day as previously taught!) https://ashpublications.org/blood/article-lookup/doi/10.1182/blood-2015-05-642223 … 11/n

        1 reply 4 proslijeđena tweeta 58 korisnika označava da im se sviđa
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      12. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        Iron deficiency is difficult to treat without managing the primary issue. HMB can be treated with hormonal options (combined oral contraceptives or progesterone only options), or hemostatic agents (antifibrinolytics such as lysteda or amicar, DDAVP or factor products). 12/n

        1 reply 1 proslijeđeni tweet 44 korisnika označavaju da im se sviđa
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      13. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        Choice of treatment is based on patient preference, desire/need for contraception, and tolerance of side effects. Typically if the patient is severely anemic, complete suppression of their menses is required for some period to replenish iron stores and treat their anemia. 13/n

        1 reply 1 proslijeđeni tweet 39 korisnika označava da im se sviđa
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      14. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        It is important to ask about contraindications to estrogen (migraine with aura, personal hx of VTE, or known thrombophilia.) Progesterone only has lower thrombotic risk and progesterone only pills are very effective at menstrual suppression if taken at the same time daily 14/n

        1 proslijeđeni tweet 48 korisnika označava da im se sviđa
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      15. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        The IUD is fantastic for menstrual suppression but often is not the first choice for adolescents, especially if they have not been sexually active. The nexplanon can be effective in some patients but often leads to irregular bleeding which is a nuisance. 15/n

        1 reply 1 proslijeđeni tweet 34 korisnika označavaju da im se sviđa
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      16. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        Hemostatic agents are most helpful in patients who have regular heavy bleeding which is not too long in duration. Although there is a black box warning, we do use antifibrinolytics and OCPs together and there is data to show that this is safe. 16/n

        1 reply 1 proslijeđeni tweet 35 korisnika označava da im se sviđa
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      17. Shematologist, MD‏ @acweyand 15. sij
        • Prijavi Tweet

        Biggest take home pts -Ask details about menstrual cycles as patients may not know what is "normal" -Think about anemia and iron deficiency in adolescents with HMB -Do not be timid in referring to hematology and/or gynecology as we love to help with these patients! 17/fin

        9 replies 4 proslijeđena tweeta 109 korisnika označava da im se sviđa
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      18. Shematologist, MD‏ @acweyand 16. sij
        • Prijavi Tweet

        And just to clarify, it is the teenagers I see that don’t want the IUD. Medically, it is a fantastic option! And once they do get it, adolescents love them. It is getting them comfortable with the idea that is the hurdle.

        0 proslijeđenih tweetova 61 korisnik označava da mu se sviđa
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