Tag Archives: MAHA

Case 31 part 4 – summary

Thanks for all of your comments. The film had numerous red cell changes including fragmentation (schistocytes), Howell Jolly bodies, accanthocytes, spherocytes. There was also thrombocytopenia and Howell-Jolly like inclusions in the neutrophils. The most significant finding are the red cell fragmentation. … Continue reading

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Case 31 part 4 – the beginning

Here’s the next installment in our series of short cases. This was a film from a nine year old post haematopoietic stem cell transplant for relapsed AML. The patient was one month post transplant with no evidence of AML but still … Continue reading

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Case 7 – summary

Patient update: After a rather stormy few days the patient starts to improve.  Thankfully an HDU/ICU stay is not needed and he manages to stay on the renal ward.  S/D plasma exchange is continued with standard FFP and a further … Continue reading

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Case 7 – update 6

Unfortunately on day four of PEX the platelet count falls to 19, LDH rises and he spikes a temperature.  Antibiotics for presumed sepsis are started.  PEX is increased to BD with no improvement in platelet count and he starts to … Continue reading

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Case 7 – update 5

We are now sure the patient has TTP.  Results of previously requested investigations show: Viral screen (HIV/Hep B/C) – negative Autoimmune screen – negative CXR – lung fields clear, heart size normal, no obvious bone or soft tissue abnormality ECG … Continue reading

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Case 7 – update 4

After clinical review it is clear the patient is deteriorating.  He needs urgent treatment for highly likely TTP.  He has HIV, hepatitis, troponin, amylase, haemolysis screen (LDH/haptoglobin/retics), TFTs, lupus anticoagulant, autoimmune screen and an ADAMTS13 assay requested.  CXR and ECG are performed. … Continue reading

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Case 7 – update 3

The blood film is reported by the haematology SpR and the comment states that “thrombocytopenia is confirmed on the blood film, with no evidence of platelet clumps.  The platelets seen appear normal in morphology.  There is evidence of haemolysis with RBC fragments … Continue reading

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Case 7 – update 2

Thrombocytopenia is a common feature in acute hospital admissions, The differential diagnosis is wide, with the most common causes being drug-related and sepsis.  It is important to rule out artefact and repeating the test is often appropriate although shouldn’t delay … Continue reading

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Case 7 – update 1

Some of the differentials so far Acute leukaemia HUS WAS (Wiskott–Aldrich syndrome) ITP Autoimmune condition e.g.lupus Viral e.g. hep B/C, HIV Luckily local measures have stopped the bleeding.  His obs are as follows BP: 110/80, pulse 105bpm, resp 20rpm, SpO2 … Continue reading

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Case 7 – the beginning

As the ENT SHO you take direct admissions from the Emergency Department’s triage nurse for anything ENT related.  You get a call about a 35 year old gentleman who has had on-and-off epistaxis for the past 24 hours and is … Continue reading

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