A 34-year-old Afro-Caribbean woman with HbSS sickle cell disease is admitted with a 24-hour history of fever, right upper quadrant pain and vomiting. Ultrasound confirms acute calculous cholecystitis, and the hepatobiliary surgical team plans an urgent laparoscopic cholecystectomy within the next 24 hours. Her medical history includes: Previous acute chest syndrome (ACS) requiring mechanical ventilation 2 years ago Pulmonary hypertension (estimated pulmonary artery systolic p

A 46-year-old man is referred to the haematology clinic with a 4-month history of progressive fatigue, drenching night sweats, weight loss, and generalized pruritus. He has recently developed cervical and axillary lymphadenopathy. Examination demonstrates generalized lymphadenopathy, moderate hepatosplenomegaly, and a widespread erythematous rash. Full blood count reveals: Hb: 102 g/L WBC: 58.4 × 10⁹/L Eosinophils: 18.6 × 10⁹/L Platelets: 118 × 10⁹/L Peripheral blood film sho

New Bispecific Antibody For Haemophilia A-Denecimig❤️

A 76-year-old woman presents with spontaneous extensive bruising, painful swelling of the right thigh, and persistent epistaxis. She has a history of rheumatoid arthritis and hypertension but no previous bleeding disorder. Examination reveals large ecchymoses over the limbs and a tense right thigh suggestive of an intramuscular haematoma. Initial laboratory investigations show: Test Result Hb 84 g/L Platelets 295 ×10⁹/L APTT 96 seconds (reference 24–36) Mixing study Fails to

A 30-year-old woman (G3P1+1) at 28 weeks' gestation is referred to the fetal medicine unit with severe fetal anaemia secondary to anti-D alloimmunisation. The fetal middle cerebral artery peak systolic velocity (MCA-PSV) is 1.8 MoM, and fetal blood sampling confirms a fetal haemoglobin of 55 g/L. An intrauterine transfusion (IUT) is planned. The consultant transfusion laboratory scientist prepares an irradiated, CMV-negative, HbS-negative, group O RhD-negative red cell unit w

Prevention, Diagnosis and Management of Acute Venous Thromboembolism (VTE) in Pregnancy❤️

A 33-year-old woman (G2P1) presents at 31 weeks' gestation with a 12-hour history of sudden onset pleuritic chest pain, progressive dyspnoea and mild haemoptysis. She has no fever or productive cough. Her obstetric history is significant for an unprovoked proximal deep vein thrombosis (DVT) 4 years previously. She was treated with warfarin for 12 months before discontinuation. During this pregnancy she has been receiving prophylactic enoxaparin 40 mg once daily from booking b

Argatroban Infusion Recommendations

A 72-year-old man is admitted with septic shock complicated by acute kidney injury. Five days after receiving unfractionated heparin, his platelet count falls from 290 × 10⁹/L to 68 × 10⁹/L, and he develops a new femoral vein thrombosis. The 4Ts score is 7, and argatroban is commenced while awaiting immunological confirmation of heparin-induced thrombocytopenia (HIT). His weight is 90 kg, and he has Child-Pugh B cirrhosis. Baseline coagulation tests are normal. Argatroban is

G6PD Testing

A 29-year-old Pakistani woman with β-thalassaemia intermedia is reviewed in the haemoglobinopathy clinic. She has never required a regular transfusion programme but has received occasional red cell transfusions during pregnancy and severe infections. Over the past year, she reports worsening fatigue and reduced exercise tolerance. On examination, she has frontal bossing, hepatomegaly (4 cm), and splenomegaly (7 cm). Her investigations show: Hb: 73 g/L MCV: 57 fL Reticulocyte

IVIG For ITP

A 62-year-old man is admitted with epistaxis, haematuria and widespread purpura. He has chronic ITP and has been receiving prednisolone for the last 5 days without response. His platelet count is 3 × 10⁹/L. CT brain is normal. He is scheduled for urgent endoscopy because of suspected upper gastrointestinal bleeding. The consultant decides to administer IVIG. Which ONE of the following statements regarding IVIG is MOST CORRECT? A. If the platelet count remains below 50 × 10⁹/L

A 64-year-old woman is admitted for right hemicolectomy for a newly diagnosed caecal adenocarcinoma. Two weeks earlier, she developed a symptomatic proximal left femoral deep vein thrombosis (DVT), confirmed on compression ultrasonography. She was commenced on therapeutic LMWH and has remained clinically stable. The colorectal surgeon plans surgery in 2 days' time and advises that therapeutic anticoagulation will need to be discontinued 24 hours before surgery because of the

Updated Algorithm of Multiple Myeloma-Current UK Practice.

Latest updates about Plasma Cell Leukaemia. Link: https://doi.org/10.1182/blood.2025032145

A 62-year-old man is admitted to the intensive care unit with severe community-acquired pneumonia complicated by septic shock. He required vasopressor support and invasive mechanical ventilation for 9 days. His shock has resolved, inflammatory markers are improving, and renal function is normal. Sedation has been discontinued and the intensive care team plans spontaneous breathing trials to facilitate extubation. His observations are: Temperature 36.8°C Heart rate 88 bpm Labo

A 22-year-old woman with Glanzmann thrombasthenia experiences recurrent spontaneous epistaxis and menorrhagia despite tranexamic acid. She has developed anti-GPIIb/IIIa antibodies following multiple platelet transfusions, making future platelet transfusions less effective. She is enrolled in the HMB-001 Phase 1/2 trial investigating a novel prophylactic therapy. Which ONE of the following best describes the mechanism of action of HMB-001? A. It binds activated factor X and th

A 46-year-old man with end-stage renal disease undergoes a living-donor kidney transplant. The donor is group O RhD positive, while the recipient is group A RhD positive. Immunosuppression consists of tacrolimus, mycophenolate mofetil and prednisolone. On day 10 post-transplant, he develops worsening jaundice, dark urine and fatigue. Investigations: Hb: 58 g/L (pre-transplant 108 g/L) LDH: 1680 U/L DAT: Strongly positive (IgG only) Blood film: Marked spherocytosis. Despite re