Category Archives: Related to other specialities

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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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

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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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