Author Archives: TeamHaem

About TeamHaem

Online education and discussion about all things haematological

Case 137 – Update 3

You have undertaken a bone marrow biopsy and the aspirate (shown below) and flow are back. There is a population of abnormal CD20+, CD38+, CD138+, CD56+ cells. Cytogenetics awaited His calcium is a little better at 3.1 but his renal … Continue reading

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Case 137 – Update 2

You have treated our gentleman with AKI and hypercalcaemia with IVT and once well hydrated, you added an IV bisphosphonate.  His calcium is a little better at 3.2 and his renal function is also a little better with creating improved … Continue reading

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Update 1

Your 53 year old male patient seems very vague and his partner tells you that he has been very forgetful and low in mood recently. He feels weak and achey and has to force himself to go downstairs to eat. … Continue reading

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Case 137 – The beginning

You are a medical SHO and have been asked to see a 53 year old man who has been referred in by his GP with symptomatic anaemia with a Hb of 78g/L. He feels weak, achey and tired but his … Continue reading

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Case 136 – the summary

This week we followed the case of a 71 year old patient with multiple co-morbidities who required optimisation of her haemoglobin level before an elective operation. The crux of this case is Patient Blood Management, which is something we all … Continue reading

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Case 136 – update 2

We are trying to optimise a 71 year old lady for orthopaedic surgery. You voted in the poll to proceed with IV iron – this has been administered at the correct weight-based dose for her Hb. Repeat bloods 6 weeks … Continue reading

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Case 136 – update 1

We are advising the orthopaedic SpR, Ms Fi Moor, about a 71 year old lady listed for urgent THR who has a normocytic anaemia (Hb 84) and requires optimisation pre-op. You have requested the following info: PMH: Hypertension, type 2 … Continue reading

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Case 136 – the beginning

You are the haematology SpR holding the on-call phone. You are called by an orthopaedic SpR regarding a 71-year-old lady she has reviewed in clinic with significant osteoarthritis of the right hip. The patient’s mobility and quality of life have … Continue reading

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Many thanks for all your thoughts and suggestions this week. The case this week was an 81 year old lady who presented with AIHA. She had an incidental finding of mild lymphocytosis, small Ig M Paraprotein and splenomegaly and was … Continue reading

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Case 135 – Update 1

Thanks for your help so far… We have now established that our 81 year old lady with AIHA has been feeling tired for several months and has noted some exertional dyspnoea. She has noted recently that she has lost some … Continue reading

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Case 135 – update 3

20 months after initial treatment for AIHA you are asked to review the patient as she is noting increasing abdominal discomfort and has started to have drenching night sweats. You note she is becoming slowly more thrombocytopenic and anaemic but … Continue reading

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Case 135 – Update 2

Our patient was discharged home and took 60mg Prednisolone for 3 weeks. She successfully started a steroid wean following this and is slowly reducing down to 30mg of prednisolone daily at present. Her Hb has normalised at 130g/l with a … Continue reading

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Case 135 – The beginning

You are the medical SHO on call and get asked to review an 81 year old lady with symptomatic anaemia on a Friday evening. She has had no bloods taken for the preceding two years and her Hb has been … Continue reading

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Case 134: Summary

Thank you for your contributions to this case! We discussed a 61-year old man who presented to haematology with a 6-month history of weight loss, night sweats and a left axillary lump. He was diagnosed with peripheral T-cell lymphoma, NOS. … Continue reading

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Case 134: Update 5

CT head shows no abnormalities and his blood tests are unremarkable.You commence the patient on intravenous methylene blue as treatment for ifosfamide-induced encephalopathy. His mental state returns to normal within a few days and he is discharged. He successfully undergoes … Continue reading

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Case 134: Update 4

You notice the patient’s liver function tests are deranged:Bilirubin 7 µmol/LAlanine aminotransferase (ALT) 73 U/LAlkaline phosphatase (ALP) 400 U/LAlbumin 30 g/L You are concerned the patient may now have disease in his liver. You decide to proceed with chemotherapy. Five … Continue reading

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Case 134: Update 3

Our patient unfortunately has refractory disease to standard CHOP chemotherapy. He wishes to pursue intensive treatment. The local MDT recommends treatment escalation to IVE/MTX (ifosfamide, etoposide, epirubicin, methotrexate) and autologous stem cell transplantation. He is booked into the haematology ward … Continue reading

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Case 134: Update 2

Considering our patient’s age and overall fitness, the MDT decides to offer him CHOP chemotherapy. He tolerates this well with no significant toxicities. Mid treatment PET shows progressive disease with new lymphadenopathy in the mediastinum. How does this change your … Continue reading

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Case 134: Update 1

History does not reveal much more of significance. He has not been abroad in the last 2 years.Examination reveals a palpable 2x2cm left axillary node, as well as splenomegaly. No rashes.His renal and liver function are normal. LDH is elevated … Continue reading

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Case 134: The beginning

You are in the haematology clinic. Your next patient is a 61-year old man who has been referred to you by a GP due to a 6-month history of weight loss, night sweats and a lump under his left arm. … Continue reading

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