Inspired by @GeriatricDr and the rules of #GeriatricsClub, #teamhaem have compiled some of our own ‘rules’. Some hints and tips… See what you think. Any suggestions? If so contact us on twitter @TeamHaem
1) Repeating an abnormal test is always a good thing
2) If in doubt make a slide
3) Transfuse the patient, not the number
4) Inherited thrombophilia screens have few specific indications… don’t worry – we may advise some other fancy tests!
5) Polyclonal rise in immunoglobulins is not myeloma
6) Mild pancytopenia has many causes and often resolves if no adverse features. #drugs #autoimmune #sepsis #viral #B12folate. Ask for a film.
7) Don’t wait for the FBC if you suspect neutropenic sepsis. Treat immediately #sepsis
8) FFP should not routinely be used for warfarin reversal #prothrombinconcentrate
9) Haematologists generally do not run a ‘Hickman line removal service’… sorry!
10) Where does hairy cell leukaemia get its name? Because the cells are hairy! See… haematology is not so tough!
11) Lymph nodes in lymphoma can ‘wax and wane’… don’t be fooled
12) Iron deficiency anaemia is generally not due to a haematological problem #gynae #gastro
13) Dodgy full blood count or coag result? Take a closer look – there may be a comment by a friendly haematology registrar to guide your way!
14) Ask the lab! They have a wealth of knowledge and may be able to help with aspects of transfusion, morphology and coag.
15) Haematologists don’t generally dose warfarin
16) Before referring have a think! Oxford handbook/Google… you never know you may learn something!
17) A bone marrow biopsy is most useful when correlated with a strong clinical suspicion.
18) It is difficult to sort out complex clotting problems when the patient is on the operating table… advanced discussions are useful!
19) A full blood count can be perfectly normal in lymphoma… a surgical biopsy, as in any other cancer, is what is needed.
20) A normal coag screen and FBC does not mean no bleeding tendencies and vice versa. History is key. (@wai2k)
21) Neutrophilia, polycythaemia and thrombocytosis are mostly secondary to reactive causes but can relate to a primary haematological problem. A careful history and examination will help.
22) When examining suspicious blood smear, judge dubious cells by their friends! (@JonesScarlett)
24) Poor adherence to warfarin is not an indication to start the newer oral anticoagulants! (@wai2k)
25) Never ignore a high LUC (large unstained cells) result (@hematologeek)
26) Elevated light chains in renal failure is NOT myeloma! (@eleonora7)
Any more? contact us on twitter @teamhaem
Please reply on Twitter (@teamhaem) and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to evolve over the coming week so keep checking #teamhaem for more information.
Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.
TeamHaem are not a position of authority. It is an educational platform to allow discussion