A previously well and fit 50 years old gentleman presented to hospital emergency department with sudden onset visual loss and headache His evaluation in Emergency revealed: BP 178/100 Rest of the systemic examinations: NAD Fundoscopy: bilateral optic disc oedema Noted: Ophthalmology review 2 months ago: Bilateral retinal vein occlusion: managed with Bevacizumab injections and local measures NO other macro-vascular risk factors advised to refer to haematology for routine evaluation to exclude any pro-thrombotic conditions Blood test: FBC UES LFT, Bones profiles: all Normal Liver function test: Raised Total protein : Serum Globulin 107 very high Serum proten electrophoresis: Confirmed paraprotein 68 g Whole body CT and PET CT: Mild adenopathy, mild spleneic enlargement: Due vile uptake 5 Bone marrow confirmed: Lymphoplasmocytic cells : CD19, CD20, CD38, CD138 cyto kappa restricted plasma cells , SmIgs restriction on B cells patient under went emergency plasmapheresis 2.5 volumes MDT: Approves : Bendamaustine and Rituxamab chemotherapy: Cycle 1 only Benamustine without Rituximab as risk of paraprotein flares and risk of hyperviscosity Rare presentaion of LPC/WM low grade NHL Plasmapheresis is life saving Could have been diagnosed earlier during ophthalmology/AE presentation if full liver profiles are done, which would have prompted to do serum protein electrophoresis as reflex testing by the laboratory   Dr Amin Isma FRCP FRCPath UK

VTE and VTE prophylaxis Septmber 2020 20