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 and excitement for the brilliant world of Haematology. Warmest Regards,Dr. EverdenDr. FaseyDr. JafriDisclaimer: 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
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Feedback 00:52 Intro 02:10 Definition Common: Alloantibody neutralizes FVIIIRare: causes increased clearance of FVIII1/3 of Severe Haemophilia A patientsMedian time 10-15 emergency dosesRF: Mutation types (INSIGHT study), <5 or >60, African/Hispanic, HIVneg, large rFVIII doses, FVIII + inflammatory stimulus07:05 Inhibitor classifications Titres: Low (<5 BU) vs. High (>5 BU)Responder: Low vs HighTime: Dependent (FVIII inh.) vs Independent (FIX inh.)09:50 Presentation in practice Tr...
Haemophilia A: Management Basics (01:24:40)
Feedback 00:52 Intro 02:35 Structure of Haemophilia A care 05:10 Key aspects of management (On-demand vs prophylaxis) 07:00 Prophylaxis: reduce death rates from ICH and reducing joint bleeds - Primary prophylaxis: before the 2nd joint bleed Severe haemophiliaAny child spontaneous ICHModerate haemophilia A (1-3 IU/dL)- Secondary prophylaxis: After the 2nd joint bleedLimit joint damage and maximize long term functionESPRIT trial- Tertiary prophylaxis: If joint disease already establishedSlow p...
Feedback 00:52 Intro 02:00 What is Haemophilia A? 03:00 Factor VIII, Pathogenesis of Haemophilia A 07:10 Structure of Factor VIII (exam pearl) 300kDHeavy (A1 A2, B) + Light Chain (A3, C1, C2) bound by a metal ions *Calcium*A subunits are 30% homologousB subunit (variable region) is cleaved by thrombin to get Factor VIIIaC1 and C2 help bind to VWFGood to r/o VWF10:55 Epidemiology and history taking- X-linked recessive Factor VIII is (mostly) feminist.....Turners syndrome, Androgen Insensitivit...
Factor XIII (13), Fibrinolysis & Thrombolysis (00:46:21)
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 Assay16:00 Fibrinolysis definition and pathway 21:00 Activators of Fibrinolysis: tPA vs. uPA 23:23 Inhibitors of Fibrinolysis: PAI-1, PAI-2,...
Inhibitors in Haemostasis (01:03:02)
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 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 Bethesd...
Heparin & the Anti-Xa Assay (00:59:29)
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 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 ...
Thrombin Time & Fibrinogen Assays (00:38:08)
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 ...
Mixing Studies & Factor Assays (00:51:35)
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-ha...
Mantle Cell Lymphoma (01:25:06)
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!
Practical Haemostasis of the Clotting Screen (00:34:27)
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 Patholog...
The Clotting Screen: Back to Basics (00:45:19)
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)...
Essential Thrombocythemia (ET) (01:11:45)
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!
Immune Thrombocytopenia (ITP) (01:18:24)
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!
Heparin Induced Thrombocytopenia (HIT) (01:00:26)
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!
Polycythemia Rubra Vera (PRV) (01:12:33)
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 Abs...
Secondary CNS Lymphoma (00:37:30)
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 (bl...
Primary CNS Lymphoma (01:09:06)
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 - ...
Chronic Monomyelocytic Leukemia (CMML) (00:41:56)
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) O...
Chronic Lymphocytic Leukemia (CLL) (01:18:33)
Feedback 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 lymphocyte...
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