Category Archives: Anaemia

Case 63 – update 1

We have a pale four year old boy who appears to be generally unwell with occasional fever and sore throat. On examination his observations show a tachycardia of 140bpm and respiratory rate of 35rpm. There is no menginism. There are … Continue reading

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Case 63 – the beginning

You are a general practitioner and are reviewing a four year old boy. His mother is worried that he is looking rather pale and has been unusually tired and off his food. He has a sore throat and occasional fever over … Continue reading

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Case 50 part 2 – summary

In haematology it is important integrate laboratory investigations to clinical presentations. A blood transfusion was requested in a young patient with macrocytic anaemia with no previous blood count information. The blood film was reviewed rapidly:   The diagnosis of a … Continue reading

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Case 50 part 2 – the beginning

A 21 year old female presents with chest pain. You are asked to authorise a blood transfusion as she is anaemic. Hb 69g/L (115-160) MCV 111fL (79-98) WCC 12.6×10*9/L (4-11) Neuts 10.6×10*9/L (2-7) PLT 578×10*9/L (150-400) Here is her blood … Continue reading

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Case 50 part 1 -summary

Thanks for all of the contributions. The marrow showed erythrophagocytosis. This can be a sign of autoimmune haemolytic anaemia. In particular it can be seen in paroxysmal cold haemoglobinuria. We were slightly mean and didn’t show the rest of the … Continue reading

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Case 50 part 1 – update

We were reviewing the marrow smear from an elderly gentleman with weight loss and macrocytic anaemia. Further results include: Reticulocyte count 276×10*9/L Bilirubin 54ug/L LDH 1056U/L DAT IgG 4+   The above is consistent with warm autoimmune haemolytic anemia. The … Continue reading

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Case 50 part 1 – the begining

This week we will be doing some short cases based around some pictures. Each case will last around 24-36 hours, so get in quick!  As always – the information is posted here and the discussion will be on Twitter. Follow … Continue reading

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Case 49 – summary

Thanks to everyone who  tweeted for our case! The learning points are summarised below.   The case was based around a nulliparous 27 yr old women with sickle cell disease.  She wished to seek prior to conception.  Ideally pregnancy’s should … Continue reading

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Case 49 – update 2

The patient presents to a&e with shortness of breath at 22weeks gestation.   how would you assess this patient? management? differential?

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Case 49 – update 1

Partner testing reveals beta- thal trait.  How would you council this lady? The patient was commenced on hydroxycarbamide two years ago due to recurrent acute chest crisis.   As suggested by one of our followers – advice would be to … Continue reading

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Case 49 – the beginning

Our case this week focuses around a 27 year old lady who is know to have sickle cell disease.  She attends the joint haematology/obstetric clinic for preconceptual counselling.   As the junior haematology registrar in this clinic, consider how you … Continue reading

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Case 46 – #UnofficialCSIM2 summary

Thank you to those of you who joined in with this case; we hope it was a useful and enjoyable way to learn. We covered a few important topics during the case: the differential for a macrocytic anaemia Investigating macrocytosis … Continue reading

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Case 46 – #UnofficialCSIM2: Update 2

Mr Ordie was referred to Haematology clinic after his initial investigations were unremarkable. Bhy this point his Hb was 85g/l with an MCV of 114fl, platelets of 107. A bone marrow biopsy was performed, which showed: . IMAGE: dysplastic red … Continue reading

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Case 46 – #UnofficialCSIM2 Update 1

Thanks for all your hard work so far. We’ve established that Mr Ordie has a macrocytic anaemia with normal thyroid function tests, normal B12 and folate and no significant alcohol history. He takes methotrexate and folic acid for rheumatoid arthritis. Methotrexate … Continue reading

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Case 46 – #UnofficialCSIM2 Haematology Week

NB To our lonstanding teamhaemers: this week’s case is for medical students. Whilst we may call on some of the usual team to help us out, for now please observe without speaking! Thanks in anticipation.

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Case 45 – summary

This case dealt with two relatively common problems. We had a pregnant patient who was both iron deficient and thrombocytopenic. 1) Iron deficiency in pregnancy Anaemia in pregnancy is fairly common. There can be a 45% increase in plasma volume which will … Continue reading

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Case 45 – update 4

The iron deficiency anaemia has resolved. A ferritin was checked (although not technically necessary) and it was reassuringly well within the normal range indicating adequate iron stores. Now the issue is she is thrombocytopenic in week 36: Hb 118g/L MCV … Continue reading

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Case 45 – update 3

The blood film in the earlier post has been reported as : “Microcytic anaemia with no specific features of iron deficiency or haemoglobinopathy; suggest check iron status” The HPLC shows no variant haemoglobin and the HbA2 is within normal limits … Continue reading

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Case 45 – update 2

So far we have a pregnant lady who is feeling tired and has a microcytic anaemia. It is likely she has iron deficiency. Her family origin questionnaire is done as part of antenatal screening and she states that she is … Continue reading

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Case 45 – update 1

So far we have a women who is 11 weeks pregnant and feeling tired and out of sorts. She has a microcytic anaemia and a borderline platelet count. Firstly let’s think about the anaemia. The two most common causes of … Continue reading

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