[embeddoc url=”http://janaanhealth.org/wp-content/uploads/2021/01/CPC-December-2020-BSH.pdf” width=”100%” download=”all” viewer=”google” CPC December 2020 BSH
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
a young patient was anesthetized for emergency evacuation of retain product of conception, lab called to say she has a non specific antibody and needs 3 more tube bloods for detail antibody detection in national blood services as per protocols what would be your approach in such situation: what is the blood group of the patient ?: A Rh D positive so haemolytic disease of new born is not a problem in future How likely she will be needing blood transfusion? in other word expected blood loss?: very unlikely. in that case go ahead with the surgery and try to avoid blood transfusion. discuss with 24/7 on call haematologist in case she need transfusion In emergency what types of blood should be selected: O positive in this patient as she is A Rh D positive what are the risk to mother if she receives O positive bloods : She might have developed delayed haemolytic transfusion reaction if developed specific antibodies In Emergency there are always help available either locally or nationally from NHS blood and transplant for any blood transfusion issues For more reading please visit NHS blood and transplant web page and contact haematologist in your area/hospital Dr Amin Islam FRCP FRCPath London
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