Basics To Brilliance: Haematology podcast

#Science #Biology #Basics To Brilliance #Fitness #Podcasting Education #Medicine

8:36

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Basics to Brilliance: Haematology Podcast

maison des série•Feed

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 1

All 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 and excitement for the brilliant world of Haematology.
Warmest Regards,
Dr. Everden
Dr. Fasey
Dr. Jafri
Disclaimer: This podcast is intended as a revision aid and should not be used for the medical management of patients. Guidelines in the initial episodes span 2023/2024. We aim to update our content in accordance with the most recent available guidelines when possible.

This podcast is CPD accredited by the Royal College of Pathologists UK

16 episodes

Basics to Brilliance: Haematology Podcast

updated il y a un an

maison des série•Feed

- Science/lab detail

- UK guidelines, hallmark trials and how these translate into clinical practice

- Future research directions

- The whole syllabus for FRCPath part 1

This podcast is CPD accredited by the Royal College of Pathologists UK

16 episodes

#Science #Biology #Basics To Brilliance #Fitness #Podcasting Education #Medicine

Tous les épisodes

Basics to Brilliance: Haematology Podcast

1
Factor XIII (13), Fibrinolysis & Thrombolysis 46:21

il y a 15 weeks46:21

46:21

Feedback 01:45 Case: Neonate with repeated umblical bleeding. IC haemorrhage. Normal Factors (so far), Normal VW screen, Normal FBC and normal film. 05:35 Factor XIII (13): function and presentations in deficiency 09:45 Testing, testing! ELISA/Ammonia Release Assay then a Mutational Analysis Honarable mention: Clot Solubility Assay 16:00 Fibrinolysis definition and pathway 21:00 Activators of Fibrinolysis: tPA vs. uPA 23:23 Inhibitors of Fibrinolysis: PAI-1, PAI-2, TAFI, α2-antiplasmin, and Factor XIII (13) 26:28 Thrombolysis: defintion, examples and uses 32:20 Case: Thromboembolic stroke, thrombolysis 24 hours prior, haemorrhagic transformation 36:19: Tranexamic Acid (Hari’s favourite drug) Honarable mention: Dr Utako Okamoto and the WOMAN trial CRASH 2 and CRASH 3 trials HALT-IT trial 41:22 D-Dimer 44:00 Summary ' 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!…

Basics to Brilliance: Haematology Podcast

1
Inhibitors in Haemostasis 1:03:02

il y a 20 weeks1:03:02

1:03:02

Feedback 00:52 Intro: definition and prompts 04:25 Intro to Case 1: Haemophilia B, 3rd dose of BeneFix 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 Acting 14:54 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 40:30 Auto vs Allo Antibodies 42:00 Kinetics of a Time Dependent Inhibtor 44:45 Case 1 results 45:50 Case 2 results 51:00 Case 3 (real-life scenario): young girl, subdural bleed after fall, deranged clotting found incidentally 59:30 Summary ' 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!…

Basics to Brilliance: Haematology Podcast

1
Heparin & the Anti-Xa Assay 59:29

il y a 22 weeks59:29

59:29

Feedback 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 activity UfH Anti-IIa acitivity = Anti-Xa activity 15:30 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 ' 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!…

Basics to Brilliance: Haematology Podcast

1
Thrombin Time & Fibrinogen Assays 38:08

il y a 23 weeks38:08

38:08

Feedback 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 (email us your questions!) ' 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!…

Basics to Brilliance: Haematology Podcast

1
Mixing Studies & Factor Assays 51:35

il y a 26 weeks51:35

51:35

Feedback 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/Factor%20Assays/chromogenic_factor_assays.html ' 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!…

Basics to Brilliance: Haematology Podcast

1
Mantle Cell Lymphoma 1:25:06

il y a 29 weeks1:25:06

1:25:06

Feedback ' 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!…

Basics to Brilliance: Haematology Podcast

1
Practical Haemostasis of the Clotting Screen 34:27

il y a 29 weeks34:27

34:27

Feedback 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 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!…

Basics to Brilliance: Haematology Podcast

1
The Clotting Screen: Back to Basics 45:19

il y a 30 weeks45:19

45:19

Feedback 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 37:25 NICE Guidelines Reference for Surgery 38:15 David's Scenarios 42:00 Summary ' 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!…

Basics to Brilliance: Haematology Podcast

1
Essential Thrombocythemia (ET) 1:11:45

il y a 32 weeks1:11:45

1:11:45

Basics to Brilliance: Haematology Podcast

1
Immune Thrombocytopenia (ITP) 1:18:24

il y a 33 weeks1:18:24

1:18:24

Basics to Brilliance: Haematology Podcast

1
Heparin Induced Thrombocytopenia (HIT) 1:00:26

il y a 33 weeks1:00:26

1:00:26

Basics to Brilliance: Haematology Podcast

1
Polycythemia Rubra Vera (PRV) 1:12:33

il y a 1 year1:12:33

1:12:33

Feedback 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 - Appropriate: High altitude, chronic hypoxia, localised hypoxia, congenital - Inappropriate: Tumors, EPO doping, Testosterone replacement, diabetic meds EPO independent: - Acquired: Primary PRV (low EPO level, feedback) - Congential Polycythemia= mutations in EPO receptors Inv: - Tumor Hunt - Hx + Exam: ?True vs. Apparent - FBC, U+E, LFTs, Ca2+ - Blood film - Ferritin: low in 1’ PRV - EPO - Imaging - NB: Normal Hct + High Red Cell # + Low MCV + Low ferritin –> Masked PRV - Molecular Testing: JAK2 (V617F)(96-97%)...SAMURAI JACK=BLOODY) EXXON 12 (3%) Del (13q), Del (20q), Del (1q), Tris. 8/9 - *SV thrombus 50% chance MPN - BMBx: Tri-lineage myeloid expansion - Familial screen for congenital(young) Sx of primary PRV: - Arterial*+ Venous clot (splanchnic*) - Hyperviscosity sx - Splenic sx - Gout Indications for urgent venesection ...Hyperviscosity sx BSH diagnostic: JAK2 Pos - Hct M >0.52, F > 0.48. Or RCM >25% above baseline OR Splanchnic vein thrombus - JAK2 positive JAK2 Neg= A1-4 + either ≥ 1 A or 2 B’s A1: Hct M >0.60, F > 0.56. Or RCM >25% above baseline A2: No JAK2 A3: No 2' cause A4: BMBx pos A5: Palpable splenomegaly A5: Acq. genetics in BM cells B’s: Plt >450, Neut >10 (>12.5 in smokers), Radiological splenomegaly, Low EPO Congenital testing Risk Stratification: - Thrombi.. ECLAP study High Risk:>65 + prev clots Low Risk: <65 + no prev clot - Malignant Transformation to MF (5-15% in 10 years), AML (2% at 10 year) markers: Splenomegaly, LDH, HVAF burden >50% at diagnosis Management: - Lifestyle...CV factors decrease - Aspirin +PPI for all (after confirmed)- decrease CV events 60% (ECLAP) - Venesection first line (?isovolemic)- sx*** CYTO-PV trial: Hct aim <0.45, make iron def. 400-450ml off Weekly -> 3-4x/year - If previous clots: Lifelong anticoag (w/out aspirin) - NB: if plt>1000 (acq. VWF) bleeding risk, 1st cytoreduce Cytoreduction : (once confirmed primary PRV) - High risk - Progressive Hepatosplenomegaly - Plts >1500 - WCC >15 - Constitutional Sx - Poor tolerance of venesection 1st line : (OHC then/or IFN) OHC - Risk: Macrocytosis, ulcers, SCC, Malignant transformation NB: pregnancy Peg IFN-A Young + fertile Lowers HVAF PROUD PV study (2020) Continuation PV study (2022) SE: flu like sx, AI disease (*thyro ' 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!…

Basics to Brilliance: Haematology Podcast

1
Secondary CNS Lymphoma 37:30

il y a 1 year37:30

37:30

Feedback - 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 - ?Stereotactic Brain Biopsy w/ Intraoperative rapid cytology and rv of frozen sections......NB: Steroids pre-biopsy may yield non-diagnostic results (1/3 if 7 days steroids) - Correlate with imaging and timescale - LP o Good for leptomeningeal (15%) which can be missed on MRI o CSF protein levels are prognostic o Flow cytometry o Cytospin o PCR for IGHV rearrangement: sens. Trial : MARIETTA study, or also known as the IE LSG 42 - Single arm prospective trial, 75 patients - +/- Steroid pre-phase –>MATRIX + RICE alternating induction x3–>CR/PR ->Carmustine-Thiotepa AutoSCT - Pre-morbid performance status <=3 - 2-year overall survival for all of those patients included in the trial just under 50% - NB: cytaribin omissions if poor performance status - RICE (Ritux isophosphamide, carboplatin and etoposide)…NB, peripheral neuropathy and neurotoxicitiy - TN-SCNSL best 70% 2 year PFS - RI-SCNSL 40% 2 year PFS... can also be given just MATRIX - RC-SCNSL 14% 2 year PFS - NB if frail elderly, change MATRIX to MARTA Response assessment : - TN-SCNSL and RC-SCNSL o Brain MRI +/- Spine every 2 cycles o PET scan every 2-3 cycles o PET and MRI pre-auto, determine least partial response o End of treatment PET (6-8 weeks post) and MRI - RI-SCNSL : MRI brain +/- spine every 2 cycles…PET only if suspicion of progression elsewhere Relapse post MARIETTA : -BTKi ?compassionate access vs Trial -ZUMA7 trial: CAR-T (anti CD19) NB : ICANS/CRS….Approved for DLBCL 12 relapse within 12 months and primary refractory disease that hasn’t responded - PALLIATIVE CARE NB Immuno-privileged sites : - Primary Intraocular Lymphoma : o Stage w PET, MRI head, US Testes o MATRIX vs MARTA vs PREMAINE as frailty allows (like 1’ CNS) –> AutoSCT o +/- Occular RT o Frail++ +-> Intravitreal MTX - Primary Testicular Lymphoma o If 1 testicle involved 1/3 of patients have the other involved too o US Testes –> Orchidectomy + histopathology…if lymphoma ->imaging and investigations as above o LP with above investigations as 1/3 have CNS involvement o ?skin lesions sometimes in testicular lymphoma o RCHOP vs RPolaChP + CNS prophylaxis w MTX o Radiotherapy (30gy) to contralateral testes to reduce contralateral Relapse risk and/or BL orchidectomy- fertility discussion o System ' 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!…

Basics to Brilliance: Haematology Podcast

1
Primary CNS Lymphoma 1:09:06

il y a 1 year1:09:06

1:09:06

Feedback 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), GFR, U&Es - LDH (prog.) - Virology (Hep+HIV) - IGs, SPEp (paraprotein) - Stereotactic Brain Bx w/ IO rapid cytology and rv of frozen sections NB: Steroids pre-biopsy ?non-diagnostic results - LP: .Leptomeningeal* .CSF protein- prognostic .Flow .Cytospin .PCR for IGHV r. - CT Head - MRI H (w gadolinium) +/- spine Staging: -R/O systemic lymphoma -PET/CT -US Testes -Opthalmoscopy/fundoscopy +/- Vitreal biopsy +/- subretinal aspirate -?BMBx Pre-treatment: -Baseline neuropsych + cognitive ax -Premorbid performance status: ECOG, Echo, GFR, PMHx Dx w/o Bx - MRI -Clinical features -Clonal B cells in CSF/Vitreous fluid and/or PCR IGHV rearrangement Treatment: Induction main: - MATRIX- younger <70 - MARTA- older >65 Consolidation: - Whole brain RT - BCNU Thiotepa AutoSCT- gold standard if fit...Within 6-8 weeks of the 1st day of final induction: consider for all patients with non-progressive disease (EOT MRI) Trials: IELSG32 study (Leukemia, 2022)- induction + consolidation choices for < 70 Induction: 3 arms, MTX + Cyt main - MATRIX- MTX +Cyt + Thiotepa + Ritux -> AutoSCT…..best choice (4 cycles)... 7yr 70% survival Consolidation: efficacy equal AutoSCT and WB-RT, favoured AutoSCT for Sx. ... MATRIX regimen available on NSSG: - Dose ++ to cross BBB - Folinic Acid rescue* - IVF till MTX levels <0.1 umol/L (1st lvl 48hrs after MTX) - EF >45% - GFR >50 NB: stop co-trimoxazole, penicillins, aspirin, NSAIDs, PPIs (inhibit MTX clearance) - MTX build up in 3rd spaces - Stem cell harvest post #2 - Treatment related mortality 4-7% mostly in #1 - Dose reduce Cytaribin (2/3instead of 4 cycles) if pre-morbid, 25-50% total MARTA study (Blood, Nov 22): fit for autosct and >65 - 2x MTX, cytarabin and rituximab ->AutoSCT PRIMAIN study(2017): not fit for autosct >= 65 1. 4x MTX, Ritux + PO procarbazine 2. 6mo of PO procarbazine as maintenance ?WB-RT for residual disease - Palliative if unfit and older: Dex Temozolomide WB-RT ?IT Chemo in leptomeningeal IELSG43 study … favoured AutoSCT PFS and OS to de-escalation consol. Follow Up: - Response Ax with contrast enhanced MRI scan: 1-2mo after consol. - Rpt MRI every 3-4mo for 2 years ++- - CR: MRI NAD, normal eye, clear CSF - Stable: <50% decrease, <25% increase - PR: 50% tumor reduction ?persistent CSF - ' 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!…

Basics to Brilliance: Haematology Podcast

1
Chronic Monomyelocytic Leukemia (CMML) 41:56

il y a 2 years41:56

41:56

Feedback 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 Genetic Abnormalities No single diagnostic test - Exclude MPNs: CML, MF, pre-fibrotic MF, PRV and ET - Exclude Genetics: PDFGR A and B, FGFR 1, JAK-2 rearrangement - Ensure less than 20% blasts Common Presentation: - Constitutional Sx - Cytopenias and sequelae - Effusions pericardial or pleural (inflammation and infiltration) - Skin deposits - Autoimmune disorders (higher incidence of CMML) Classification: - Myelodysplastic CMML - WC<13 o Cytopenias** - Myeloproliferative CMML – WC ≥ 13 o Activate RAS pathway mutations o Leukostasis**(*brain and lung*) o More adverse clinical outcomes o More splenomegaly and extra-medullary (infiltrative) PROGNOSTIC CLASSIFICATION: Blast Count - CMML-1: BMBx <10% blasts - CMML-2: BMBx <20% blasts OR Presence of Auer Rods (trumps blast %) OTHER: o CPSS-Mol: cytogenetics, "NARS”, blast count, WBC count, transfusion dependence Investigations - R/O infection - FBC and trend - Blood film - Flow of Peripheral blood (immunophenotyping): Chronic Panel o Classical Monocyte MO1: CD14 +ve and CD16 -ve - If >=94% MO1 on flow specific and sensitive for malignant - Can help differentiate reactive monocytes MO3 (CD14 weak +ve, CD16 +ve) -BMBx if appropriate as per age and fitness o Aspirate: Dysplasia, Excess monocytes o Flow: Acute panel (check blasts percentage) o Cytogenetics: - Poor cytogenetics: Trisomy 8, Chrom. 7 abnormalities, complex cytogenetics (3 or more cytogenetic abnormalities) -Good cytogenetics: Isolated loss of chromosome Y o Molecular: PCR in EDTA- “NARS”.....NRAS, ASXL1, RUNX1, SETBP1 Treatment decisions: - High risk (AML risk) + Tx eligible -> Intensive chemo (AML style) and Tx - Transplant outcomes: Overall survival approx. 30% but curable - Low risk and not transplant eligible : QOL improvement o Watch and wait o Cytopenia supportive treatment w/ transfusions o CMML-1 with raised WC count : ->Hydroxycarbimide as long as it provides benefit but can worsen cytopenias in patients with stable counts o CMML-1 with significant cytopenias MML-2 with WC <13 with high risk of AML -> Azacytidine (hypomethylating agent) Subcutaneous ' 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!…

Basics to Brilliance: Haematology Podcast

1
Chronic Lymphocytic Leukemia (CLL) 1:18:33

il y a 2 years1:18:33