“Changing landscapes of Myeloma Treatments And The Role of Haematopoietic Stem Cells Transplantations, In the era of Targeted and Immunotherapy”
BICC 2019 DHAKA updated
HaematoConBD November 2019, Dhaka, Bangladesh
Download This File [4.62 MB]
Abdominal pain and a Blood film
78 years old lady went to see her GP with increasing headache, initial management with reassurance and pain control flailed to control her diffuse moderate headache prompted her GP to check her bloods All the other systems examinations were unremarkable BLOOD TESTS HB 120 WCC560 PLT 430 Norma (N 150-450) Basophilia and eosinophilia noted mainly neutrophils and myelocytes on film Her biochemistry all are within normal range Bloods film Reviewing the Film by consultant haematologist suggested the diagnosis of chronic myeloid leukaemia in chronic phase She was brought in to the hospital and had emergency assessment and investigations including bone marrow test A final diagnosis of CML (Chronic myeloid leukaemia) in chronic phase were made and she was commenced on Hydroxycarbamide and Imatinb with allopurionl Learning pint CML is a curable condition prompt assessment is necessary to exclude high count bloods for Hyperleckocytsosis and also to exclude Acute leukaemia Prompt discussion with consultant haematologist is they key for the management of this patients group
Cold agglutinin disease
80 years old lady was admitted via emergency department with increasing shortness of breath and cold fingers. she has no past medical history. Not on any medication Evaluation in the emergency department revealed only acrocyanosis . Her saturation were unobtainable via pulse oxymetry. System examinations were unremarkable emergency blood test are as below CHAD Film HB 43 MCV 127 (Significantly raised- normal range 82-95 ) WCC 12 , Neutrophils 7, Lymphocytes 5, CRP 100. Bilirubin 45, Creatinine 100 LDH 1200 Raised (Normal range 120-450) CXR : NAD Blood film examination showed roulaux formation http://janaanhealth.org/wp-content/uploads/2019/01/CHAD-Film.pptx Haematology team were contacted Direct antiglobulin test IGM +4 CD3d positive A diagnosis of Cold agglutinin disease were made CHAD Mainly idiopathic underlying LPD or rarely viral /bacterial infection usually refractory to Steroids unlike Warm autoimmune haemolytic anaemia Management look for underlying cause cold avoidance trial of prednisolone 1mg/kg may need CD20 antibody Rituximab or treat in underlying LPD Full antibody test at NHS BT Virology Folic acid life long 5mg po od there are case report of success with Eculizumab and Valcade in refractory disease under clinical trial
Acute Myeloid leukaemia with leuckostasis-A medical emergency
AML Blood film 64 years old lady presented to emergency department with history of coffee ground vomiting and being unwell. She had emergency resuscitation and appeared to be unwell . her vital signs were all stable apart from Pyrexia of 38.4 C. Blood pressure : normal Examinations were all unremarkable apart from bibasal crackles on both lower bases Her urgent blood test results were HB 64 WCC 360 PLT 172 CRP 389 high Uresa : 10, Creatinine : 98 (upper limit of normal) Full clotting screen : all Normal She was transferred to a ward and a haematologist on call were contacted she had emergency blood film as per Laboratory criteria which were looked at by biomedical scientist: suggested Acute myeloid leukaemia with over 90% myeloid blast initial management: 1,DO NOT TRANSFUSE 2,Patient is at risk of Leuckostasis 3,Exclude APML (Auer rods on film) 4,Full clotting screen (This patient has risk of DIC) Emergency transfer to the tertiary facility where emergency leukopheresis can be done Phone haematology consultant is the most important point of this patient care and should take emergency steps
A heart breaking experience
A heart breaking experience and few learning points to share 26th October 2016 Village: Teka Mudra, Athasohn, 7 miles from Fenchugonj, Sylhet, Bangladesh We arrived around 10 am by a 7 sitter from Sylhet town. This is not the first time I have visited this village. 2 patients I intended to see. I was greeted by crowds of villagers who were waiting to receive us from the road. Soon after I finished seeing my second patient, a small child was brought in by her father asking me to give some advice and treatment. The father started saying that the child was being unwell for 4 days with fever cough and reluctant to eat and drink. They showed me a prescription given by a quack 2 days ago who prescribe paracetamol and anti-histamine syrups. On inspection and basic examination I realized that this baby had possibly bad pneumonia with already signs of early respiratory arrest, the child becoming listless and exhausted, was floppy. I spent not a moment advising them to take her to nearest hospital which is 7 mile away from the village. The baby was rushed to nearest hospital by a motor bike where attending doctors declared her dead. While I was still in the village examining my next patient who has possible cerebral palsy I was given the sad news. The whole family and the whole community became stand still; everyone started crying, it was a very painful moment of life. There are many factors why this […]
CLL IPI score
CLL IPI score can predict long term outcome for asymptomatic patient depending on their risk score low, intermediate or high there is a 30 % chance asymptomatic patients will never need treatment for CLL there are only phase 1 clinical trial available if patients are willing to participate in UK
Shaon 2 years 5 months
14th February 2018: shaons journey to National Heart foundation Dhaka, Bangladesh Underwent complex 8 hours Cardiac surgery under Professor Abul Kalam Shamsuddin ( many thanks to his kindness and great empathy) After 10 Days stay in NICU ventilated and successfully extubated discharged home with uneventful recovery on 12th March 2018 with 4 weeks follow up appointment This is an example how screening, counselling, and on going support can save human life little shaons Bravery is an example how we can overcome lots of social stigma and shed some light and hope his parents smiley face and joy will be remaining in this world for the days and years to come in sha Allah Thank you Dr Shamsuddin and Dr Helal Uddin for your kind cooperation and great skills Amin islam London 29th April 2018