Category Archives: Myeloproliferative neoplasm

Case 69 -part 1 – summary

The blood film was leucoerythroblastic with left shifted granulocytes and nucleated red cells. There were tear drop cells with red cell anisopoikilocytosis and enlarged platelets.    A leucoerythroblastic film can be seen in the following: Marrow infiltration (haematopoietic and non-haematopoietic malignancy, … Continue reading

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Case 69 – part 1 – the beginning

A 58 year old gentleman presents with fatigue and weight loss. As part of the work up he has a full blood count performed and a blood film is made:     Questions How name five features on the blood film? … Continue reading

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Case 66 – summary

Thanks for all who have been involved in this week’s case.  We reviewed the causes of thrombocytosis in general and also applicable to pregnancy. Causes of thrombocytosis are usually reactive or secondary to another cause: Blood loss Infection/inflammation Malignancy Thrombopoietin … Continue reading

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Case 66 – update 3

Our patient is diagnosed with essential thrombocythaemia/thrombocytosis (JAK2 V617F positive) and is started on aspirin 75mg od.   At 28 weeks she has a painful swollen left leg. It is hot and tender. An ultrasound confirms a deep vein thrombosis. … Continue reading

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Case 66 – update 2

All reactive causes of thrombocytosis have been ruled out and our pregnant patient has a persistently elevated platelet count of 500×10*9/L. There is no history of VTE or miscarriage. There are no systemic symptoms such as weight loss, rash or … Continue reading

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Case 66 – update 1

Our pregnant patient with thrombocytosis has ferritin checked which is low at 17ug/l. Her CRP was also checked and it was <5ug/l. She is prescribed oral iron replacement – ferrous sulphate 300mg TDS and a FBC post iron replacement shows: … Continue reading

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Case 66 – the beginning

You are a GP and are reviewing blood tests that were taken during a booking appointment for a 29 year old who is 10 weeks into her first pregnancy. They show: Hb 100g/L (105-165) MCV 76fL (82-98fL) WCC 10×10*9/L (4-11) Neutrophils … Continue reading

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Case 52 – summary

Our case was based on a 34 year old lady with a new diagnosis of CML. Diagnosis CML in a proportion of patients is diagnosed on routine blood tests prior to onset of symptoms.  However, symptoms can include: lethargy shortness … Continue reading

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Case 52 – update 2

Great discussion so far regarding staging and options for treatment. Overall I think the consensus is to treat this lady with imatinib. The patient commences treatment and BCR-ABL1 shows a major molecular response at 18 months. At this clinic appointment … Continue reading

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Case 52 – update 1

This patient gives a history of palpitations for the past two days.  On questioning she has noted occasional night sweats, and describes some abdominal fullness, but otherwise is usually fit and well with no significant past medical history.  She is … Continue reading

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Case 52 – the beginning

A 34 year old female presents to A&E with a 2 day history of palpitations.   Full blood count shows: Hb 84 g/l (135-180) MCV 91 fl (78-100) MCH 29 pg (27-32) Plts 649 x10*9 (150-400) WCC 88 x10*9 (4-11) Differential … Continue reading

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Case 50 part 4 – summary

The laboratory data of anaemia, thrombocytosis, a leucoerythroblastic film and tear drop poikilocytes point towards a diagnosis of myelofibrosis. Other causes of a leucoerythroblastic film with tear drop poikilocytes may include: Beta thal intermedia/major (this should be obvious from the … Continue reading

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Case 50 part 4 – update

#TeamHaem correctly identified the main abnormalities in the film: Tear drop poikilocytes Leucoerythroblastic features (left shifted granulocytes and nucleated red cells) The patient had splenomegaly and was suffering from weight loss and subjective fevers.   Questions: Name three possible causes of … Continue reading

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Case 50 part 4 – the beginning

You are the GP reviewing a patient. He has indigestion and looks pale. A FBC is done: Hb 92g/L (115-160) MCV 76fL (79-98) WCC 15.6×10*9/L (4-11) Neuts 12.6×10*9/L (2-7) PLT 578×10*9/L (150-400) Here is the blood film:   Questions: Describe … Continue reading

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Case 41 – summary

This case highlighted the investigation of a patient with eosinophilia.  Eosinophilia can occur in 1-1.5% of blood counts in the UK.  Eosinophils  develop in the bone marrow and IL-3, IL-5 and GM-CSF are essential for their differentiation. Sometimes solid tumours can … Continue reading

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Case 41 – update 4

For the start of the case and the first and second updates scroll below (and also look at #teamhaem on Twitter for any relevant comments)… To summarise – our patient has significant eosinophilia with a non-itchy maculopapular rash, splenomegaly and symptoms … Continue reading

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Case 41 – update 3

For the start of the case and the first and second updates scroll below (and also look at #teamhaem on Twitter for any relevant comments)… Our patient has progressive eosinophilia of unknown cause (eosinophils 9.2×109/L (0-0.5)). He now has respiratory symptoms … Continue reading

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Case 41 – update 2

For the start of the case and the first update scroll below (and also look at #teamhaem on Twitter for any relevant comments)… Our patient has mild eosinophilia (eosinophils 1.5×109/L (0-0.5)) with the rest of the count being rather unremarkable and no … Continue reading

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Case 41 – update 1

Thanks for your great suggestions so far on #TeamHaem. The case started here and this is the first update. Our patient has had a routine full blood count done as part of a ‘health check’. It should a mild eosinophilia … Continue reading

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Case 41 – the beginning

Welcome back to #TeamHaem. You are a GP reviewing a patient’s full blood count. The reason for request was ‘routine health check’. The patient is a 45 year old male and you can see he has a past medical history … Continue reading

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