Category Archives: Myeloma/paraproteins

Case 85 – summary

So, our patient has had quite a week! Thanks to your efforts, he is safely back on the ward, conscious and improving.  Recap: We have managed an emergency presentation of an unconscious patient with severe hypercalcaemia, hyperviscosity and an AKI. … Continue reading

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Case 85 – update 2

We rejoin our patient on HDU… He remains unconscious and lacks capacity to currrently make decisions regarding his further management.  Based on our team’s suspicion of an underlying plasma cell disorder, that may be driving our patient’s hypercalcaemia, AKI and … Continue reading

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Case 85 – update 1

Thank you for all your help so far on the medical admissions unit. Assessment Our patient was initially assessed using an ABCDE approach: A) Snoring, requiring an airway adjunct (nasopharangeal airway) B) RR16, chest clear to auscultation, sats 97% room … Continue reading

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Case 85 – the beginning

Welcome to our new case. We need your help urgently. Our patient is a 55 year old man who is drowsy and confused. His friend is extremely worried and has brought him to the Medical Admissions Unit front door for … Continue reading

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Case 75 – summary

Case 75 – Summary! Thank you for all of the contributions with Case 75, where we encountered a 43 year old who presented with back pain and circulating plasma cells in his peripheral blood. In summary we established that this … Continue reading

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Case 75 – update 3

Bortezomib-based regimes are associated with better outcomes as it more rapidly reduces tumour load and reverses complications. What would you combine Bortezomib with in our patient? How would you consolidate this treatment if response achieved? Would the cytogenetics results influence … Continue reading

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Case 75 – update 2

Our patient has >2×109 plasma cells in peripheral blood without a history of myeloma consistent with a diagnosis of primary plasma cell leukaemia (pPCL). Flow is typical of  pPCL – myeloma markers with CD56- and CD20+. Our patient had a … Continue reading

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Case 75 – update 1

Thanks for everyones contributions. The following results are now back:   SFLC kappa: lambda ratio: 6543. Igs and serum electrophoresis: Immuneparesis and IgA kappa paraprotein 18 B2 microglobulin 8.7. Albumin 28. Bone marrow biopsy: 66% plasma cells morphologically. Flow cytometry … Continue reading

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Case 75 – the beginning

A 43 year old man presents to A+E with severe back pain. He also has a 2 month history of progressive fatigue. On examination he has pallor, splenomegaly and marked tenderness to L2-L5. How would you further assess this patient? … Continue reading

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Case 62 – summary

Haematological emergencies   Patient A presented with an episode of neutropenic sepsis.  As a junior you should be suspicious of someone being neutropenic if they have had recent chemotherapy (usually within the past 1-2 weeks).  Reviewing patients previous blood results … Continue reading

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Case 62 – part B

Case B A 55 year old women attends the Haematology day unit where you are the junior reviewing emergencies.  She has a background of IgG MGUS.  She has noticed some difficult walking up the stairs over the past few weeks … Continue reading

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Case 54 – summary

Case A Our first case looked at a blood film of a 48 year old gentleman who had presented with neutropenia and monocytopenia.  This is a common presentation for patients with hairy cell leukaemia and this leaves them susceptible to … Continue reading

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Case 54 – case D

  Case D 45 year old gentleman complaining of back pain. Hb 120 g/l, calcium 2.33 mmol/L, creatinine 75 IgG 34g/L Serum involved:non-involved light chains – 115 BM – 35% plasma cells MRI – no lytic lesions How would you … Continue reading

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Case 50 part 3 – summary

It just goes to show that picking up on simple signs can lead to the start of a diagnostic journey. The patient with the film below (second from left) had a FBC as she had suffered from back pain and … Continue reading

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Case 50 part 3 – the beginning

You are reviewing the blood films from today. Can you make a diagnosis without a microscope?     Please reply to us (@TeamHaem) on Twitter and always include #TeamHaem to allow others to follow your comments. Please join in the … Continue reading

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Case 48 – #UnofficialCSIM2 summary

Thank you for joining the case. We’ve already met Mr Jones, a 75 year old man admitted following a fall to an orthopaedic ward with a fractured neck of femur. We agreed that his behaviour was new and odd and … Continue reading

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Case 48 – #UnofficialCSIM2 update 1

Thanks for joining the case, where as a surgical FY1 doctor you were asked to review Mr  Jones, a 75 year old man who had been admitted after a fall leading to a femur fracture. The nurses were worried that … Continue reading

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Case 48 – UnofficialCSIM2 – oncology week

Hi to all those joining us from #unofficialCSIM2. To remind our usual teamhaem-ers again – the #unofficialCSIM2 project is aimed at 4th year medical students. Whilst everyone’s input is appreciated, it would be helpful if those of you with more … Continue reading

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Case 47 – summary

Thank you for all your help with this weeks case! We have had some very helpful renal input this week! This week we looked at the case of a normally fit 60year old gentleman who presented with peripheral oedema and … Continue reading

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Case 47 – update 2

So we have another update on our gentleman. He has been found to have nephrotic syndrome and a renal biopsy has been performed which has now come back and is consistent with AL Amyloid nephropathy. Further investigations revealed an IgG … Continue reading

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