Basics to Brilliance: Haematology Podcast
Welcome to Basics to Brilliance, the podcast created to supplement & bolster your knowledge of Haematology.Featuring a two way, non-didactic conversational-style Q&A between the SpR and SHO, this podcast will be your pocket companion no matter where you are.We aim to cover: - Malignant and non-malignant topics- Science/lab detail- UK guidelines, hallmark trials and how these translate into clinical practice- Future research directions- The whole syllabus for FRCPath part 1All readily accessible and completely free of charge!For every budding haematologist out there, we hope this podcast aids you in your endeavours and fills you with interest a...
Inhibitors in Haemostasis
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00:52 Intro: definition and prompts
04:25 Intro to Case 1: Haemophilia B, 3rd dose of Venefix, Anaphylaxis
06:03 Intro to Case 2: Severe Haemophilia A, joint bleed, non-responsive to emergency Factor VIII
07:30 Initial screening tests
NB: Inhibitors: Time Dependent vs. Immediate Acting14:54 Flash examples of Mixing Study importance
16:35 Bethesda Assay
**Bethesda Studios made the Elder Scrolls and Fallout games: they Inhibit Haider from doing any work**
28:45 Bethesda Assay Summary
30:00 Nijmegen Modification of Bethesda Assay
34:30 Heat Treatment of Bethesda Assay
36:25 ELISA Assay
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Heparin & the Anti-Xa Assay
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00:52 Intro (shoutuout to the BSH anticoagulant monitoring guidelines)
02:15 Practical relevance of testing and monitoring anticoagulants
07:30 Heparin: The Basics
09:00 Unfractionated Heparin vs. Low Molecular Weight Heparin
10:24 Mechanism of action of Heparin (UfH vs. LMWH)
LMWH: more Anti-Xa activityUfH Anti-IIa acitivity = Anti-Xa activity15:30 Pharmacokinetic differences (UfH vs. LMWH)
23:28 Unfractionated Heparin uses and monitoring
34:34 Anti Xa Assay
42:32 Activated Clotting Time (POCT)
46:56 Anti Xa in LMWH: Practical considerations
52:03 LMWH uses and dosing
55:30 Summary
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Thrombin Time & Fibrinogen Assays
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00:54 Intro and table of contents
1:48 Case 1: pre-op, prolonged PT and ++ prolonged APTT…thrombin time done
03:44 Case 2: post-op, normal PT and prolonged APTT…thrombin time done
04:46 Thrombin Time definition and ingredients (its all about the fibrinogen!)
10:45 Differentiating causes of prolonged thrombin time- protamine, reptilase, ecarin
17:24 Case 3: Major Haemorrhage (Variceal), due OGD, Derived PT Fibrinogen normal
20:45 Clauss Fibrinogen- methodology, causes of change and treatment of deranged fibrinogen
30:09 Derived PT Fibringoen
31:20 ELISA, TEG and ROTEM (brief)
33:07 Summary
36:56 David’s request...
Mixing Studies & Factor Assays
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0:52 Intro and table of contents
2:36 CASE 1- Infection, due surgery and a prolonged APTT ft. a refresher on APTT prolongation
08:00 Mixing studies- definition and uses ft. Hari’s exam nugget
17:00 Factor assays (1 stage, 2 stage and chromogenic assays) ft. David’s humorous humility
43:30 David applies his new-found knowledge to our first case
45:45 CASE 2- Infection, hx of weight loss and bleeding and a prolonged APTT
47:36 Summary
https://practical-haemostasis.com/Factor%20Assays/1_stage_pt_factor_assay.html
https://practical-haemostasis.com/Facto...
Mantle Cell Lymphoma
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'Basics to Brilliance: Haematology Podcast' has been accredited for CPD credit by the Royal College of Pathologists UK.
Medical professionals and clinical scientists holding career-grade positions, who are registered with any of the Royal Colleges for CPD, will be eligible to earn 1 credit for every hour of learning.
Email: basicstobrilliancehaem@gmail.com
Insta: BasicstoBrilliance
X: @basics_2_brill
Send us your feedback!
Practical Haemostasis of the Clotting Screen
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00:00 Intro
04:25 Automated Methods of Measuring a Clot
05:50 Scenario 1 & Pre-Analytical Variables
11:50 HIL Index & Patient Factors
15:55 Blood Tube Basics
21:10 Nitty Gritties- What Happens When We Send a PT?
23:20 PT vs INR for Warfarin- Going Down The Rabbit Hole...
26:35 Heparin Neutralising Buffer
29:00 APTT
33:05 Summary (& an honorable mention)
'Basics to Brilliance: Haematology Podcast' has been accredited for CPD credit by the Royal College of Pathologists UK.
Medical professionals and clinical scientists holding c...
The Clotting Screen: Back to Basics
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0:00 Intro
2:45 What is Haemostasis?
3:55 Stages of Haemostasis (summary)
4:45 Primary Haemostasis
8:35 Secondary Haemostasis
11:10 The Clotting Cascade
12:20 Common + Extrinsic Pathway
13:50 Intrinsic Pathway (TwelvEleveNinEight)
14:25 Clotting Tests
16:30 Hari Pops The Bubble
18:05 In-Vivo vs. In-Vitro
22:20 Isolated PT Prolongation- causes
25:46 Isolated APTT Prolongation- causes
27:43 Paired PT/APTT Prolongation- causes
28:50 Best Test for Bleeeding (David makes Hari proud)
30:24 Bleeding History Pearls and Questionnaires
33:55 When The PT/APTT Screen Doesn't Work
Essential Thrombocythemia (ET)
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'Basics to Brilliance: Haematology Podcast' has been accredited for CPD credit by the Royal College of Pathologists UK.
Medical professionals and clinical scientists holding career-grade positions, who are registered with any of the Royal Colleges for CPD, will be eligible to earn 1 credit for every hour of learning.
Email: basicstobrilliancehaem@gmail.com
Insta: BasicstoBrilliance
X: @basics_2_brill
Send us your feedback!
Immune Thrombocytopenia (ITP)
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'Basics to Brilliance: Haematology Podcast' has been accredited for CPD credit by the Royal College of Pathologists UK.
Medical professionals and clinical scientists holding career-grade positions, who are registered with any of the Royal Colleges for CPD, will be eligible to earn 1 credit for every hour of learning.
Email: basicstobrilliancehaem@gmail.com
Insta: BasicstoBrilliance
X: @basics_2_brill
Send us your feedback!
Heparin Induced Thrombocytopenia (HIT)
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'Basics to Brilliance: Haematology Podcast' has been accredited for CPD credit by the Royal College of Pathologists UK.
Medical professionals and clinical scientists holding career-grade positions, who are registered with any of the Royal Colleges for CPD, will be eligible to earn 1 credit for every hour of learning.
Email: basicstobrilliancehaem@gmail.com
Insta: BasicstoBrilliance
X: @basics_2_brill
Send us your feedback!
Polycythemia Rubra Vera (PRV)
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Polycythaemia- red cell #
Erythrocytosis – in red cell mass
Absolute Erythrocytosis
- M: Hct >0.60 or >0.52 + RCM >25% of mean
- F: Hct >0.56 or >0.48 + RCM >25% of mean
Apparent Erythrocytosis
- Men: Hct >0.52 + normal RCM
- Women: Hct >0.48 + normal RCM
Relative erythrocytosis
-Normal RCM + Reduced plasma volume (pathological dehydration)
M>F
Median >60yo
2' PRV: treat underlying cause +/- venesection (higher hct threshold)
Classification of Absolute:
EPO dependent
Secondary CNS Lymphoma
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- Synchronous CNS and systemic lymphoma at initial presentation (treatment-naïve; TN-SCNSL)
- CNS relapse without recurrent systemic lymphoma (relapsed isolated CNS lymphoma; RI-SCNSL)
- Relapsed concomitant systemic and CNS disease following treatment for systemic lymphoma (RC-SCNSL)
Generally hybrid disease
Investigations
- MRI Head w gadolinium
- PET-CT
- Testicular US (blood testes barrier influences treatment)
- Opthalmoscopy/fundoscopy +/- Vitreal biopsy +/- subretinal aspirate – could need RT
- Lymph node Biopsy
NB: Worthwhile to remember patient hx re relapses<...
Primary CNS Lymphoma
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CNS Lymphomas
1% of all NHL
3% of all Brain tumours
Most common subtype (90%) is DLBCL
Clinical division:
1. 1* CNS lymphoma,
2. 2* CNS lymphoma
- TN-SCNSL
- RI-SCNSL
- RC-SCNSL
3. Immune deficiency assoc- HIV; better prog.
Presentation:
- SOL Sx
- Raised ICP: morning headaches w N+V
- Neuropsych, Behavioural, Memory, Language
- Focal motor + Stroke Sx
- Seizures
- Visual Sx and uveitis
Investigations:
- FBC + Blood film (exclude 2* CNS lymphoma and BM), G...
Chronic Monomyelocytic Leukemia (CMML)
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Chronic MyeloMonocytic Leukemia (not CML)
Persistently high monocyte count- 3 months
Most frequent MDS/Myeloproliferative neoplasms – a cross between the two
Median age 72
Median survival 20-40 months
Transformation to AML (15-30%)
WHO definition of CMML:
1. Excess monocytes- persistent over 3 months, ≥ 1
- Monocytes 10% of total WC count
2. Dysplasia: morphological difference (blood film on BMBx)
OR
3. Genetic abnormalites ( on cytogenetics or molecular)
WHO Addition in 2022:
Persistent 3 months Monocytes ≥ 0.5 over 10% of WC count
AND Dysplasia
AND...
Chronic Lymphocytic Leukemia (CLL)
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Chronic Lymphocytic Leukemia (CLL)- Chronic Relapsing Remitting
Most common leukemia in adults
Incurable but treatable
*Remember Supportive Care*
Median age of 72
M > F
80% incidental
SLL: lymphocytes in lymph nodes and spleen instead of blood
Presentation:
1) Fatigue
2) B symptoms
3) High WC
4) Cytopenias (Marrow infiltrate, AIHA, ITP, Hyposplenism)
Rule out: Reactive (viral serology)- Hepatitis, HIV
Investigate:
1) FBC + blood film (mature lymphocytes) w/ trend
2) Haemolysis screen + Coombs test
3) B2 Microglobulin (prognostic marker)
...
