A 65-year-old woman with a medical history of diabetes mellitus, essential hypertension, and ischaemic heart disease with a previous myocardial infarction presents with a platelet count of 700 × 109/L (150-400). A bone marrow biopsy reveals an increase in megakaryocytes with lobulated nuclei and abnormal localization, and a positive JAK-2 mutation is detected. What is the appropriate course of action for managing essential thrombocythemia in this patient?
A 29-year-old Afro-Caribbean male presents with a sudden onset of left-sided weakness that has been ongoing for two hours. He denies any sensory involvement, dysarthria, or dysphasia. The patient has a history of sickle cell disease and has experienced two previous episodes of transient ischemic attacks and an acute chest syndrome attack ten days ago. On examination, the patient displays 1/5 power in his left arm, 2/5 in his left leg, and 5/5 in his right side. He reports no sensory disturbances, and his plantar responses are downgoing bilaterally. The patient is unable to perform finger-nose testing. He denies any illicit drug use, is a non-smoker, and does not drink alcohol. The patient has no other past medical history. A hyperacute CT head reveals an area of acute ischemia in the right internal capsule region. What is the most appropriate immediate treatment?
A 55-year-old man presents with the following blood results: haemoglobin 53 g/L (130-180), WBC 250 ×109/L (4-11), and platelet count 25 ×109/L (150-400). He is diagnosed with acute myeloid leukaemia and started on chemotherapy with daunorubicin and cytarabine. On day five, he develops a fever of 39°C, tachycardia of 130 bpm, and blood pressure of 80/45 mmHg. What is the most appropriate treatment for his condition?
A 30-year-old female is involved in a car accident and sustains multiple injuries including fractures of her pelvis, right femur, and left humerus. She undergoes surgery immediately, but experiences life-threatening bleeding during and after the procedure. In total, she receives 24 units of red cells, 6 units of platelets, and 16 units of fresh frozen plasma. Her recovery is difficult, with complications both in the ICU and on the general ward.
Five days after surgery, you are called to see the patient. She is currently receiving a blood transfusion and has developed a fever 45 minutes after starting a unit of red cells. Her temperature is 38.2°C, blood pressure is 110/70 mmHg, and heart rate is 98 bpm. The transfusion is stopped and the patient’s identity and the unit of blood are checked, but everything appears to be correct. The hospital’s transfusion team initiates an investigation into the reaction, and the patient is closely monitored. Fortunately, she remains stable over the next 24 hours and her temperature returns to normal soon after stopping the transfusion.
Further investigation reveals that the patient is blood group A rhesus D negative, and the unit of blood being transfused during the reaction was the correct group and cross match compatible. However, it is discovered that the patient received 2 units of rhesus D positive platelets during her emergency surgery and subsequent bleeding.
What course of action do you recommend at this point?
A 67-year-old male has been diagnosed with chronic lymphocytic leukemia. Before beginning chemotherapy with fludarabine, what antimicrobial prophylaxis should be administered?
As a haematologist, you have been referred a 71-year-old man by the general surgeons. He has been experiencing weight loss and a change in bowel habit for the past two months. A CT scan showed mesenteric lymphadenopathy, with the largest lymph node measuring 4 cm in diameter. The biopsy report of the lymph node reveals a lack of mantle zone and a predominant population of centrocytes with few tangible body macrophages. Immunohistochemistry confirms strong positivity for CD20, CD70a, CD10, BCL2, and BCL6. The proliferation index (Ki-67) is low, no more than 20%. What is the most likely diagnosis?
A 19-year-old female patient visits the haematology clinic with complaints of spontaneous bruising, heavy menstrual bleeding, and recurrent nosebleeds. She has been experiencing these symptoms continuously since her teenage years, but recently received an iron transfusion due to anaemia which prompted further investigation.
During the examination, the patient appears alert and in good health. Multiple purpura are observed on both arms, and the patient denies any trauma or itchiness.
The following test results were obtained:
– Hb: 98 g/l
– Platelets: 314 * 109/l
– WBC: 5.6 * 109/l
– PT: 13.8
– APTT: 34.3
– PFA-100 assay: prolonged closure time
– Flow cytometry: GPIIb/IIIa negative
– Ristocetin-induced platelet aggregation: normal agglutination
What is the most likely diagnosis for this patient?
A 35-year-old male presents with a rash and low-grade fever (37.6°C) three weeks after receiving an allogeneic bone marrow transplant for high-risk acute myeloid leukemia in first complete remission. Initially, the rash is maculopapular and affects his palms and soles. However, after 24 hours, general erythroderma is noted on his trunk and limbs. Although his total bilirubin was previously normal, it is now 40 µmol/L (1-22). Despite these symptoms, he remains in good health. What would be the appropriate management for this patient at this stage?
A 50-year-old woman is being evaluated before undergoing a hysterectomy and oophorectomy. She has no family history of bleeding or thrombosis, and has not experienced any post-traumatic or post-surgical bleeding (although she has had an appendicectomy and tonsillectomy in the past). Additionally, she is not taking any anti-thrombotic or anticoagulant medication. What is the appropriate method for assessing her risk of bleeding prior to surgery?
Is there a current trend of excessive thrombophilia testing in various situations where it has been proven unnecessary?
At what age should clinicians consider screening for thrombophilia in specific clinical scenarios?