Basics to Brilliance: Haematology Podcast

Basics to Brilliance: Haematology Podcast

By Basics To Brilliance

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

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Best of Basics to Brilliance: Haematology Podcast

The most played episodes among Podcast App listeners.

  1. Number 1: Von Willebrand Disease: Diagnosis and Lab Tests

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

    56min
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  2. Number 2: Essential Thrombocythemia (ET)

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

    1h 12min
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  3. Number 3: Immune Thrombocytopenia (ITP)

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

    1h 19min
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  4. Number 4: Polycythemia Rubra Vera (PRV)

    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: 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 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 (*thyroid), mood disturbances 2nd line Rux: JAK2i (works for EXXON) RESPONSE + RESPONSE 2 trial MAJIC PV study SE: immunosuppression, skin cancer, wean dont stop Older Busulfan: 1 dose (w monitoring) vs intermittent Risk: leuk transformation, pneumonitis** Pregnancy: inc. DVT OHC not safe (stop 3 months prior) IFN 1st Aspirin Uterine Doppler from 20wks of gestation?flow LMWH 6 wks postpartum '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!

    1h 13min
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  5. Number 5: Primary CNS Lymphoma

    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 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 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 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: 25% increase and/or new lesions - Relapse/Refractory 25% asymptomatic OS 3-5mo ?Trial Re-Bx and r/o other brain tumors Restaging Re-induction w/ salvage chemo .MATRix if remission > 2 years +/- WB-RT if post auto .Ifosfamide based: RICE or RIE Future: 2nd gen BTKis- Ibrutinib or Zanibrutinib '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!

    1h 10min
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The podcast currently has 29 episodes available.