Category Archives: Related to other specialities

Case 87 – summary

This week we looked at a case of pulmonary embolism in a lady who was 28 weeks pregnant.   Initial management included: ABC ECG – T wave inversion. S1Q3T3 pattern and right bundle branch block.  May also help with identifying … Continue reading

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Case 87 – the beginning

A 32 year old lady presents to A&E with incresing shortness of breath and chest pain.  She is 28 weeks pregnant. What further information do you need? Initial management/investigations?

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Case 84 – summary

Thank you for all your help with this weeks case! This week we looked at a case of a patient with type 1 Gaucher’s disease . She was found to be mildly anaemia with a mild thrombocytopenia. A CT scan … Continue reading

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Case 84 – update 2

So we have the results of our patient’s bone marrow and it looks to be consistent with Gaucher’s disease! Our patient has a raised serum ACE and ferritin which is typical of Gaucher’s disease. Our bone marrow shows the typical … Continue reading

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Case 84 – update 1

So we have an update: We have found our patient is thrombocytopenic, and has a mild normocytic anaemia. Our patient has been slightly tired for a year or so, but still manages to do her demanding job as a PE … Continue reading

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Case 84 – the beginning

Welcome to our new case! We start in the GP surgery with a 21 year old woman. She has been feeling tired for a while so has come to get checked. Your colleague did some bloods on the previous visit … Continue reading

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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

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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

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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

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