Author Archives: TeamHaem

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Online education and discussion about all things haematological

Case 117 update 2

Bone marrow trephine shows a hypocellular trephine throughout the specimen, supporting your suspicion of aplastic anaemia. There are no dysplastic features present There is no evidence of a PNH clone. How would you classify this patient? What are your immediate … Continue reading

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Case 117 update 1

So far our investigations have shown: Normal haematinics Negative viral screen Negative autoimmune screen Blood film – no blasts/no dysplasia. Anisopoikilocytosis Normal LDH Negative abdominal ultrasound Reticulocytopenia Patient has no significant past medical history and is not taking any regular … Continue reading

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Case 117

31 year old man attends GP feeling tired. Bloods show HB 65 Platelets 45 WCC 1.2 What further test would you advise? Immediate management?? Please reply to us (@TeamHaem) on Twitter and always include #TeamHaem to allow others to follow … Continue reading

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Case 116 – Summary!

Thank you for everyone’s involvement in the case this week. We discussed a 56 year old man who presented with an acute stroke. This was managed with oral aspirin as his NIHSS score was low at 3 and he presented … Continue reading

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Case 116 – Update 3!

Thank you for everyone’s contributions. Due to his history of renal disease and renal transplant it is important that we consider these as potential secondary causes of polycythaemia. However, taking a thorough history and review of previous blood results has … Continue reading

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Case 116 – Update 2!

Thank you for everyone’s contributions so far! It has been noted that our patient who presented with an ischaemic stroke has a raised HCT and you have mentioned that we need to ensure this is an absolute polycythaemia and if … Continue reading

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Case 116 – Update 1!

Thanks for everyone’s contributions so far. Our 56 year old man was commenced on aspirin by the acute stroke team. He was not suitable for thrombolysis (presented later than 4.5hours of onset of symptoms) and it was felt thrombectomy was … Continue reading

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Case 116 – The Beginning!

A 56 year old man presents with left sided arm weakness and slurred speech. His symptoms started 6 hours prior to presentation. He has a significant past medical history of a renal transplant 6 months ago. A CT confirms a … Continue reading

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Case 115 summary

Our patient presented with MAHA, thrombocytopenia and neurological symptoms which prompted further investigations and confirmation of TTP. Teamhaem have covered TTP previously in case 7, with a different clinical scenario. Therefore the majority of this summary is taken from the … Continue reading

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Case 115 update 3

Our patient improves clinically with PEX/steroids/rituximab. Unfortunately she also suffers a miscarriage. What is your ongoing treatment plan? How would you council her for future pregnancies? Would you offer any treatment pre.conceptually?

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Case 115 update 2

TTP is confirmed by ADAMTS13 level of 2%. What further information would be useful and why? Plasma exchange was initiated promptly along with methylprednisone. The patient has had 1.5 plasma volume exchange over the first 3 days of admission. Platelet … Continue reading

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Case 115 update 1

You have reviewed the film and concur with the finishing of marked red cell fragmentation. Thrombocytopenia is also confirmed. You contact the A&E doctor who has reviewed the patient and they confirm as history of a possible seizure prompted hospital … Continue reading

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Case 115

As the haematology registrar on call, you are contacted at 2am by the lab scientist. He has reviewed a film of a patient and reports marked red cell fragmentation. What else would you like to know? What is your response? … Continue reading

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Case 114 – Summary!

Acute Promyelocytic Leukaemia Thank you for everyone’s contributions throughout our case this week! It started as a seemingly simple advice call regarding a platelet count of 51. However the clinical history of marked bleeding was inconsistent with this platelet count … Continue reading

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Case 114 – Update 5!

Thanks to everyone’s advice our patient didn’t develop differentiation syndrome following administration of dexamethasone prophylaxis. She also received hydroxyurea in addition to ongoing ATRA / arsenic to reduce the WCC. Her DIC is also improving. She has had issues with … Continue reading

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Case 114 – Update 4!

Thank you for the ongoing contributions to our case. Following everyones input our 43 year old female patient has been commenced on intravenous arsenic alongside ATRA. This decision was made as her APL is considered non-high risk as initial WCC … Continue reading

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Case 114 – Update3!

Thanks for everyones contributions to our case so far! We now have confirmation of our suspected diagnosis of Acute Promyelocytic Leukaemia by FISH. We have already began discussing initial management. Following the suggestions to date we have instituted the following: … Continue reading

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Case 114 – Update 2!

As highlighted by our followers the patients degree of bruising is out of proportion to a platelet count of 51. As requested a thrombin time and ddimer have been performed and are both prolonged. Thrombin time: 19 Ddimer 6320 (reminder: PT … Continue reading

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Case 114 – Update 1!

Thank you for all your contributions. Following your requested information and initial investigations you now know: Our 43 year old patient has previously been fit and well with no prior significant medical history. Over the past 2 weeks she has … Continue reading

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Case 114 – The Beginning

You are the haematology registrar on-call and a GP contacts you for advice regarding investigation and management of a platelet count of 51. The GP performed a FBC on a 43 year old woman who had presented to him with … Continue reading

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