Author Archives: TeamHaem

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Online education and discussion about all things haematological

Case series 138 – Summary

This week, we covered a series of cases in various clinical settings with patients presenting with very high white cell counts (>50 x 109 / L). The differential diagnosis is wide, including both haematological (hyperleukocytosis) and non-haematological (leukemoid reactions) causes. … Continue reading

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Case series 138 – part 3

You are a GP registrar working in primary care. It’s 5 pm on Friday and you are going through the last few blood results before the weekend. The final patient is a normally fit and well 69 year old man … Continue reading

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Case series 138 – part 2

You are the critical care registrar on call and get called to A+E to review a 65 year old patient in resus. The patient is in extremis with sats of 88% on 15 L non-rebreath mask and is septic with … Continue reading

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Case series 138 – Part 1

You are the surgical SHO on call and get called by A+E to see a 23 year old patient with severe abdominal pain. The patient is septic and being treated with broad spectrum antibiotics and fluid resuscitation. Examination demonstrates severe … Continue reading

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Case 137 – Summary

Thank you for your help in the management of our 53 year old man who presented with all of the CRAB constellation of symptoms of multiple myeloma (hypercalcaemia, renal impairment, anaemia and lytic bone lesions). We talked a bit about … Continue reading

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case 137 – Update 5

It is now nearly 3 years since our patient completed his treatment for myeloma and you noticed that he had started to become a little anaemic with Hb 97, neuts 1.9 and plts 120. You asked for more information. Film … Continue reading

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Case 137 – Update 4

Thanks for all your help with management of this chap. We have confirmed his diagnosis of multiple myeloma on bone marrow biopsy and completed imaging with plain films of his long bones as he has already had a whole spine … Continue reading

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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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