Basics to Brilliance: Haematology Podcast

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We are delighted to have Dr. Noémi Roy Consultant Haematologist at Oxford University Hospitals NHS Foundation Trust join us for this very special episode!

'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: [email protected]
Insta: BasicstoBrilliance
X: @basics_2_brill
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Welcome to the Red Cell Series!
Timestamps and notes to follow...

'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: [email protected]
Insta: BasicstoBrilliance
X: @basics_2_brill
Send us your feedback!

Feedback
Timestamps to follow!

'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: [email protected]
Insta: BasicstoBrilliance
X: @basics_2_brill
Send us your feedback!

Feedback
This is a discussion about possible factors and strategies to consider and should not be used as a guideline for clinical practice. Always discuss complicated cases with the attending H&T consultant.
00:52 Intro
01:30 Case 1: 41M Severe Haemophilia A, acute MI needing PCI
Try the 4 steps!
Bleeding Risk
Anticoagulant characteristics
Intensity of anticoagulant (prophylactic vs therapeutic)
Duration of anticoagulant therapy
11:20 Cardiac Disease in Haemophilia: thoughts and considerations 
20:40 Case 1: a potential algorithm in action
24:15 Case 2: 60M Moderate Haemophilia A, positive cardiac Hx, AF on ECG
33:30 Case 3: Moderate Haemophilia A, lobectomy, DVT on USS doppler of leg
40:00 Golden nuggets with a side of ffries

'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: [email protected]
Insta: BasicstoBrilliance
X: @basics_2_brill
Send us your feedback!

Feedback
00:52 Intro and chuckles
01:40 Case study: 75M, left calf swelling, put on DOAC, 24 hrs later haematoma and deep bleed on CT
06:00 General information
Elderly (>65), Mortality 8-40%
Common presentations: GI and UG bleeding, Retroperitoneal and muscle bleeds (compartment syndrome)
Ptegnancy, TTP, Malignancy (15%), Autoimmune disease (17%)
08:56 Pathogenesis and diagnosis: AutoAb against F8
*Bethesda units do not correlate with bleeding phenotype in Acquired HA- second orfer kinetics*
History
APTT, PT (isolated raised APTT)
Mixing studies: 50/50 or 80/20 mix
Factor Assays (**Intrinsic**)
Decreased Factor VIII + Non-paralellism -> Bethesday Assay
20:20 Non-clotting investigations
22:05 Treatment
MDT + Comprehensive Care Center escalation
RICE., TXA, Bypassing agents
Limit iatrogenic bleeding
Review medications
Pregnancy: birth plan!!!  inhibitor can cross palcenta
Steroid +/- Cyclophosphamide
27:10 Bypassing Agents in Acquired Haemophilia A
FENOC + EACH2 study: FEIBA vs NovoSeven = No difference in bleeding/thrombosis rates- more info at 33:25 for EACH2
Obizor can be titrated according to response whereas FEIBA and NovoSeven cannot
Emicizimab +/- Immunosuppression  = Not currently licesnsed in the UK 
32:25 Inhibitor eradication
Mean time to remission: 5 weeks
Good prognostic markers: FVIII 1 or more, Inhibitor titre < 20
EACH 2 Study: Steroids -> Steroids + Cyclophosphamide -> Steroids + Cyclo + Rituximab
Biggest cause of death: infection
36:45 Follow up 
Weekly FVIII levels and inhibitor monitoring till remission then monthly for 6 months then 2-3 monthly for a year
Planned procedure; FVIII level
38:45 Golden Nuggets

'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: [email protected]
Insta: BasicstoBrilliance
X: @basics_2_brill
Send us your feedback!