Category Archives: Thrombosis

Case 93 – summary

Posted on 18/05/2018 by

This case highlighted a number of issues in the management of VTE. 1) The investigation of a patient with newly diagnosed DVT One of the most useful parts in the history taking is the identification of a provoking factor. We … Continue reading →

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Case 93 – update 3

Posted on 16/05/2018 by

Our patient has his d-dimer checked which is positive and has an ultrasound scan of the left leg which has confirmed a clot. On review of the images the clot is more extensive that previously. This combined with the clinical … Continue reading →

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Case 93 – update 2

Posted on 15/05/2018 by

We discussed what anticoagulant to start in our patient with a newly diagnosed DVT. There are a number of options and the main ones will include: LMWH then warfarin LWMH then dabigatran Rivaroxaban Apixaban LMWH then edoxaban   Various factors … Continue reading →

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Case 93 – update 1

Posted on 14/05/2018 by

Our patient has a confirmed proximal DVT and we recognised the important points in the clinical evaluation by looking for provoking factors: Malignancy Family history Periods of immobility Recent surgery or hospital stays Hormonal therapy or pregnancy Nephrotic syndrome Autoimmune … Continue reading →

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Case 93 – the beginning

Posted on 13/05/2018 by

Welcome to our new #TeamHaem case. You are the acute medicine senior house officer working in ambulatory care. A GP has referred a 58 year old gentleman with left leg swelling and is concerned about deep vein thrombosis (DVT). He … Continue reading →

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Case 87 – summary

Posted on 04/12/2017 by

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

Posted on 26/11/2017 by

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 86 – part C2

Posted on 16/11/2017 by

Thanks for your help with this short case. We examined this blood film of an unwell female: The most striking abnormality is red cell fragmentation. This can be seen in: AIHA/Evans’ syndrome DIC Pregnancy-associated (HELLP, pre-eclampsia, malignant hypertension, fatty liver of … Continue reading →

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Case 86 – part 3A

Posted on 15/11/2017 by

A 32 year old female presents with headaches, visual disturbance and fever. Hb 92g/L MCV 99fl Platelets 38×109/l WCC and differential – mild neutrophilia Questions Name some features of the blood film? What are the differential diagnosis? What further investigations … Continue reading →

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Case 82 – update 2

Posted on 22/08/2017 by

Our patient continues to deteriorate and the following investigations are now back: Hb 103, Plts 75, WCC 3.4, Neuts 1.6. Blood film: red cell fragments with infrequent spherocytes and polychromasia. Bili 152 (predominantly conjugated), ALT 54, Alk phos 340. Urea … Continue reading →

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Case 82 – update 1

Posted on 22/08/2017 by

Thanks for all the contributions! We now know from the history and investigations requested that: This patient has had no obvious provoking factors for both his previous and current PE – including no symptoms/signs suggestive of autoimmune disorder / maligancy. … Continue reading →

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Case 82 – the beginning

Posted on 20/08/2017 by

Welcome to our new case! A 45 year old gentleman is admitted to the medical assessment unit as he has been diagnosed with a large pulmonary embolus (PE) within the right pulmonary artery. He is requiring 2 litres of oxygen … Continue reading →

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Case 70 – part 3 – summary

Posted on 13/01/2017 by

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

Posted on 12/01/2017 by

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 66 – summary

Posted on 22/10/2016 by

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

Posted on 19/10/2016 by

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

Posted on 18/10/2016 by

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

Posted on 17/10/2016 by

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

Posted on 16/10/2016 by

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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Case 58 – summary

Posted on 30/05/2016 by

We covered a lot of issues this week. Here is a link to the case on Storify: https://storify.com/TeamHaem/case-58-teamhaem-does-dvt Our patient was a 37 year old female with left leg swelling. She had no major medical problems and was on no … Continue reading →

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