Author Archives: TeamHaem

About TeamHaem

Online education and discussion about all things haematological

Case 96 – update 3

The blood film has been reported: – leukocytosis with neutrophilia and monocytosis, there is left shift and toxic granulation and vacuolation. Occasional primitive cells ~ 2%. No nucleated RBCs. The appearances might be reactive/infection related, and infection as well as … Continue reading

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Case 96 – update 2

An USS abdomen has been performed which confirms mild hepato-splenomegaly. CXR was reported as normal. Faecal elastase, TTG, TFTs, ILGF1 all normal. You phone the haematology registrar to look at the blood film in view of the abnormal FBC. Questions: … Continue reading

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Case 96 – update 1

This 13 month old boy was born at 39/40 by normal delivery. His birth weight was 2.6kg. He is normally fit and well with no significant problems and no previous hospital admissions. He is up to dates with all his … Continue reading

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Case 96 – the beginning

Welcome to our new #TeamHaem case. You are an SHO in a general paediatric outpatient clinic. Your next patient is a new GP referral – a 13 month old boy who has not been putting on weight for the past … Continue reading

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Case 95 – summary

Thankyou for all your help this week. This week we had a look at mantle cell lymphoma (MCL). MCL is a type of none Hodgkin’s lymphoma, and comprises between 3 and 10% of NHL, and often has features of both … Continue reading

Posted in Chronic leukaemia, Laboratory morphology, Lymphoma | Tagged , ,

Case 95 – update 2

We have monitored our patient for a year. Unfortunately at his most recent appointment he has begun to complain of weight loss of 7kg, drenching night sweats and fatigue. What would you want to do next? Are there any investigations … Continue reading

Posted in Chronic leukaemia, Lymphoma | Tagged , ,

Case 95 – update 1

So we have found our patient has a lymphocytosis on repeat bloods, we have no historical results. He denies and weight loss, sweats or tiredness. On examination you can feel an enlarged spleen 4cm below the costal margin, but you … Continue reading

Posted in Chronic leukaemia, Laboratory morphology, Lymphoma | Tagged ,

Case 95 – the beginning

Welcome to our new case! This week we start in GP. We have a 59 year old gentleman who A&E have asked you to follow up as he was found to have a slight lymphocytosis on some bloods that were … Continue reading

Posted in Chronic leukaemia, Lymphoma | Tagged

Case 94 – update 1

Our patient has undergone emergency surgical decompression for severe C3/4 spinal cord compression secondary to a lesion in his C3 vertebral body. He is recovering well on the neurosurgical ward. Initial investigations were unremarkable. Results update: Following discussion, the further … Continue reading

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Case 94 – the beginning

Welcome to our new #TeamHaem case! You are the junior doctor in A+E. The next patient to be seen is a 38 year old man who has presented with severe neck pain. He works as a builder and has been … Continue reading

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Case 93 – summary

This case highlighted a number of issues in the management of VTE. 1) The investigation of a patient with newly diagnosed DVT One of the most useful parts in the history taking is the identification of a provoking factor. We … Continue reading

Posted in Anticoagulation, Thrombosis | Tagged , , , , , , , ,

Case 93 – update 4

Our patient has had one left leg DVT which was treated with rivaroxaban. He had no symptoms of malignancy. Two months later he presents again with increased leg swelling and pain and has the thrombosis has increased compared to previous. … Continue reading

Posted in Anticoagulation | Tagged , , , ,

Case 93 – update 3

Our patient has his d-dimer checked which is positive and has an ultrasound scan of the left leg which has confirmed a clot. On review of the images the clot is more extensive that previously. This combined with the clinical … Continue reading

Posted in Anticoagulation, Thrombosis | Tagged , , , ,

Case 93 – update 2

We discussed what anticoagulant to start in our patient with a newly diagnosed DVT. There are a number of options and the main ones will include: LMWH then warfarin LWMH then dabigatran Rivaroxaban Apixaban LMWH then edoxaban   Various factors … Continue reading

Posted in Anticoagulation, Thrombosis | Tagged , , ,

Case 93 – update 1

Our patient has a confirmed proximal DVT and we recognised the important points in the clinical evaluation by looking for provoking factors: Malignancy Family history Periods of immobility Recent surgery or hospital stays Hormonal therapy or pregnancy Nephrotic syndrome Autoimmune … Continue reading

Posted in Anticoagulation, Thrombosis | Tagged , ,

Case 93 – the beginning

Welcome to our new #TeamHaem case. You are the acute medicine senior house officer working in ambulatory care. A GP has referred a 58 year old gentleman with left leg swelling and is concerned about deep vein thrombosis (DVT). He … Continue reading

Posted in Anticoagulation, Thrombosis | Tagged ,

Case 92 – summary

Thanks for your help with the cases. This week we have looked at three different scenarios regarding bleeding or bruising presenting in the paediatric population. The cases although different have some common themes: Coagulation testing in paediatrics is challenging for … Continue reading

Posted in Acquired bleeding, Inherited bleeding, Paediatric haematology | Tagged , , , , , , , , , , , , , , , ,

Case 92- update part C

We have a 7 year old boy who has presented with bruises over abdomen and one on his ear. Social services have been contacted as there is concern this may be an NAI. The boy is otherwise well has no … Continue reading

Posted in Acquired bleeding, Inherited bleeding, Paediatric haematology | Tagged , , , ,

Case 92 – part C

Thanks for your help with case 2 the patient has been diagnosed with Ehlers Danlos and will have an echo arranged to check for any cardiac problems. You now receive a call from the local district general hospital regarding a … Continue reading

Posted in Acquired bleeding, Inherited bleeding | Tagged , , , ,

Case 92 – part B

Thanks for your help with case 1 the baby is improving. The following morning you as the Haematology registrar have been referred a 5 year old girl who presented due to parental concern with easy bruising. The bruising was noted … Continue reading

Posted in Acquired bleeding, Inherited bleeding, Paediatric haematology | Tagged , , , , , ,