Category Archives: Acquired bleeding

Case 14 – the beginning

You are an SHO on the medical admissions unit.  You are checking the bloods for a patient, who your colleague reviewed earlier that day.  You notice that the APTT is prolonged on the coagulation screen at 43 seconds. What are … Continue reading

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Case 7 – summary

Patient update: After a rather stormy few days the patient starts to improve.  Thankfully an HDU/ICU stay is not needed and he manages to stay on the renal ward.  S/D plasma exchange is continued with standard FFP and a further … Continue reading

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Case 7 – update 6

Unfortunately on day four of PEX the platelet count falls to 19, LDH rises and he spikes a temperature.  Antibiotics for presumed sepsis are started.  PEX is increased to BD with no improvement in platelet count and he starts to … Continue reading

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Case 7 – update 5

We are now sure the patient has TTP.  Results of previously requested investigations show: Viral screen (HIV/Hep B/C) – negative Autoimmune screen – negative CXR – lung fields clear, heart size normal, no obvious bone or soft tissue abnormality ECG … Continue reading

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Case 7 – update 4

After clinical review it is clear the patient is deteriorating.  He needs urgent treatment for highly likely TTP.  He has HIV, hepatitis, troponin, amylase, haemolysis screen (LDH/haptoglobin/retics), TFTs, lupus anticoagulant, autoimmune screen and an ADAMTS13 assay requested.  CXR and ECG are performed. … Continue reading

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Case 7 – update 3

The blood film is reported by the haematology SpR and the comment states that “thrombocytopenia is confirmed on the blood film, with no evidence of platelet clumps.  The platelets seen appear normal in morphology.  There is evidence of haemolysis with RBC fragments … Continue reading

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Case 7 – update 2

Thrombocytopenia is a common feature in acute hospital admissions, The differential diagnosis is wide, with the most common causes being drug-related and sepsis.  It is important to rule out artefact and repeating the test is often appropriate although shouldn’t delay … Continue reading

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Case 7 – update 1

Some of the differentials so far Acute leukaemia HUS WAS (Wiskott–Aldrich syndrome) ITP Autoimmune condition e.g.lupus Viral e.g. hep B/C, HIV Luckily local measures have stopped the bleeding.  His obs are as follows BP: 110/80, pulse 105bpm, resp 20rpm, SpO2 … Continue reading

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Case 7 – the beginning

As the ENT SHO you take direct admissions from the Emergency Department’s triage nurse for anything ENT related.  You get a call about a 35 year old gentleman who has had on-and-off epistaxis for the past 24 hours and is … Continue reading

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Case 6 – summary

Beriplex use for warfarin reversal Using the BCSH guidelines, we can identify that this patient requires reversal of warfarin immediately, given the history of a possible fall (head injury) and the history of amnesia. Major bleeding is defined as limb … Continue reading

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Case 6 – update 2

So …. CT confirms a subdural bleed and the patient has recieved beriplex at a dose of 30 units/kg and vitamin K 2mg IV.  Initial INR was 2.6 and repeat INR 30mins following beriplex was 1.2.    Discussion with neurosurgeons … Continue reading

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Case 6 – update 1

20 minutes after his son reports that he appears more confused.  On review you note a slight facial droop, his speech is a little slurred, and he is definitely more confused.  His daughter has brought in a list of medications … Continue reading

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Case 6 – the beginning

You are working a night shift in A&E.  A 82 year old gentleman attends with his son.  The son reports that his father had a fall earlier that day.  The son was in the house, but did not witness the fall.  … Continue reading

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