Category Archives: Thrombosis

Case 58 – update 4

Our patient has a confirmed left sided DVT. Prior to initiation of anticoagulation a clotting screen is performed. It shows: PT 12s (11-14) APTT 49s (35-40) Fibrinogen 5.5g/L (1.5-4) d-dimer 990ng/mL (<500)   Questions How do you interpret the results? … Continue reading

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Case 58 – update 3

Our patient has a swollen left leg and an intermediate Wells’ score but a positive d-dimer result. She goes on to have an ultrasound of her lower limb. There is debate on whether to do a full leg ultrasound scan … Continue reading

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Case 58- update 2

Our patient has a possible DVT. She has a painful, swollen left leg with some mild erythema. The Wells’ score is 1 and therefore a d-dimer test is required. Had the score been 2 it would be reasonable to move to … Continue reading

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Case 58 – update 1

Thanks for the contributions so far.   We have established that our patient is a 37 year old female and has presented to her general practitioner with a swollen left leg. She had a recent car journey of 90 minutes … Continue reading

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Case 58 – the beginning

Welcome back to TeamHaem. Please read the case below then make some comments/answer the questions on Twitter using #TeamHaem.   A 37 year old female presents to her general practitioner with a swollen leg which has gotten worse over the … Continue reading

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Case 39 – summary

.The final part of our case was dedicated to discussing what tests, if any, should be requested on a patient presenting with an unprovoked VTE (uVTE). Clearly there are many other topics in the field of ‘clots and cancer’ that … Continue reading

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Case 39 – update 2

In the last few days we have established that the 74 year old man with a confirmed DEEP vein thrombosis (in the superficial femoral vein – see this link for discussion of this misnomer: http://jama.jamanetwork.com/article.aspx?articleid=389874). He has had significant indigestion … Continue reading

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Case 39 – update 1

One of the team has written a fantastic summary of differentials and points to consider in the history and examination: thanks olitodd1984! Please see his comments below: Rule out infection– in the history ask about fevers, sweats, rigors, loss of appetite. On … Continue reading

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Case 39 – the beginning

Welcome to case 39, a short case exploring DVT/PE management. Sound dull? Well, we’re going to show you why it’s not just a DVT. This case is particularly aimed at: General medics Surgeons Medical students Nursing students Acute medicine practitioners … Continue reading

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Case 37 part 3 – summary

Our patient was unwell with pneumonia. The results showed an isolated prolonged APTT: PT 14s (11-14s) APTT 48s (33-40s) APTT 50:50 mix 47s Fibrinogen (Clauss) 4.9g/L (1.5-4.5g/L) Thrombin time 16s (15-19s) She was not on any anticoagulation and had no … Continue reading

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Case 37 part 3 – update 1

The patient is rather unwell with a community acquired pneumonia and requiring supplemental oxygen and intravenous antibiotics. She is not ‘septic’ with low BP etc. There is no history of bleeding and the coagulation screen 5 years pre knee operation … Continue reading

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Case 37 part 3 – the beginning

Welcome back. Case 37 has focused around an abnormal APTT. This is a common finding in the routine coagulation screen. It is important to investigate appropriately to avoid delayed procedures and patient anxiety. The first case had a factor XII … Continue reading

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Dermatology short cases: case 2 (answers)

Case two was, as so many of you rightly identified, a case of warfarin induced skin necrosis. This is a rare condition but is clearly potentially devastating and is the reason that all patients starting on loading doses of warfarin … Continue reading

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Dermatology short cases: case 2

What is the cause of this lesion? And if you know the answer…why does it happen? Please reply in twitter and use the #teamhaem hashtag. All comments are welcome, so join in the debate! Case Three will follow soon.

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Dermatology short cases: case 1

This photo is an example of livedo reticularis: The haematological condition that is associated with livedo reticularis is Antiphospholipid syndrome. APS is also associated with: necrotizing vasculitis thrombophlebitis cutaneous ulceration Necrosis subungual splinter haemorrhages erythematous macules, purpura, ecchymoses painful skin … Continue reading

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Case 23 – summary

This was a case involving a common medical problem – the DVT.  There were a number of important points 1) Idiopathic DVT (i.e. those not provoked by a risk factor such as surgery, plaster casts, pregnancy and medications) require careful thought … Continue reading

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Case 23 – update 4

Our young patient with newly diagnosed DVT has cervical cancer and needs total abdominal hysterectomy semi-urgently.  As the DVT is recent and as the surgery has a high risk of blood loss it is felt that inserting an IVC filter … Continue reading

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Case 23 – update 3

Unfortunately following gynaecological review our patient is found to have cervical cancer.  She needs hysterectomy within the next week.  Following #teamhaem suggetstions she is given intravenous iron in an attempt to optomise her haemoglobin pre surgery and avoid the use of blood … Continue reading

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Case 23 – update 2

Thanks for all of your comments so far.  We have decided that she has a high Well’s score and therefore does not need a d-dimer in diagnostic work up.  However having a baseline d-dimer may be useful in later stages … Continue reading

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Case 23 – update 1

The patient attends EAU and more history is gained by the medical SHO. She is a 31 year old female who has felt her right calf has been more swollen for the last three days.  She has not had any … Continue reading

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