Category Archives: Myeloproliferative neoplasm

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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Case 31 part 2 – summary

So… we have a leucoerythroblastic film (left shifted granulopoiesis and nucleated red cells) along with tear drop cells. The main differentials the team came up with were: Myelofibrosis (primary or secondary – he did have a haematology past) Metastatic carcinoma … Continue reading

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Case 31 part 2 – update 1

Thanks for all of the suggestions! Here’s a slightly bigger picture of the nucleated red cell and tear drop poikilocytes: The GP tells you the patient used to be under haematology review elsewhere but since moving locally has not been … Continue reading

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Case 31 part 2 – the beginning

This blood film was taken by a local GP as the patient was feeling run down and tired. Hb 95g/L MCV 69fL WCC 14.5×10*9/L PLT 432×10*9/L Questions: Describe the film What is going on? What will you advise the GP? … Continue reading

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Case 29 – summary

Polycythaemia is a common finding amongst general medicine and general practice. The vast majority of causes are secondary or reactive to other causes or are due to reduced plasma volume making the blood more concentrate (‘pseudo’  or relative/apparent polycythaemia). As with … Continue reading

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Case 29 – update 3

We are discussing a chap in his 40s with angina, previous transient ischaemic attack and polycythaemia. Because of his smoking history and relative alcohol excess we were wondering about secondary polycythaemia. He has had some fluids and his indices remain the … Continue reading

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Case 29 – update 2

We are discussing a case of polycythaemia. When finding polycyhthaemia (or erythrocytosis) it is important to think about the causes logically.  Here is a way of classifying the disorder: As haematologists we are most worried about polycythaemia vera as there … Continue reading

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Case 29 – update 1

We have a gentleman presenting with intermittent angina-like chest pains who is polycythaemic. From our contributions we have ascertained the following about our patient: He is a smoker – 20-30 per day lifelong He probably drinks too much alcohol and … Continue reading

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Case 29 – the beginning

Welcome to #teamhaem! The rules are simple… we post a case on this site and then people comment on Twitter by replying to @teamhaem and using #teamhaem so everyone else can follow the conversation. Join in! This week’s case starts … Continue reading

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Morphology week – summary

Slide 1 Answer:  Bernard Soulier syndrome, bleeding disorder characterized by thrombocytopenia and large platelets.  Autosomal recessive inheritance.  Presentation consistent with low or dysfunctional platelets and include easy bruising, nosebleeds, mucosal bleeding, menorrhagia, and, occasionally, GI bleeding. Slide 2 Answer:  Hairy cell leukaemia. … Continue reading

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