Category Archives: Related to other specialities

Case 83 – summary

Many thanks to everyone who contributed to our case. This week the case centred on a pregnant female who was an obligate carrier of Haemophillia A (Her Father was affected). She had a factor VIII level of 54%. She was … Continue reading

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Case 83 – update 3 

Our pregnant patient had a factor VIII level of 54%. She is a carrier of intron 22 inversion as predicted from family history.  The free fetal DNA testing confirms she is carrying a male fetus. The patient has decided that … Continue reading

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Case 83 – update 2

Our pregnant patient returns to clinic she is now 13 weeks pregnant.  Her factor VIII level was 54%. She is a carrier of intron 22 inversion as predicted from family history.  The free fetal DNA testing confirms she is carrying … Continue reading

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Case 83 – update 1

After consideration of her family tree you realise  if there are no non-paternity issues she is an “obligate carrier” of Haemophillia A.  After counselling and discussion she agrees to having genetic testing for herself. She is willing to have free … Continue reading

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Case 83 – the beginning

You are in a joint obstetric haematology clinic and have been referred a 24 year old lady who is 13 weeks pregnant P0 G1 You take a family history and find her father and paternal uncle have severe Haemophillia A. … Continue reading

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Case 72- summary

Answers A – hereditary elliptocytosis B – hairy cell leukaemia C – metastatic prostate cancer Case A The first case, we started with something relatively straightforward: This was a blood film of a 21 year old pregnant women who was … Continue reading

Posted in Anaemia, Chronic leukaemia, Lymphoma, Related to other specialities | Tagged , , , , ,

Case 72 – case C

Sticking with bone marrow trephine! What do you think of this one? 58 yr old gentleman presents to GP feeling tired.  Bloods show Hb 78, wcc 2.1, platelets 52. Blasts were seen on film, aspirate dry tap.  What other investigations … Continue reading

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Case 71 – summary

Our patient had high ferritin which was detected on a routine blood test. Hyperferritinaemia is common and causes can usually be differentiated by history and clinical examination. Potential causes include: Any inflammation including rheumatological conditions and renal failure Infections Liver … Continue reading

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Case 71 – update 3

The patient has 500mL of blood venesected and tolerates this well. He stops drinking alcohol and within six weeks his ALT is almost within the reference range.   He has two children – one male and one female.   Questions … Continue reading

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Case 71 – update 2

The causes of high ferritin include: Any inflammation including rheumatological conditions and renal failure Infections Liver disease Chronic blood transfusion Haemochromatosis Myelodysplasia Porphyria cutanea tarda Hereditary hyperferritinaemia cataract syndrome Inherited anaemias including sideroblastic anaemia, congenital dyserythropoietic anaemia and some inherited … Continue reading

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Case 71 – update 1

Our patient has a high ferritin. He has complained of joint pains affecting the knees and hands for some time and was diagnosed with osteoarthritis. He takes occasional paracetamol for this. He does not have a history of blood transfusion. … Continue reading

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Case 71 – the beginning

A 57 year old male has routine blood tests at his general practitioner’s surgery due to feeling slightly tired. They reveal the following results: Hb 156g/L (130-180) MCV 92fL (82-98) HCT 0.47 (0.39-0.50) WCC 9.5×10*9/L (4-11) Platelets 200×10*9/L (150-450) Ferritin … Continue reading

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Case 70 – part 3 – summary

For our last short case this week we looked at a 50 year old gentleman who developed a subdural following an assault. He had been diagnosed with a provoked DVT 1 week prior following knee surgury and had been loaded … Continue reading

Posted in Anticoagulation, Related to other specialities, Thrombosis | Tagged , , ,

Case 70 – part 3 – the beginning

And for our last case, a 50 year old gentleman has attended A&E following an assault. A CT head has shown a subdural and the neurosurgeons want to take him to theatre. The patient had a knee replacement about 4 … Continue reading

Posted in Anticoagulation, Related to other specialities, Thrombosis | Tagged , , ,

Case 70 – part 2 – summary

We have a 76 year old gentleman with AF and a recent CVA making him high risk for thromboembolic events.  He was on dabigatran and presented 5 hours after taking his last dose with haematemesis and a perforated DU.  Dabigatran … Continue reading

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Case 70 – part 2 – the beginning

So we now have our second case. A 76 year old gentleman had been admitted under the surgeons with a haematemesis and a perforated duodenal ulcer. The surgeons would like to take him to theatre within the next hour. The … Continue reading

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Case 70 – part 1 – summary

So our patient was a 75 year old male who has a PMH of NIDDM, HTN, AF and a previous bioprosthetic AV replacement. He is anticoagulated for AF with a CHADS2 score of 3 – which is an annual stroke … Continue reading

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Case 70 – part 1 – the beginning

Welcome to our cases this week. This week we will do 3 short cases looking at anticoagulation and perioperative management around elective and emergency surgery. Our first case is a patient who is being seen pre operatively. The patient needs … 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

Posted in Myeloproliferative neoplasm, Related to other specialities | Tagged , , , , ,

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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