Author Archives: TeamHaem

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Online education and discussion about all things haematological

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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Case 140: Update 2

This lady’s blood film shows red cell agglutination at room temperature which resolves with samplewarming to 37 degrees Celsius. There is also polychromasia with spherocytosis. Herthrombocytopenia is mild but genuine with no platelets clumps. You suspect this lady has haemolytic … Continue reading

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Case 140: Update 1

This lady has a new macrocytic anaemia and is symptomatic. She is also mildly thrombocytopenic. Her B12 and folate are normal, unfortunately the rest of her biochemistry has haemolysed. Her reticulocyte count is raised at 188 ×109/L. She has no … Continue reading

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Case 140: The beginning

You are the on call haematologist and are asked by one of the secretaries to speak to a worried GPon the phone. It is regarding a 52 year old lady who saw her GP with a 2 week history of … Continue reading

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Case 139 – Summary

The cases this week were designed to consider the complexities of VTE management in cancer patients.  VTE is four to seven times as common in the cancer population compared to the general population. Cancer associated thrombosis is the second commonest … Continue reading

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Case 139 – short case 2 update 2

Thanks for your input with regards to IVC filter decision making. You ask a few more questions and establish that the patient has declined any further investigation for her likely metatataic malignancy and the oncology team advise her prognosis is … Continue reading

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Case 139 – short case 2

You are the haematologist on call and phoned at 5pm on a Friday about a 75 year old lady who presented to the acute admissions unit with confusion. She was diagnosed with Hypercalcaemia and a subsequent CT is suggestive of … Continue reading

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Case 139 – short case 1 update 3

After careful consideration you opted for weight based LMWH due to concerns about Thrombocytopenia and he has a bladder cancer with history of haematuria. A month later his platelet count has recovered but he has developed new dyspnoea. He is … Continue reading

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Case 139 – short case 1 update 2

The decision was made not to give thromboprophylaxis in the poll. As previously provoked DVT and also history of ongoing bleeding and iron deficiency with risk of thrombocytopenia on the chemotherapy. His Khorana score was 1 (Intermediate risk 1.8-2% chance … Continue reading

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Case 139 – short case update 1

You establish the patient apart from his new cancer diagnosis and previous DVT is usually well. BMI 30. His full blood count is normal apart from microcytic anemia Hb 101, MCV 77, plt 300, Wcc 9. He has been having … Continue reading

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Case 139 – the beginning of short case 1

This week we are going to have two short cases to discuss the tricky management of cancer associated VTE. It would be great to hear your thoughts and suggestions as like so much of practice there are likely several approaches … Continue reading

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