A 15-year-old boy of African-American descent is diagnosed with homozygous sickle cell anaemia. He presents with severe pain in his right hip that has been ongoing for two days. His haemoglobin level is 70 g/L, which is lower than his baseline of 76 g/L. An MRI of the hip shows no signs of osteomyelitis or avascular necrosis of the femoral head. What is the most suitable treatment option for this sickle cell crisis?
A 20-year-old woman presents with a 4-week history of fever, night sweats, and weight loss. On physical examination, she has hepatosplenomegaly. Her blood count reveals a WBC count of 130 ×109/L (4-11), a hemoglobin level of 68 g/L (115-165), and a platelet count of 21 ×109/L (150-400). A peripheral smear shows circulating blasts, which are confirmed to be B-ALL by flow cytometry immunophenotyping. Cytogenetics confirms positivity for BCR-ABL (Philadelphia chromosome). What is the most appropriate therapy to initiate at this point?
A 35-year-old man presents to the Emergency Department after being stung by a bee while gardening. He has a history of allergic reactions to bee stings and took a loratadine tablet earlier in the day. On examination, his BP is 100/70 mmHg and his heart rate is 80 bpm and regular. He is experiencing mild wheezing and has some swelling around the sting site. Oxygen saturations are measured to be 95%, with a FiO2 of 21% by nasal cannula.
He is treated with further intramuscular adrenaline and shows some mild improvement. However, within 20 minutes, his repeat BP is 90/50 mmHg, heart rate 120 bpm, respiratory rate 30 breaths per minute and oxygen saturations 92% on 60% FiO2.
What is the most appropriate next step in managing this patient?
A 27-year-old woman who had previously been treated for nodular sclerosing Hodgkin lymphoma and had been in remission for nine months after undergoing six cycles of ABVD chemotherapy, presents with a dry cough that has persisted for a month. A chest radiograph reveals mediastinal widening, and a PET scan shows active thoracic disease. A biopsy of the mediastinal mass confirms nodular sclerosing Hodgkin. What is the best course of action for managing this patient?
A 70-year-old patient is on warfarin for a prosthetic mitral valve. After completing a 7-day course of oral azithromycin for a chest infection, he comes in for an international normalised ratio (INR) check. There is no evidence of increased bruising or bleeding from mucous membranes.
Investigations:
Investigation Result Normal value
Haemoglobin 130 g/l 135–175 g/l
White cell count (WCC) 6.8 × 109/l 4–11 × 109/l
Platelets 195 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l
Creatinine 120 µmol/l 50–120 µmol/l
International normalised ratio (INR) 6.5 0–1.1
What is the most appropriate course of action regarding his INR levels?
A 65-year-old female with a history of chronic lymphocytic leukaemia (CLL) presents with symptoms of a cold. Upon examination, there are no notable findings. Her blood test results are as follows:
10 months ago 4 months ago Today
Hemoglobin 115 g/l 110 g/l 108 g/l
White blood cell count 30.0 *10^9/l 48.0 *10^9/l 56.0 *10^9/l
Neutrophils 6.5 *10^9/l 4.5 *10^9/l 3.8 *10^9/l
Lymphocytes 23.0 *10^9/l 43.0 *10^9/l 52.0 *10^9/l
Platelets 365 *10^9/l 290 *10^9/l 275 *10^9/l
What is the most suitable treatment option?
An 80-year-old man presents to the haematology clinic with a diagnosis of chronic lymphocytic leukaemia made 8 months ago. He has been under surveillance monitoring and reports occasional fatigue but otherwise good health. However, he has been experiencing intermittent fevers and chills for the past week. On examination, he is febrile with mild tachycardia and palpable splenomegaly. His full blood count shows an increase in lymphocytes and a decrease in platelets compared to 6 months ago, with smudge cells seen on blood film. What is the indication to start treatment in this patient?
A 75-year-old woman with chronic lymphocytic leukaemia is being regularly reviewed in haematology clinic. She has lost 5% of her body weight in the last 9 months and reports occasional fatigue. She lives alone and is independent. On examination, there are two 0.5cm lymph nodes palpable in her neck, which were palpable at her previous appointment. Her recent blood tests show a decrease in platelets and an increase in white blood cells and lymphocytes. What patient-specific factor does this patient possess that warrants commencing treatment for her underlying malignancy?
A 28-year-old woman who is currently using a contraceptive pill requests sterilisation, as she is concerned about the risks of blood clots involved with the pill. Her 60-year-old maternal aunt developed deep vein thrombosis following a long-haul flight, for which she was anticoagulated. Her aunt went on to have subsequent screening of procoagulant tendencies and heterozygous factor V Leiden was identified. The patient’s mother has suffered no problems, having had two normal pregnancies and occasional leg swelling only.
What advice would be given to the patient?
A 27-year-old woman presented at 35 weeks of pregnancy with profuse vaginal bleeding. She had suffered two previous miscarriages.
She had a pulse of 95 beats per minute, blood pressure of 110/84 mmHg and no fetal heart sounds were audible.
Investigations revealed:
Haemoglobin 98 g/L (115 – 165)
Platelets 66 ×109/L (150 – 400)
Prothrombin time 21 sec (11.5-15.5)
APTT 52 sec (30-40)
Fibrinogen 0.5 g/L (2-4)
What is the most appropriate next step in management?