Category Archives: Platelet disorders

Case 13 – the beginning

You are the surgical house officer and you are managing a 49 year old male who was admitted for an elective left hemicolectomy for colorectal cancer.  He has a past medical history of hypertension and hypercholesterolaemia.  He is an ex-smoker … Continue reading

Posted in Myeloproliferative neoplasm, Platelet disorders, Related to other specialities | Tagged , | 1 Comment

Case 11 – summary

Our patient As with a number of haematological emergencies, the first sign of a major problem is through a grossly abnormal full blood count.  In this case the biomedical scientists made a blood film and confirmed the thrombocytopenia was true. … Continue reading

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Case 11 – update 4

More info on case: HIV, auto antibody screen, immunoglobulins, Hep B/C, lupus anticoagulant, anti-cardiolipin antibodies and TSH all normal.  A pregnancy test is negative. The trip to the Caribbean was three months ago and she stayed in the Bahamas and … Continue reading

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Case 11 – update 3

The case starts just below here! – click https://teamhaem.wordpress.com/2013/06/16/case-11/ Further blood tests reveal normal B12 and folate.  Ferritin is low at 9ug/L.  Clotting screen is normal.  There are no signs of major bleeding. HIV, hepatitis B/C and an autoimmune screen have … Continue reading

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Case 11 – update 2

The case starts just below here! – click https://teamhaem.wordpress.com/2013/06/16/case-11/ The patient has arrived on AMU and is being clerked by the medical SHO. She is a 27 year old female and is fit and well.  She had a ruptured appendix last … Continue reading

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Case 11 – update 1

The case starts just below here! – click https://teamhaem.wordpress.com/2013/06/16/case-11/ So there’s been plenty of discussion about what the blood film shows.  One of the arts of morphology is saying what you see… and saying what you don’t see. Here is the … Continue reading

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Case 11 – the beginning

This week’s case starts here! You are looking through the blood films for the day and find this one.  What do you think? Please reply on Twitter and include #TeamHaem Please reply on Twitter and always include #teamhaem to allow … Continue reading

Posted in Laboratory morphology, Platelet disorders | Tagged | 3 Comments

Case 7 – summary

Patient update: After a rather stormy few days the patient starts to improve.  Thankfully an HDU/ICU stay is not needed and he manages to stay on the renal ward.  S/D plasma exchange is continued with standard FFP and a further … Continue reading

Posted in Acquired bleeding, Anaemia, Platelet disorders | Tagged , , , | 1 Comment

Case 7 – update 6

Unfortunately on day four of PEX the platelet count falls to 19, LDH rises and he spikes a temperature.  Antibiotics for presumed sepsis are started.  PEX is increased to BD with no improvement in platelet count and he starts to … Continue reading

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Case 7 – update 5

We are now sure the patient has TTP.  Results of previously requested investigations show: Viral screen (HIV/Hep B/C) – negative Autoimmune screen – negative CXR – lung fields clear, heart size normal, no obvious bone or soft tissue abnormality ECG … Continue reading

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Case 7 – update 4

After clinical review it is clear the patient is deteriorating.  He needs urgent treatment for highly likely TTP.  He has HIV, hepatitis, troponin, amylase, haemolysis screen (LDH/haptoglobin/retics), TFTs, lupus anticoagulant, autoimmune screen and an ADAMTS13 assay requested.  CXR and ECG are performed. … Continue reading

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Case 7 – update 3

The blood film is reported by the haematology SpR and the comment states that “thrombocytopenia is confirmed on the blood film, with no evidence of platelet clumps.  The platelets seen appear normal in morphology.  There is evidence of haemolysis with RBC fragments … Continue reading

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Case 7 – update 2

Thrombocytopenia is a common feature in acute hospital admissions, The differential diagnosis is wide, with the most common causes being drug-related and sepsis.  It is important to rule out artefact and repeating the test is often appropriate although shouldn’t delay … Continue reading

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Case 7 – update 1

Some of the differentials so far Acute leukaemia HUS WAS (Wiskott–Aldrich syndrome) ITP Autoimmune condition e.g.lupus Viral e.g. hep B/C, HIV Luckily local measures have stopped the bleeding.  His obs are as follows BP: 110/80, pulse 105bpm, resp 20rpm, SpO2 … Continue reading

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Case 7 – the beginning

As the ENT SHO you take direct admissions from the Emergency Department’s triage nurse for anything ENT related.  You get a call about a 35 year old gentleman who has had on-and-off epistaxis for the past 24 hours and is … Continue reading

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Case 1 – summary

Thank you for your comments about anticoagulation management in HIT. Argatroban and danaparoid would be appropriate anticoagulants to use in this setting. Lepirudin is no longer available, having been recently withdrawn from Europe. Fondaparinux would not be suitable at this … Continue reading

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Case 1 – update 2

Hello all. Thank you for your comments on investigations for HIT. As mentioned by a number of contributers there are a number of tests available when investigating a patient for possible HIT. These are summarised in a comment from a … Continue reading

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Case 1 – update 1

Welcome back team. Thanks for your comments so far. On reviewing the case notes you find out the following: Mr X has had simple valve replacement but developed acute kidney injury and has been on CVVH for six days now … Continue reading

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Case 1 – the beginning

Welcome to TeamHaem’s first case discussion. Please read the following case outline and respond to the initial question posed via Twitter. Keep an eye on the twitter feed as more information will be released as the discussion develops. A 65 … Continue reading

Posted in Anticoagulation, Platelet disorders, Thrombosis | Tagged , | 4 Comments