Author Archives: TeamHaem

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Online education and discussion about all things haematological

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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Case 113 – Summary

Our patient was found to have systemic anaplastic lymphoma kinase (ALK) positive anaplastic large cell lymphoma (ALCL). ALK-positive ALCL is a rare, mature T-cell non-Hodgkin lymphoma (NHL). Key learning points: 1. Epidemiology 3% of all adult NHL 10 – 20% … Continue reading

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Case 113 – update 1

Thank you for your contributions so far… Initial work-up: Our patient has expressed a short history of significant weight loss, fatigue and night sweats. In addition he has palpable superficial adenopathy. He has no clear infective history. Examination reveals widespread … Continue reading

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Case 113 – the beginning

Welcome to our new #TeamHaem case! Tim, a 31 year old teacher, has made an urgent GP appointment to come and see you. He tells you that he feels exhausted and is falling behind in his work. In the last … Continue reading

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Case 112 SUMMARY

Our case presented a 34 year old lady with known sickle cell disease to the A&E department complaining of shortness of breath and chest pain.  The case starts by reminding us of the basic management of a patient with sickle … Continue reading

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Case 112 update 2

Imaging has confirmed a pulmonary embolism.  How would you manage this patient?  What would be our long term management?   She has been expressing the desire to become pregnant, what you be your advise?

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Case 112 update 1

Baseline observations – sats 89% room air, HR 126, BP 111/65, RR33, temp 36.5 Chest x-ray – NAD D-dimer – 775 ( normal range 208-318 ng/ml) Hb 67 g/L Retics – 4% HbS 40% eGFR 70 ml/min Urinalysis 1+ protein … Continue reading

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Case 112

Welcome to our next case.   A 34 year old female presents to A&E with increased shortness of breath and chest pain. You are contacted as the haematology registrar oncall, by the SHO working in A&E as the patient has … Continue reading

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Case 111 – transfusion related complications – summary

So thanks for all of your input into our 2 short cases which focused on transfusion in cases of anaemia and some of the complications which you may get asked about. Most important points to make are that blood transfusion … Continue reading

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