Author Archives: TeamHaem

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Online education and discussion about all things haematological

Case 146 – the beginning

You are about to see a new patient in the Haematology clinic. She is a 58-year old lady with a background of hypertension. Ramipril is her only medication. She is otherwise fit and well. She has been referred to you … Continue reading

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Case 145 – continued

The critical care team inform you that while he was on LMWH prophylaxis whilst an inpatient for his acute appendicitis, he has not had any further heparin exposure in the last three weeks. Further investigations are arranged with results as … Continue reading

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Case 145 – the beginning

You are on-call for haematology and receive a call from the critical care team regarding a 36-year-old male with a complex medical history. With the exception of an episode of uncomplicated acute appendicitis 3 weeks ago which required a laparoscopic … Continue reading

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Case 144 – Summary

The case this week focused on the use of Viscoelastic Haemostatic assays (VHA). The patient had a ruptured AAA. Initial TEG testing was normal but she continued to bleed. Repeat TEG showed she had developed shortened R time and increased … Continue reading

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Case 144 -update 4

The clinical team looking after the lady are not happy to give tranexamic acid as they feel it will be a thrombotic risk. They do accept advice to give 4FFP and a pool of platelets given the long R time … Continue reading

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Case 144 – update 4

The clinical team looking after the lady are not happy to give tranexamic acid as they feel will be a thrombotic risk. They do accept advice to give 4FFP and a pool of platelets given the long R time and … Continue reading

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Case 144 – update 3

The lady has been taken to theatre but the team have noted she is becoming more unstable despite ongoing replacement with the Major Haemorrhage packs She had 4 RBC 4 FFP and you advised 2 cryo following initial lab tests. … Continue reading

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Case 144 – update 1

You establish the patients isn’t on any anticoagulants or antiplatelet agents. She has no cardiac history and the team don’t know about her blood group. She had an ABG that shows a Hb of 64. You advise the team that … Continue reading

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Case 144 – Update 2

You establish the patients isn’t on any anticoagulants or antiplatelet agents. She has no cardiac history and the team don’t know about her blood group. She had an ABG that shows a Hb of 64. You advise the team that … Continue reading

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Case 144 – The Beginning

A 76 year old lady with a history of Hypertension and Diverticular disease collapses while out having her Sunday lunch with her family. An ambulance is called and she is hypotensive complaining of abdominal pains. The Paramedics bring her to … Continue reading

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Case 144: The Beginning

A 76 year old lady with a history of Hypertension and Diverticular disease collapses while out having her Sunday lunch with her family. An ambulance is called and she is hypotensive complaining of abdominal pains. The Paramedics bring her to … Continue reading

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Case 143: summary

Thanks for your help with this week’s case! We discussed a 55 year old man who presented with persistent erythrocytosis, thrombocytosis, and leukocytosis. This was associated with a thrombotic event (myocardial infarction). Further investigations revealed JAK2 V617 positivity and a … Continue reading

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Case 143: update 5

Our patient has a repeat bone marrow biopsy which unfortunately demonstrates progression to myelofibrosis. His spleen has also increased in size. He is referred to the regional centre for an allogeneic stem cell transplant and ongoing care. Well done, team!

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Case 143: update 4

Our patient wants to stop hydroxycarbamide side effects. He agrees to switch to ruxolitinib therapy. His condition is well controlled on this for over a year until one day in clinic he complains ofabdominal discomfort and his blood counts are … Continue reading

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Case 143: update 3

The patient is diagnosed with a myeloproliferative neoplasm. He is not keen on chemotherapy and is commenced on a venesection programme, aiming for Hct <0.45. Although his counts start to show some improvement, he eventually becomes troubled by symptomatic iron … Continue reading

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Case 143: update 2

This man is referred to the haematology clinic. Apart from his recent hospital admission, there isnothing else of note in his history apart from the fact that he smokes. Examination is alsounremarkable. You organise JAK2 testing, an ultrasound of his … Continue reading

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Case 143: update 1

This man has no known past medical history and takes no regular medications. He is usually fit andwell and works as a chef. He smokes 10 cigarettes per day and drinks alcohol within recommendedlimits. He lives in Newcastle, UK. Examination … Continue reading

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Case 143: the beginning

A 55 year old man is admitted to the emergency department complaining of shortness of breath. This came on suddenly a few hours ago. He had a full blood count taken in triage: Hb 192 g/LHct 59%MCV 84 fLPlt 512 … Continue reading

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Case 142: summary

Pregnancy-associated TTP Definition: Rare but life-threatening thrombotic microangiopathy characterised by thrombocytopenia, MAHA and end organ damage due to microvascular thrombosis Pathogenesis: Severe ADAMTS13 deficiency (acquired or congenital) ULVWF multimers lead to platelet adhesion resulting in platelet-rich microthrombi, red cell fragmentation … Continue reading

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Case 142: update 3

ADAMTS13 activity level subsequently comes back at <5% with positive anti-ADAMTS13 IgG antibodies, consistent with a diagnosis of acquired, immune TTP. The patient continues on daily PEX and 1 mg/kg prednisolone for immunosuppression. The patient responds well with resolution of … Continue reading

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