Problem Solving in Haematology.pdf

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ProblemSolving in

Haematology

G R A E M E S M I T H

C L I N I C A L

P U B L I S H I N G

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Problem Solving in

Haematology

GRAEME SMITH

Consultant Haematologist, Clinical Director, Department of Haematology,

St James’s Institute of Oncology, Leeds, UK

CLINICAL PUBLISHING

OXFORD

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CLINICAL PUBLISHING

an imprint of Atlas Medical Publishing Ltd

Oxford Centre for Innovation

Mill Street, Oxford OX2 0JX, UK

tel: +44 1865 811116

fax: +44 1865 251550

email: info@clinicalpublishing.co.uk

web: www.clinicalpublishing.co.uk

Distributed in USA and Canada by:

Clinical Publishing

30 Amberwood Parkway

Ashland OH 44805 USA

tel: 800-247-6553 (toll free within US and Canada)

fax: 419-281-6883

email: order@bookmasters.com

Distributed in UK and Rest of World by:

Marston Book Services Ltd

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© Atlas Medical Publishing Ltd 2010

First published 2010

All rights reserved. No part of this publication may be reproduced, stored in a

retrieval system, or transmitted, in any form or by any means, without the prior

permission in writing of Clinical Publishing or Atlas Medical Publishing Ltd.

Although every effort has been made to ensure that all owners of copyright material

have been acknowledged in this publication, we would be glad to acknowledge

in subsequent reprints or editions any omissions brought to our attention.

Clinical Publishing and Atlas Medical Publishing Ltd bear no responsibility for the

persistence or accuracy of URLs for external or third-party internet websites referred

to in this publication, and does not guarantee that any content on such websites is,

or will remain, accurate or appropriate.

A catalogue record for this book is available from the British Library.

ISBN 13

978 1 84692 005 9

ISBN e-book

978 1 84692 605 1

The publisher makes no representation, express or implied, that the dosages in this book

are correct. Readers must therefore always check the product information and clinical

procedures with the most up-to-date published product information and data sheets

provided by themanufacturers and the most recent codes of conduct and safety

regulations. The authors and the publisher do not accept any liability for any errors

in the text or for the misuse or misapplication of material in this work.

Project manager: Gavin Smith, GPS Publishing Solutions, Herts, UK

Typeset by Phoenix Photosetting, Chatham, UK

Printed by Marston Book Services, Abingdon, Oxon, UK

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Contents

Contributors

vii

Abbreviations

ix

Introduction

SECTION 1

1.

The approach to the patient with an abnormal blood count, G Smith

1

Haemostasis and Thrombosis

SECTION 2

2.

Anticoagulation, L Newton

7

3.

Bleeding in an intensive therapy unit patient, C Millar

14

4.

Investigation of easy bruising, L Newton

21

5.

Inherited disorders of coagulation, L Newton

26

6.

Thrombophilia, L Newton

32

Red Cell Disorders and Aplastic Anaemia

SECTION 3

7.

The investigation of anaemia and the anaemia of chronic

disease, G Smith

41

8.

Aplastic anaemia, P Hillmen

45

9.

Paroxysmal nocturnal haemoglobinuria, P Hillmen

50

10.

Sickle cell disease, A Critchley

54

11 .

β

-Thalassaemia major, Q Hill

62

SECTION 4 Clinical Blood Transfusion

12. Acute haemolytic transfusion reaction (ABO incompatibility),

D Norfolk 71

13. Massive blood transfusion, D Norfolk 76

14. Refractoriness to platelet alloimmunization, D Norfolk

80

15. Transfusion-related acute lung injury, D Norfolk

85

SECTION 5 Acute and Chronic Leukaemia and

Myelodysplasia

16. Acute myeloid leukaemia, D Bowen 89

17. Paediatric acute lymphoblastic leukaemia, S Kinsey

94

18. Adult acute lymphoblastic leukaemia, M Gilleece

98

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vi

Contents

19. Chronic lymphocytic leukaemia – early stage disease, P Hillmen 101

20. Chronic lymphocytic leukaemia – advanced stage disease, P Hillmen

105

21. Chronic myeloid leukaemia, G Smith 110

22. Low-risk myelodysplastic syndrome, D Bowen

11 5

SECTION 6 Myeloproliferative Disorders

23. Primary polycythaemia, D Swirsky

11 9

24. Primary myeloﬁbrosis, Q Hill 123

25. Essential thrombocythaemia, Q Hill

128

26. Hypereosinophilic syndrome, G Smith

133

SECTION 7 Lymphoma

27. Hodgkin lymphoma – early stage disease, D Gilson 137

28. Hodgkin lymphoma – advanced stage disease and long-term sequelae,

D Gilson 143

29. High-grade diffuse large B-cell non-Hodgkin’s lymphoma, R Johnson

148

30. Primary central nervous system lymphoma, R Johnson

153

31.

Indolent lymphoma – follicular non-Hodgkin lymphoma, R Johnson

158

32. Indolent lymphoma – Waldenström’s macroglobulinaemia epistaxis,

R Owen

163

SECTION 8 Plasma Cell Disorders

33. Myeloma – diagnosis and prognosis, G Cook, S Feyler

169

34. Myeloma – management, G Cook, S Feyler 174

35. Myeloma – treatment in the less ﬁt or compromised patient,

G Cook, S Feyler 180

36. Myeloma – solitary plasmacytoma, G Cook, S Feyler

183

37. Myeloma – AL amyloid, G Cook, S Feyler

187

General index

193

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