Bloody Minded

Have you been asked to review “TLS” bloods?? Are you concerned the nursing staff are pranking you with haematology bloods that don’t include a FBC or coags? Why could you possibly want to look at something that isn’t a cell count? What crazy person decided after hours bloods needed to be collected on ICE? And WHY ?!?! Join us for an On The Wards approach to dealing with those TDS TLS SOS calls. TIMESTAMPS: 0:56 - The team breaking stuff 3:40 - Episode overview 5:07 - Setting the scene 6:33 - The history of TLS 7:28 - (nailed it) 8:00 - Pathophysiology of TLS 10:41 - Mechanisms of renal injury in TLS 11:39 - Clinical consequences of TLS 12:46 - Diagnostic criteria in TLS 15:10 - Clinical TLS vs lab TLS 15:35 - Grading TLS 16:55 - Other clues of TLS 18:09 - Who is at risk of TLS? 23:15 - Prevention of TLS 24:27 - Allopurinol 26:58 - Rasburicase 33:03 - Fluids fluids fluids 33:44 - Deciding who gets prophylaxis 35:50 - What ARE TLS bloods? 36:31 - What to do with a TLS on the ward 40:05 - Take home messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

It’s the heaviest matter of haematology as we look at the role of heavy metals in our favourite metalloenzymes. What - you don’t have a favourite metalloenzyme? But nothing else matters?! Anyway, this is no esoteric surgical content, join us as Nick, Cale and Bashar get comfy with the weirder parts of the periodic table and how they apply to less common deficiencies or toxicities in haematology. Look we’ll be honest with you - this is pretty low yield listening but it was fun, and really isn’t that point at the end of the day. TIMESTAMPS 0:55 - Wacken Open Air or Bloody Minded? 3:58 - Molybdenum ft. Black Eyed Peas 11:07 - Copper ft. Calf Livers 14:41 - Zinc ft. Dentures 18:35 - Cobalt - ft. Goblins and Beer 22:40 - Lead ft. Basophilic Stippling 26:13 - Aluminium ft. Pronunciation Issues 28:29 - Take Home Messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Is it a giant Cthulu-esque sea monster? Is it an excellent Australian parody breakfast show? No - it’s everyone’s favourite (well everyone who counts) coagulation related Vitamin - Vitamin K! Where does it come from? Why is it so hard to find on the eMR when you want to prescribe it and what is it doing under phytomenadione? Can we test for it? After listening to Nick, Cale and Bashar wax lyrical about carboxylation for half an hour you’ll be ready to vitamin K-nock yourself out. TIMESTAMPS 0:53 - Birdsong 3:54 - The history of Vitamin K 10:02 - Types of Vit K 12:02 - K1 + K2 13:16 - K3 + K4 14:18 - K1-4 without the possession 15:46 - What does Vit K actually do? 19:37 - Dietary sources of Vit K 23:20 - Vit K Absorption Pathway 28:00 - Vit K + Gamma glutamyl carboxylase 33:20 - Practical aspects of Vit K replacement 38:48 - Take Home Messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Four humours in balance, the ancients decreed - so open a vein, let the bad blood be freed. From Galen to Harvey, from humours to genes, From black bile and phlegm to the things on our screens. From PML::RARA to blood counts okay Let’s celebrate our specialty - we’ve come a damn long way Join us as we travel from the first man to see a red cell, to the first to give people arsenic on purpose who was actually well-intentioned! Pour one out for Galen who was confidently incorrect for fifteen centuries but everyone just went with it anyway because it seemed pretty good at the time. We interrupt your scheduled haematinic programming for a historical grab bag and some chat about the podcast as we celebrate 100 episodes and still going strong. TIMESTAMPS 1:49 - Sappy Stuff 7:15 - In the Beginning 9:52 - Leeches 12:57 - Harvey 14:43 - Microscopes 16:08 - Leukaemia 18:11 - Transfusion 20:30 - Anticoagulants 22:55 - Molecular 27:23 - Chemo 29:34 - Transplant 31:07 - Coags 33:07 - CAR-T 35:11 - Wrapup Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Two vitamins survived the great B-numbering cull to become the tests we order most and trust least. Meet the 80% of your B12 result your cells can't touch, and the antibody that sabotages the very test built to catch it. Join the Bloody Minded Crew as we come to the lab for a second time this season to learn how B12 and folate assays are performed. TIMESTAMPS 0:55 - The boys check out a new lab 2:25 - Episode overview 3:43 - Sample requirements 4:12 - B12 refresher 6:03 - Total B12 assays 9:36 - Caveats in interpretation 14:00 - Active B12 15:59 - MMA and Homocysteine 18:13 - Folate testing 22:18 - Take home messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

‘This bad boy can fit so much iron in it’ he said slapping the roof of a badly photoshopped molecule of apoferritin superimposed on a car. Is too much ferritin bad for you? Of course it is - too much is precisely the quantity that is in excess. But most of the time hyperferritinaemia has nothing to do with iron overload. Strap in to your 1992 Honda Civic as the Bloody Minded Crew learn all about ferritin, and why most of the time too much of it has nothing to do with your iron levels at all. Also join Cale specifically as he continues his vendetta against hepatology and their referrals. Timestamps 0:59 - Bashar visits the salon 2:03 - Hyperferritinaemia overview 3:13 - Ferritin vs Iron Overload 6:08 - Signs and Symptoms associated with Hyperferritinaemia 10:50 - Causes of Hyperferritinaemia w/o Iron Overload 16:59 - Hyperferritinaemia w/ Iron Overload 21:30 - Chelation 22:43 - Erythoferrone 24:16 - Summary Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

It's a BONUS episode today as the Bloody Minded Crew are delighted to partner with the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ). After (correctly) exiling Nick to another country after he suggested yet more coagulation themed episodes, he's returned like Gandalf stronger and more powerful than ever. We cornered THANZ members at the International Society for Thrombosis and Haemostasis 2026 meeting to chat about what was keeping them interested. Special thanks to Dr Danny Hsu, Dr Sara Ng, Dr George Mason, Dr Angela Huang, Dr Ibrahim Tohini-Esfahani, Dr Emily Powley, Dr Catherine Neal, Dr Marc Ellis, Dr Charithani Keragala, Hadley Bortz and Danielle Boyle for their contributions. Check out the THANZ website (www.thanz.org.au) and consider signing up if you're an Australian based scientist, clinician, nurse or allied health professional with an interest in Thrombosis and Haemostasis. There will be no show notes for this episode and our regular programming will continue as usual. Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Nick wanted to talk about buckets all episode. I’ve convinced him to at least let us get angry at iron polymaltose, hypophosphatemia and nangs all over again. You don’t think you need this episode but you’d be amazed how many consults come through to Haem thinking we’re the gatekeepers of iron in the building. Ironic, really. TIMESTAMPS 0:56 - 1960s pop culture reference 3:20 - Episode overview 4:40 - Iron deficiency 6:28 - Pica chat 7:53 - Presentations of iron deficiency 8:36 - Causes of iron deficiency 11:10 - Taking a menstrual history 12:53 - Non-menstrual causes of iron deficiency 14:40 - Oral iron replacement 18:19 - IV iron replacement 25:01 - Folate deficiency 27:18 - Folate replacement 29:18 - B12 deficiency 31:19 - Causes of B12 deficiency 32:00 - Diagnosis of B12 deficiency 32:55 - B12 replacement 34:58 - Dealing with concurrent deficiencies 36:20 - Take home messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

On the Ning Nang Nongs where the youths smoke bongs and the marrow all screams HELP! Join the Bloody Minded crew as they go through the round window, follow B12 and folate around the body in a Nang induced haze, presumably just like the writers on Play School once were. Mandatory viewing: https://www.youtube.com/watch?v=3SUU1f3Mgpc&list=RD3SUU1f3Mgpc&start_radio=1 TIMESTAMPS 0:53 - A Bloody Minded After School Special 1:50 - Megaloblastic Anaemias 2:59 - An Intro to B12 7:49 - B12 Absorption 12:55 - Role of B12 15:07 - MMA + Homocysteine 16:40 - Causes of B12 Deficiency 20:04 - Nangs - Again 23:18 - Intro to Folate 25:32 - Folate Absorption 27:03 - Folate Deficiency 30:00 - Concurrent B12 + Folate Deficiency 32:18 - Take Home Messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Heal with steel? Absolutely not - There’s no alloys or for that matter surgeons allowed in the safe space of the laboratory. Join us on another wonderful lab adventure as Bashar, Cale and Nick head down to the biochemistry lab to work out exactly how our iron studies are performed in the lab before you throw the serum iron in the bin. TIMESTAMPS 0:53 - An early etymological diversion 2:53 - Serum iron 9:43 - UIBC 11:22 - TIBC 13:34 - Transferrin 15:45 - Transferrin saturation 17:25 - Ferritin 20:42 - Example of how the numbers work 23:31 - The iron stain 25:02 - Take home messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Taunted by transferrin? Befuddled by ferritin? Scratching your head at why we throw the serum iron results directly into the confidential waste bin, which is a more dignified burial than it deserves? Come along as the boys discuss the interpretation of iron studies in a definitely tight, definitely 20ish minute episode. Timestamps 00:54 - Just Iron Studies with No Nonsense 02:21 - Overview of Iron Stuides 03:42 - Serum Iron 05:35 - Transferrin 07:32 - TIBC 08:35 - UIBC 10:47 - Transferrin Saturation (TSat) 12:38 - Ferritin 14:34 - Soluble Transferrin Receptor (sTfR) 15:45 - Invasive Iron Studies 16:52 - Rapid Fire Case Studies ft. Geraldine 22:25 - Summary & Take Home Messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

One molecule to rule them all, one molecule to find them. One molecule to bring them all, and in the liver bind them. Hepcidin is the key to understanding iron metabolism and we examine how iron gets into, around and out of the body. We promise not to be too Celebrimbor-ing as you join Nick, Cale and Bashar for this discussion of the basic science of iron handling in preparation for our journey into the building blocks of blood. Welcome to Lord of the Haematinics. TIMESTAMPS 0:56 - The next arc of the Bloody Minded Cinematic Universe 3:23 - Series overview 6:21 - Basic iron metabolism 7:54 - The three main player groups in iron metabolism 8:44 - Iron binding molecules: Heme 13:22 - Non-heme iron 14:05 - Iron binding molecules: Ferritin 17:12 - Iron binding molecules: Transferrin 20:44 - Iron transporters: DMT1 25:02 - Iron transporters: ferroportin 28:21 - Iron transporters: Hephaestin 29:28 - Iron flux 33:24 - Hepcidin: Master Regulator and The One Ring 39:04 - Non-hepcidin regulation of Ferroportin and IREs 41:32 - Take home messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Has your ward team been hit with HITT? Is Jane the only Fonda you know? Is BAD an 80s hit and not a trio of anti-coagulation infusions (Bivalirudin, Argatroban and Danaparoid). Is Alison showing her age? Never fear; join Alison, Bashar, Nick and Cale as they aim to de-mystify less commonly used anticoagulation that may come up on the wards. TIMESTAMPS 0:56 - It's Fancypants Wednesday! 2:15 - Episode overview 4:37 - Fondaparinux 9:07 - When to use fonda 12:35 - Argatroban 17:25 - When to use argatroban 18:02 - Bivalirudin 19:11 - Mandatory historical diversion 22:50 - Back to bivali business 25:59 - Danaparoid 30:21 - When to use danaparoid 32:45 - Quick summary 34:13 - Dalteparin 38:02 - A bit of nonsense chitchat Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Join us in our third straight week of incredibly nice and incredibly talented haematology gurus as Professor John Moore joins us as an expert guest to discuss stem cell transplant in the myeloid disease setting. TIMESTAMPS 1:00 – HYTTIOAOA 1:47 – Introducing Professor John Moore 8:06 – Advice to RMOs on the Allo Term 11:02 – The history of allogeneic transplantation 18:26 – Modern morbidity/mortality from alloSCT for AML 23:05 – Use of transplant scoring systems 27:29 – The role of MRD in transplant decisions 30:04 – MAC vs. RIC – Choice of Conditioning 38:15 – The role of PTCy 40:17 – Second allogeneic transplants 42:02 – DLI 43:08 – Biallelic TP53 – no good options 45:29 – Free rein in the trials space 49:11 – AlloSCT/CAR-T for autoimmune disease 55:05 – Take Home Messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

This week we continue the pattern of guests who are really really ridiculously good at haematology and also really really ridiculously nice people as well. We are very excited to be joined by Dr Michael Krigstein who many of you would know as the a molecular haematology guru who has gotten countless patients through their diagnoses and countless haematology trainees through their exams. Timestamps: 01:30 - Introducing Dr Michael Krigstein 04:23 - Getting into Lab Haem 08:30 - The Mechanics of NGS 16:57 - Learning to report - RCPA Modules 19:58 - After the NGS - Curation 24:14 - NGS - Not a panacea 28:45 - Why NGS is bad at ITDs 32:42 - Panel Design 36:37 - RNA vs DNA Panels 39:16 - The future of NGS in haematology 46:56 - A standout case 53:36 - Wrapup Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

What happens when you take someone who is really really ridiculously good at haematology and also a really really ridiculously nice person as well? You get Dr Jad Othman , consultant Haematologist and Haematopathologist at Royal North Shore Hospital in Sydney who will be joining us today to discuss the use of measurable residual disease in acute myeloid leukaemia. Dr Othman is well suited to this topic, having written his doctoral thesis on molecular disease assessment in AML, sitting on the European LeukaemiaNet (ELN)-DAVID MRD Working Group as well as numerous ALLG AML and MDS working groups. We're delighted to have him field the Bloody Minded Crew's questions today. Timestamps 01:00 - The boys making outdated millenial references 02:50 - Getting to know Dr Jad Othman 09:50 - The concept of MRD 11:55 - Lab techniques for MRD 17:59 - Why doesn't everyone have an MRD marker? 20:51 - What makes a good MRD assay? 24:14 - Patients without a molecular MRD marker 26:21 - Clinical case 30:30 - What we do with MRD results 31:47 - The NPM1/FLT3 PB/BM situation 35:31 - Why MRD is actually helpful 39:40 - Why single agent treatment in AML is challenging 44:33 - The 2025 ELN DAVID update 48:44 - Does doing MRD improve OS? 52:21 - The INTERCEPT study 55:41 - Wrap up and summary Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Here’s a question, what do CD123, CD4 and CD56 have in common? Other than pleasing The Count on Sesame Street. Sorry, another question perhaps - what happens if you cross a plasma cell and a dendritic cell? The answers to these questions can be found on a most enigmatic myeloid cell - the plasmacytoid dendritic cell. And what happens when these rare beasts become neoplastic - why BPDCN of course. Embark on a journey into this weird and not so wonderful (but highly examinable) neoplasm with the Bloody Minded Crew TIMESTAMPS 0:57 – A glimpse into Cale's psyche 2:39 – Intro to BPDCN 6:56 – What IS a plasmacytoid dendritic cell? 10:24 – Pathological PDCs in BPDCN 11:42 – Clinical presentation – lots of rash talk 15:23 – Morphology in BPDCN 17:48 – Immunophenotype 21:16 – Karyotypic and molecular features 22:44 – Treatment of BPDCN 24:00 – A bit on prognostic markers 25:03 – Transplant 25:28 – Tagraxofusp 29:15 – Other treatment options 31:33 – Take home messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

“It’s pronounced nuc-ul-ophosmin” “Nucleophosmin”. “Noo-clee-o-phosmin”. FLT3-ITD got you In The Dumps? Have a Total Knowledge Deficit about TKD mutations? Struggling with the A-B-Cs of NPM1 mutations? Want to know how a cat sarcoma is somehow related to AML? Join the Bloody Minded Crew as they flit about the laboratory looking at the structure of FLT3 and NPM1, what these proteins usually do and how we test for mutations in the advanced myeloid episode. == Edit 6/5/26 = We've been made aware that strictly speaking the current MANE approved transcript for NPM1.1 has only 11 exons and therefore the mutations are best to be considered in Exon 11 as opposed to exon 12 - in contrast to what we said. == Timestamps 0:52 - Bloody Minded issues a formal apology 2:40 - Introducing molecular chaperones 5:05 - What even NPM1? 9:30 - Functions of NPM1 10:55 - Molecular biology of NPM1 in disease 15:42 - Why the subtypes are important 19:53 - NPM1 prognosis 21:35 - MRD testing in NPM1 25:52 - NPM1 summary 27:13 - Intro to FLT3 28:30 - Mandatory FLT3 history 36:28 - FLT3 pathogenesis 37:37 - FLT3 structure, ITD vs TKD 41:16 - The juxtamembrane domain 42:53 - Prognostic features in FLT3 44:17 - TKD mutations 46:26 - FLT3 in the lab 50:30 - Take home messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

U-G-L-Y, you ain't got no alibi, you dysplastic yeah yeah you dysplastic. Apologies to all the ring sideroblasts out there, but this week the Bloody Minded crew is doing a Mean Girls and judging cells by their morphology. For now we’re deciding to ignore those that would argue that it’s what’s on the inside that counts (i.e. judging by NGS… that’ll come later). TIMESTAMPS 2:28 - For some reason, an audio podcast on visual dysplasia 5:05 - Normal erythroid morphology 7:17 - Dysplastic erythroid morphology 17:32 - Normal granulocyte morphology 20:00 - Dysplastic granulocyte morphology 28:33 - Monocyte morphology - dysplastic at baseline 30:33 - Normal megakaryocyte morphology 32:24 - Dysplastic megakaryocyte morphology 35:02 - Take Home Messages Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

What do arsenic, acne tablets and Jodi Picoult have in common? Why, it must be a deep dive with Nick, Bashar and Cale on acute promyelocytic leukaemia. From buzzwords to brain bleeds, the sweetest of translocations to the cruellest of coagulopathies... The yield is almost as high as the survival rates. TIMESTAMPS 00:57 - Bloody Minded Poetry Jam & Jodi Picoult 06:25 - APML Starts Here 08:02 - APML - Where does it fit in AML? 10:02 - Morphology & Flow 12:12 - PML::RARA - t(15;17) and rare variants 16:58 - Lab Summary 17:50 - Clinical Presentation 21:02 - APML Coagulopathy 26:46 - Treatment and Risk Stratification 33:53 - High Risk Aside 36:58 - Differentiation Syndrome 41:04 - Treatment SEs 44:18 - Microgranular Variant 47:00 - Summary and Takehomes Support the show Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au