Author Archives: TeamHaem

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Online education and discussion about all things haematological

Case 143: summary

Thanks for your help with this week’s case! We discussed a 55 year old man who presented with persistent erythrocytosis, thrombocytosis, and leukocytosis. This was associated with a thrombotic event (myocardial infarction). Further investigations revealed JAK2 V617 positivity and a … Continue reading

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Case 143: update 5

Our patient has a repeat bone marrow biopsy which unfortunately demonstrates progression to myelofibrosis. His spleen has also increased in size. He is referred to the regional centre for an allogeneic stem cell transplant and ongoing care. Well done, team!

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Case 143: update 4

Our patient wants to stop hydroxycarbamide side effects. He agrees to switch to ruxolitinib therapy. His condition is well controlled on this for over a year until one day in clinic he complains ofabdominal discomfort and his blood counts are … Continue reading

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Case 143: update 3

The patient is diagnosed with a myeloproliferative neoplasm. He is not keen on chemotherapy and is commenced on a venesection programme, aiming for Hct <0.45. Although his counts start to show some improvement, he eventually becomes troubled by symptomatic iron … Continue reading

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Case 143: update 2

This man is referred to the haematology clinic. Apart from his recent hospital admission, there isnothing else of note in his history apart from the fact that he smokes. Examination is alsounremarkable. You organise JAK2 testing, an ultrasound of his … Continue reading

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Case 143: update 1

This man has no known past medical history and takes no regular medications. He is usually fit andwell and works as a chef. He smokes 10 cigarettes per day and drinks alcohol within recommendedlimits. He lives in Newcastle, UK. Examination … Continue reading

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Case 143: the beginning

A 55 year old man is admitted to the emergency department complaining of shortness of breath. This came on suddenly a few hours ago. He had a full blood count taken in triage: Hb 192 g/LHct 59%MCV 84 fLPlt 512 … Continue reading

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Case 142: summary

Pregnancy-associated TTP Definition: Rare but life-threatening thrombotic microangiopathy characterised by thrombocytopenia, MAHA and end organ damage due to microvascular thrombosis Pathogenesis: Severe ADAMTS13 deficiency (acquired or congenital) ULVWF multimers lead to platelet adhesion resulting in platelet-rich microthrombi, red cell fragmentation … Continue reading

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Case 142: update 3

ADAMTS13 activity level subsequently comes back at <5% with positive anti-ADAMTS13 IgG antibodies, consistent with a diagnosis of acquired, immune TTP. The patient continues on daily PEX and 1 mg/kg prednisolone for immunosuppression. The patient responds well with resolution of … Continue reading

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Case 142: update 2

Due to concerns regarding possible TTP, you make your way back to hospital immediately. You request a slew of investigations to be arranged urgently. LDH and reticulocytes are markedly elevated and DAT is negative, consistent with non-immune haemolysis.  Cardiac troponin … Continue reading

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Case 142: update 1

Many thanks for all your suggestions. We have some more information about the patient. She is a normally fit and well and is currently pregnant (23 weeks gestation). This is her first ever pregnancy and has been, until now, uncomplicated. … Continue reading

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Case 142: the beginning

You are the haematology registrar on call (non-resident in the evening). It’s 6:15 pm and as you’re walking into your home, you get called by the medical SHO on the Acute Medical Unit for advice on pre-procedure platelet transfusion. They … Continue reading

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Case 141: Mini case 4

You are the urology FY2, and you have been asked to clerk a patient who has been electively admitted for transurethral resection of bladder tumour (TURBT) in the morning. You look through his pre-assessment bloods from 2 weeks ago and … Continue reading

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Case 141: mini case 3

A 41 year old female patient is an inpatient on the haematology ward progressing through her first cycle of the UKALL14 protocol for a new diagnosis of ALL. She complains of a swollen and painful left arm, and US confirms … Continue reading

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Case 141: Mini case 2

You are the IMT2 doctor on a gastroenterology ward. A 54 year old man has been admitted with decompensated alcoholic liver disease and has fevers with high CRP. As part of the ward round plan you have been asked to … Continue reading

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Case 141: Short case 1

You are an interventional radiology trainee (ST5) and are running a procedure list tomorrow morning, with support from a consultant. You look through the cases and one of the request forms states: ‘New AML. For CPX. Requires Hickman line for … Continue reading

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Case 140: Summary

Thanks for your valuable input this week! This case was about a patient who develops cold haemagglutinin disease secondary tolymphoplasmacytic lymphoma. Cold haemagglutinin disease is a type of cold auto-immune haemolytic anaemia associated with IgM antibodies. It can be primary … Continue reading

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Case 140: Update 5

Given this lady’s CHAD and heavy marrow infiltration, a decision is agreed to offer treatment. She iscommenced on DRC chemotherapy (dexamethasone, rituximab, cyclophosphamide) with goodresponse. Good job, team!

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Case 140: Update 4

We now have a report on the bone marrow. Immunophenotype:Lambda restricted B cell population = 8.9% of total nucleated cells.CD19+, CD5 negative, FMC7 variable (+/neg), CD23 variable (neg/+), CD200 variable (weak/neg),CD20+, CD22+, CD103 negative, CD10 negative, CD45+, CD79b weak, CD38 … Continue reading

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Case 140: Update 3

This lady has been diagnosed with CHAD and we are trying to establish whether it is primary or secondary. Her viral serology and auto-immune screen are unremarkable. Given her full blood count and splenomegaly, you are concerned about an underlying … Continue reading

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