Author Archives: TeamHaem

About TeamHaem

Online education and discussion about all things haematological

Case 132 – the summary!

Thank you for all the contributions throughout Case 132. We discussed the case of a 66-year-old gentleman who was diagnosed with chronic lymphocytic leukaemia after he presented with cervical lymphadenopathy. He required treatment as he was symptomatic (B symptoms) and … Continue reading

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Case 133: The beginning

Its your first day oncall as a new haematology ST3. You are called by the paediatric A&E nurse. A 2 year old boy has been brought in by his Mum with a swollen right knee.  His mum says he has … Continue reading

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Case 132 – Update 6!

Thank you for your ongoing input. Unfortunately the investigations performed to assess our patients new onset B symptoms and mild lymphocytosis whilst on acalabrutinib have revealed that he has diffuse large B cell lymphoma: LDH: 1200 CT: widespread mild lymphadenopathy … Continue reading

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Case 132 – Update 5!

Thank you fo everyone’s ongoing input. Our patient had been stable on acalabrutinib for 20 months following a complete remission (complete resolution of his lymphocytosis (after 13 months), resolution of his cervical lymphadenopathy and cytopenias). However when he attends clinic … Continue reading

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Case 132 – Update 4!

The peripheral blood flow cytometry has demonstrated a CLL score of 5/5 confirming the suspected diagnosis of CLL. Cytogenetics / biomarkers: NO TP53 deletion/disruption, IGHV UNmutated, 11q deletion His staging CT (neck, chest abdo pelvis) demonstrates widespread bilateral lymphadenopathy (stage … Continue reading

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Case 132 – Update 3!

Thank you for everyone’s input and you’ve all correctly noted the blood film findings of consistent of abnormal population of predominantly mature lymphocytes (prolymphocytes only 10%) inkeeping with a lymphoproliferative disorder and genuine thrombocytopenia. The flow cytometry is as follows: … Continue reading

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Case 132 – Update 2!

Thank you for everyone’s contributions! Our list of differentials for this man with cervical lymphadenopathy, weight loss and recurrent respiratory tract infections is appropriately wide. Luckily you’ve some of your requested investigations are back: FBC: Hb 110 Plts 60 WCC … Continue reading

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Case 132 – Update 1!

Thank you for everyone’s contributions regarding our new referral of a 66 year old man with bilateral cervical lymphadenopathy. From your thorough clinical assessments we now the following information: He first noticed his neck lumps whilst shaving approximately 2 months … Continue reading

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Case 132 – The beginning

You are the haematology registrar and are just about to review a new haematology referral in an outpatient clinic. The brief referral letter states: ‘Please review this 66 year old gentleman who has a background of diabetes mellitus. He has … Continue reading

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Case 131 – Summary

This week, we followed a patient with HIV-associated Burkitt’s lymphoma. Burkitt’s lymphoma is one of a handful of true haematological emergencies and thankfully it’s very rare in the general population. However, in HIV-positive patients, it has a high incidence despite … Continue reading

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Case 131 – update 4

The case is discussed in MDT with a decision to proceed with R-CODOX-M/R-IVAC. Infectious diseases advise to continue ART. After 4 cycles, he has a complete response and enters a period of surveillance. 6 months later, he presents to A+E … Continue reading

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Case 131 – update 3

Bone marrow biopsy with IHC is in keeping with Burkitt’s lymphoma (EBV-negative). The diagnosis is confirmed by interphase FISH studies: FISH: IGH-MYC fusion POSITIVE t(8;14)(q24;q32) [35/100] / BCL6 NOT rearranged [100] / BCL2 NOT rearranged [100]  PET-CT shows markedly increased … Continue reading

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Case 131 – update 2

Peripheral blood flow cytometry identifies a population of cells (44% of total nucleated cells) with the following immunophenotype: CD19+, CD5 negative, CD200 negative, CD10 weak, FMC7+, CD23 negative, CD38+, CD11c negative, CD103 negative, CD20+, sIg+ (lambda-restricted), CD34 negative, nTdT negative … Continue reading

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Case 131 – update 1

The patient reports a 2 week history of exertional dyspnoea, fevers and weight loss. Examination does not demonstrate any lymphadenopathy or hepatosplenomegaly. Other than a few bruises on his arms and pallor due to anaemia, there are no other remarkable … Continue reading

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Case 131 – the beginning

It is 9 am and you’re the liaison haematology registrar. Having just finished your coffee, the A+E registrar calls you for some advice about a 42-year-old male with an abnormal full blood count (see below) who presented with shortness of … Continue reading

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Case 130 – the summary

In this week’s case we investigated someone with a panreactive antibody screen. In simple terms, this means that something in the patient’s plasma is reacting with all of the red cell reagents we use in our panel. This situation causes … Continue reading

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Case 130 – update 2

We have delved deeper into our 54 year old patient’s history and, as many of you guessed, he takes daratumumab for multiple myeloma. We have discussed with his clinical team and agreed to hold off transfusion until we can perform … Continue reading

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Case 130 – Update 1

Thanks for all the input thus far. We are dealing with a panreactive antibody screen (see below) in a patient not previously known to our hospital trust. The sample has been sent to NHSBT red cell immunohaematology (RCI). We are … Continue reading

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Case 130 – the beginning

It is 5pm. You are the haematology SpR and you have just congratulated yourself on clearing the blood films and aspirates to report – good job! But just as you are taking off your lab coat, a transfusion BMS pops … Continue reading

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Case 129 – Summary

This weeks case was based around Cerebral venous sinus thrombosis (CVST). Thanks for everyone’s help really lovely that so many of you contributed your thoughts. Incidence: This is a rare disorder affecting 2-4/million of the adult population a year but … Continue reading

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