Basics to Brilliance: Haematology Podcast

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'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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'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!

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Clinical Presentation

Classifications of VWD

'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!

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Haider steps out of the shadows....

Make sure you send us the questions you're too afraid to ask your haem reg (or consultant) - email address below!

'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!

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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

Send us your feedback!

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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!

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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

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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!

1. Bleeding Risk
2. Anticoagulant characteristics
3. Intensity of anticoagulant (prophylactic vs therapeutic)
4. 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

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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!

Feedback

00:52 Intro - very important topic

02:00 Case Study: Haem/Obstetrics clinic, Family Hx Severe Haemophilia A, 12wks pregnant

04:15 Clotting changes in pregnancy

• Increased: FVII, FVIII, FX, VWF, Fibrinogen
• Decreased: FXIII   Protein S, Antithrombin 
• Stable: FIX

07:57 New born to 6 months clotting:

• FVIII (8) similar to adult
• FIX (9) lower and rises after 6 months

09:30 GUEST STARRING

Dr. William Jones MRCP FRCA St6 Anaesthetics SpR with a special interest in Obstetrics

10:25 Will speaks about Delivery, Instrumentations,  Anaesthetics/Analgesia aspects of Obstetrics.

13:28 David asks about big needles, bleeding risks and Will explains Spinal vs Epidural

15:40 Three Stages of Labour (briefly, very briefly) ***

‘Haematologists advise active management of the third stage’ means:

Management of process of delivering the placenta ie.

• Uterotonic - Syntometrine IM- helps reduce bleeding and get placenta out
• Placental traction
• ?Cord clamping

Thanks Will.

17:40 All the nuggets you'll need **avoiding a traumatic ICH to a baby boy**

1/ Pre-conception: baseline factor levels, family Hx (genetic mutations), discussion of treatments and risks  

2/ Antenatal: 

• Male identification (IVF, fetal free DNA testing in maternal blood from 9 wks)
• Offer CVS (11-14 wks, miscarriage risk) or Amniocentesis (15-20 wks, pre-term delivery risk)
• Faetal anomaly scan @ 20wks
• Check FVIII/FIX at booking, pre-procedure, 28wks and 34 wks
• MDT (haematologist, anaesthetist, obstetrician, nenonatolgist, lab) 
• haemophilia centre, 24hr access to haenostasis lab
• Clear delivery plan by 37 weeks

3/ Labour/deliver

• Avoid instrumentation
• Risk of bleeding: Forceps > Ventouse > Vaginal > C Section (high mortality for mother)
• FVIII >50 IU/dL : TXA
• FVIII <50 IU/dL: TXA + DDAVP (avoid in pre-eclampsia)
• Neuro-axial anaesthesia needs FVII > 80 IU/dL
• Avoid faetal blood sampling, fetal scalp electrodes, ventouse, forceps, external cephalic version

4/ Post partum

• Uncomplicated: maintain FVIII >50 for three days
• Complicated/C-Section: maintain FVIII >50 for five days
• Continue TXA till minimal Lochia 
• If FVIII >50 needs VTEp
• Newborn: PT/APTT, FVIII and FIX (cord blood),
• Newborn: Routine screen for bleed with USS, Give factor if ANY suspicion of ICH- don't wait for a scan. CT/MRI head.
• Newborn: if ICH, maintain FVIII approx 80-100 for first 3 days, then above 50 for 2 weeks and will need prophylaxis going forwards. ?Vitamin K. SC vaccinations not IM. Give parent info. 

40:15 David attempts the case study

44:20 How to write the delivery plan:

A Practical Guide to the Management of the Fetus and Newborn With Hemophilia - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Suggested-Contents-of-the-Written-Delivery-Plana_tbl2_328606634 [accessed 10 Jan 2026]

47:20 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: [email protected]

Insta: BasicstoBrilliance

X: @basics_2_brill

Send us your feedback!