Category Archives: Myeloproliferative neoplasm

Case 89 – summary

  Thank you for all of the contributions with Case 89 where we encountered a fit 64 year old who presented with progressive anaemia and leucocytosis over the past 6 months. He also had associated weight loss of 0.5 stones … Continue reading

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Case 89 – update 2

Thank you for everyone’s contributions so far! Update of investigation results as requested: Bone marrow trephine: myelofibrosis. BM cytogenetics: monosomy 7 Peripheral blood: JAK2 positive. No circulating blasts identified on blood film. USS abdo: 16cm spleen (Hb 95, Plts 90, … Continue reading

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Case 89 – update 1

Thanks for everyones contributions so far. Further information now available as requested by yourselves: Patient decline over past 6 months – 0.5 stone weight loss, no night sweats / fevers. Marked lethargy and generally feeling ‘achey’. Poor appetite but no … Continue reading

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Case 89 – the beginning

A 64  year old man is referred to haematology outpatients with progressive chronic anaemia and leucocytosis. He has previously been very fit but has become very lethargic  over the past few months. Hb 95, MCV 103, Plts 90, WCC 17, … Continue reading

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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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