Category Archives: Uncategorised

Case 136 – update 1

We are advising the orthopaedic SpR, Ms Fi Moor, about a 71 year old lady listed for urgent THR who has a normocytic anaemia (Hb 84) and requires optimisation pre-op. You have requested the following info: PMH: Hypertension, type 2 … Continue reading

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Case 136 – the beginning

You are the haematology SpR holding the on-call phone. You are called by an orthopaedic SpR regarding a 71-year-old lady she has reviewed in clinic with significant osteoarthritis of the right hip. The patient’s mobility and quality of life have … Continue reading

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Many thanks for all your thoughts and suggestions this week. The case this week was an 81 year old lady who presented with AIHA. She had an incidental finding of mild lymphocytosis, small Ig M Paraprotein and splenomegaly and was … Continue reading

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Case 135 – Update 1

Thanks for your help so far… We have now established that our 81 year old lady with AIHA has been feeling tired for several months and has noted some exertional dyspnoea. She has noted recently that she has lost some … Continue reading

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Case 135 – update 3

20 months after initial treatment for AIHA you are asked to review the patient as she is noting increasing abdominal discomfort and has started to have drenching night sweats. You note she is becoming slowly more thrombocytopenic and anaemic but … Continue reading

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Case 135 – Update 2

Our patient was discharged home and took 60mg Prednisolone for 3 weeks. She successfully started a steroid wean following this and is slowly reducing down to 30mg of prednisolone daily at present. Her Hb has normalised at 130g/l with a … Continue reading

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Case 135 – The beginning

You are the medical SHO on call and get asked to review an 81 year old lady with symptomatic anaemia on a Friday evening. She has had no bloods taken for the preceding two years and her Hb has been … Continue reading

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Case 134: Summary

Thank you for your contributions to this case! We discussed a 61-year old man who presented to haematology with a 6-month history of weight loss, night sweats and a left axillary lump. He was diagnosed with peripheral T-cell lymphoma, NOS. … Continue reading

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Case 134: Update 5

CT head shows no abnormalities and his blood tests are unremarkable.You commence the patient on intravenous methylene blue as treatment for ifosfamide-induced encephalopathy. His mental state returns to normal within a few days and he is discharged. He successfully undergoes … Continue reading

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Case 134: Update 4

You notice the patient’s liver function tests are deranged:Bilirubin 7 µmol/LAlanine aminotransferase (ALT) 73 U/LAlkaline phosphatase (ALP) 400 U/LAlbumin 30 g/L You are concerned the patient may now have disease in his liver. You decide to proceed with chemotherapy. Five … Continue reading

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Case 134: Update 3

Our patient unfortunately has refractory disease to standard CHOP chemotherapy. He wishes to pursue intensive treatment. The local MDT recommends treatment escalation to IVE/MTX (ifosfamide, etoposide, epirubicin, methotrexate) and autologous stem cell transplantation. He is booked into the haematology ward … Continue reading

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Case 134: Update 2

Considering our patient’s age and overall fitness, the MDT decides to offer him CHOP chemotherapy. He tolerates this well with no significant toxicities. Mid treatment PET shows progressive disease with new lymphadenopathy in the mediastinum. How does this change your … Continue reading

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Case 134: Update 1

History does not reveal much more of significance. He has not been abroad in the last 2 years.Examination reveals a palpable 2x2cm left axillary node, as well as splenomegaly. No rashes.His renal and liver function are normal. LDH is elevated … Continue reading

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Case 134: The beginning

You are in the haematology clinic. Your next patient is a 61-year old man who has been referred to you by a GP due to a 6-month history of weight loss, night sweats and a lump under his left arm. … Continue reading

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Case 133: The Summary

UK guidelines support the initiation of prrophylaxis with recombinant factor VIII either from the first joint bleed or the prior to the first joint bleed for all patients were severe haemophilia. When initiating treatment and caring for families affected by … Continue reading

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Case 133: Future planning

Several weeks later the boy is much better, you review him in the haemophilia centre.  The knee has resolved, he has had a week of factor VIII treatment and physiotherapy support.  Mum is worried about future bleeds. What advice should … Continue reading

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Case 133: Starting some treatment

You explain to the Mum that you are going to give the boy some treatment with factor VIII.  You suspect he has a knee bleed and he will need to be admitted to the ward for a few days until … Continue reading

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Case 133: Some more details…

2. You attend A&E to review the young boy. – He was previously known at a different centre but the family have only recently moved to the area. The family have a planned appointment in a few weeks at the … Continue reading

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Case 132 – the summary!

Thank you for all the contributions throughout Case 132. We discussed the case of a 66-year-old gentleman who was diagnosed with chronic lymphocytic leukaemia after he presented with cervical lymphadenopathy. He required treatment as he was symptomatic (B symptoms) and … Continue reading

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Case 133: The beginning

Its your first day oncall as a new haematology ST3. You are called by the paediatric A&E nurse. A 2 year old boy has been brought in by his Mum with a swollen right knee.  His mum says he has … Continue reading

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