Teamhaem

Teamhaem Online education and discussion about all things Haematological. Discussion via https://twitter.com/teamhaem

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Teamhaem is a new project aimed at developing medical education via social media, with a particular focus on Haematology. We hope to produce material suitable for medical students, junior doctors, nurse specialists, biomedical scientists and non-specialist doctors, as well as Haematologists. Cases will be selected for the relevance to numerous specialities and we would encourage healthy dialogue between disciplines! We are a collective of Haematologists based in the Northern Deanery (England), but as this project expands we would welcome input from across the country, or indeed the world. If you have any ideas for cases that would be good discussion fodder please post your email address on the comments page and we will get in touch with you. Similarly any comments on how to improve this project are welcome. And most of all, please join in and spread the word!

This child underwent an allogenic stem cell transplant. He had to be treated for his HLH initially. Part of it involved ...
27/11/2021

This child underwent an allogenic stem cell transplant. He had to be treated for his HLH initially. Part of it involved chemotherapy (FLA) as JMML was the underlying cause driving the HLH. He is now more than 100 days post his HSCT and doing well. The choice between 'watch and wait ' vs HSCT depends on the underlying genetic subgroup along with presence or absence of somatic and germline mutations....

This child underwent an allogenic stem cell transplant. He had to be treated for his HLH initially. Part of it involved chemotherapy (FLA) as JMML was the underlying cause driving the HLH. He is no…

So , the diagnosis is JMML - Juvenile myelomonocytic leukemia. We will have a summary later but just a few brief points ...
25/11/2021

So , the diagnosis is JMML - Juvenile myelomonocytic leukemia. We will have a summary later but just a few brief points to note : JMML is unique aggressive myeloproliferative/myelodysplastic disorder of infancy and early childhood caused by proliferation of cells of monocytic and granulocytic lineage. Median age of onset is 2 years of age. Children typically present with fever , splenomegaly thrombocytopenia , high WBC count and monocytosis....

So , the diagnosis is JMML – Juvenile myelomonocytic leukemia. We will have a summary later but just a few brief points to note : JMML is unique aggressive myeloproliferative/myelodysplastic …

Going forward , we test and rule out other underlying problems : Genetic mutation for primary HLH is negative Workup for...
24/11/2021

Going forward , we test and rule out other underlying problems : Genetic mutation for primary HLH is negative Workup for organic acidemias and inborn errors are negative Extended viral panel and AFB does not help There is no evidence of double negative T cells Workup for immune deficiency is negative Meanwhile Ferritin continues to rise and there is ongoing monocytosis with cytopenias....

Going forward , we test and rule out other underlying problems : Genetic mutation for primary HLH is negativeWorkup for organic acidemias and inborn errors are negativeExtended viral panel and AFB …

Thanks a lot for your responses. Fevers continue despite good antibiotic cover. All cultures are sterile. Lymphadenopath...
23/11/2021

Thanks a lot for your responses. Fevers continue despite good antibiotic cover. All cultures are sterile. Lymphadenopathy persists and he has ongoing splenomegaly. Peripheral blood is sent for flow cytometry. There is only 1% of CD 45 weak population positive for CD 34 , HLA-DR and CD 117. Other markers are negative. CD14 positive monocytes comprise 72% of the nucleated population....

Thanks a lot for your responses. Fevers continue despite good antibiotic cover. All cultures are sterile. Lymphadenopathy persists and he has ongoing splenomegaly. Peripheral blood is sent for flow…

It is a friday afternoon and as the haematology registrar who has had a busy on call, the weekend looks quite inviting. ...
22/11/2021

It is a friday afternoon and as the haematology registrar who has had a busy on call, the weekend looks quite inviting. The phone rings and it is the Paediatric SHO. There is a 7 month old boy who has presented to the A & E. He has been irritable for the past week and has not been feeding well. He also has been reviewed by the GP for fever....

It is a friday afternoon and as the haematology registrar who has had a busy on call, the weekend looks quite inviting. The phone rings and it is the Paediatric SHO. There is a 7 month old boy who …

This week we discussed the case of a young lady with eosinophilia. She had some vague symptoms to begin with, but after ...
12/11/2021

This week we discussed the case of a young lady with eosinophilia. She had some vague symptoms to begin with, but after thorough investigation, she was found to have disseminated strongyloidiasis complicated by E. coli bacteraemia. She was immunosuppressed due to a new diagnosis of HIV infection. Strongyloidiasis is a tropical parasitic disease usually caused by the nematode Strongyloides stercoralis. This can be found in South America, South/Southeast Asia and Africa....

This week we discussed the case of a young lady with eosinophilia. She had some vague symptoms to begin with, but after thorough investigation, she was found to have disseminated strongyloidiasis c…

Stool examination (wet mount) reveals a filariform larva of Strongyloides stercoralis - thus making the diagnosis dissem...
12/11/2021

Stool examination (wet mount) reveals a filariform larva of Strongyloides stercoralis - thus making the diagnosis disseminated strongyloidiasis secondary to HIV infection. She is commenced on ivermectin and starts to improve. She has also been referred to the infectious diseases team to commence antiretroviral therapy. Well done team!

Stool examination (wet mount) reveals a filariform larva of Strongyloides stercoralis – thus making the diagnosis disseminated strongyloidiasis secondary to HIV infection. She is commenced on…

You receive a phone call from a very excited microbiologist, saying they've found something in this lady's stools! See i...
11/11/2021

You receive a phone call from a very excited microbiologist, saying they've found something in this lady's stools! See image below What is this and how would you treat it?

You receive a phone call from a very excited microbiologist, saying they’ve found something in this lady’s stools! See image below What is this and how would you treat it?

Our patient's seizure was short lived and self-terminated. Her blood cultures grow E. coli. CT head is clear. She underg...
10/11/2021

Our patient's seizure was short lived and self-terminated. Her blood cultures grow E. coli. CT head is clear. She undergoes a lumbar puncture and the microbiology lab are able to see Gram negative bacilli in her CSF. She is commenced on appropriate antibiotics. After 48h she has not had any further seizures but remains pyrexial, now with profuse diarrhoea and an eosinophil count of 19 x10^9/L....

Our patient’s seizure was short lived and self-terminated. Her blood cultures grow E. coli. CT head is clear. She undergoes a lumbar puncture and the microbiology lab are able to see Gram neg…

Our patient has been admitted for further investigations. You feel she does not require urgent steroid therapy at this p...
09/11/2021

Our patient has been admitted for further investigations. You feel she does not require urgent steroid therapy at this point. You have arranged for peripheral blood cytogenetics looking for common mutations associated with primary eosinophilia. You also organise a vasculitis screen, HBV/HCV/HIV testing, stool culture, and an echo - results in progress. She undergoes a CT CAP which shows widespread low volume lymphadenopathy above and below the diaphragm....

Our patient has been admitted for further investigations. You feel she does not require urgent steroid therapy at this point. You have arranged for peripheral blood cytogenetics looking for common …

You advise the GP to refer to the haematology clinic in view of her eosinophilia and unexplained weight loss. When you s...
08/11/2021

You advise the GP to refer to the haematology clinic in view of her eosinophilia and unexplained weight loss. When you see her clinic after about 4 weeks, she looks unwell. She tells you she has lost about 3kg in weight since she saw her GP. She is now experiencing significant diarrhoea and has developed a red itchy rash on her chest and thighs....

You advise the GP to refer to the haematology clinic in view of her eosinophilia and unexplained weight loss. When you see her clinic after about 4 weeks, she looks unwell. She tells you she has lo…

A 29 year old lady sees her GP due to feeling generally unwell. She thinks she has lost some weight over the last few we...
07/11/2021

A 29 year old lady sees her GP due to feeling generally unwell. She thinks she has lost some weight over the last few weeks, and has also had cold type symptoms during that time (sore throat, runny nose, fatigue). She has asthma for which she takes inhalers, but otherwise is fit and well. She works as a shop assistant and smokes 10 ci******es daily....

A 29 year old lady sees her GP due to feeling generally unwell. She thinks she has lost some weight over the last few weeks, and has also had cold type symptoms during that time (sore throat, runny…

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