“HATE. LET ME TELL YOU HOW MUCH I'VE COME TO HATE YOU SINCE I BEGAN AS A HAEM REG. IF THE WORD HATE WAS ENGRAVED ON EACH NANO-ANGSTROM OF THE HUNDREDS OF MILLIONS OF CONSULT NOTES I HAVE WRITTEN IT WOULD NOT EQUAL ONE BILLIONTH OF THE HATE I FEEL FOR YOU ORDERING THROMBOPHILIA TESTING INAPPROPRIATELY.” Woah - Let’s calm down, that's a bit much. Cale and Bashar are exposed to Nick’s inner monologue as the Bloody Minded Crew learn about the what, when and when not of thrombophilia testing. 

TIMESTAMPS

0:52 - Nick gets stuck in an anger loop  
2:19 - Intro to thrombophilia testing  
4:25 - Inherited thrombophilias  
5:38 - Surprise historical diversion on antithrombin  
8:14 - Proteins C and S  
9:31 - Factor V Leiden  
10:56 - Prothrombin gene mutation  
11:52 - Risk profiles in inherited thrombophilia  
18:49 - Acquired thrombophilias  
18:56 - Antiphospholipid syndrome  
19:46 - PNH  
20:22 - JAK2  
21:08 - Mid-ep summary  
22:28 - The world's biggest soapbox: what not to do  
23:25 - Soapbox: no MTHFR pls  
25:19 - Soapbox: bad times to test  
26:46 - Soapbox: don't test the obvious provoked clots  
27:30 - Bonus soapbox: factor V levels vs Leiden  
28:54 - When SHOULD we test?  
30:41 - Benefits of testing  
32:33 - Clinical scenario: spoiler, no real answer  
33:26 - Scenarios where you might test  
37:49 - Take home messages  

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We're nearly out of pipes to clean - Join us for the world's worst roadtrip we venture into the lesser known parts of human plumbing and tackle unusual site thromboembolism. From splanchnic clots, uterine and testicular thrombi it's clots as far as the eye can see (and those it can't like CRVO!)

Timestamps:

0:58 - ROADTRIP
4:07 - CVST
11:07 - CVST - Treatment
15:36 - Lemierre's
17:50 - CRVO
24:36 - Splanchnic Thrombi
34:45 - Renal Vein Thrombi
39:41 - Uterine Vein Thrombus
42:09 - Ovarian Vein
44:42 - Testicular Vein
46:35 - Takehomes

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It's said that beauty is skin deep but you know what else lurks just under your epithelium - CLOTS! Nick, Cale and Bashar head very slightly under our outer layer to the peripheral vasculature in this increasing tortured metaphor as we learn on our shortest episode to date about what to do when those not so deep vessels fill with thrombus. 

Timestamps

2:12 - Where are superficial veins?
5:23 - What's the deal with thrombophlebitis
7:34 - MONDOOORS (To the tune of Trogdor)
9:11 - Risk Factors for SVT
10:56 - Investigations
11:53 - Treatment
17:54 - Summaries

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D-ismayed by D-readful D-ressing D-owns by your D-emonstrably D-eplorable registrar? . Join de Bloody Minded Crew for a Tour D-Force of D-Dimer D-rama as we D-issect and D-iscuss this most D-ifficult of D-iagnostic tests!

Timestamps

2:14 - What is a D-Dimer and where does it come from?
6:57 - FXIII and D-Dimer
7:49 - Fibrinolysis and other degradation products
10:18 - D-Dimer Assays - LIA
14:22 - D-Dimer Units - Important!
15:39 - D-Dimer Assays - ELISA / ELFA
16:59 - D-Dimer Assays - POCT
18:13 Comparing Assays & Analytical Factors
22:12 - D-Dimer Interpretation - Clinical listeners start here!
30:16 - D-Dimer and Cancer
32:31 - D-Dimer and DIC
34:32 - Summary and Takehomes

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“Give me a 2cc bolus of clot stat Emma. No wait - not there!” But it was too late, and Em-Bolused the 2cc of clot straight to the lungs”. Join the Bloody Minded Crew as they get to the heart… no get to the lungs of the topic of Pulmonary Embolism. VanQuish the V/Q and CriTically aPprAise the CTPA with these acronyms that are just as bad as a cardiology trial and half as useful. Sadly the Top Gun soundtrack is copyrighted but nothing will stop you playing Berlin over the background of the intro (and we’d strongly suggest it). 

Timestamps

4:55 - Types of PEs
7:14 - Risk Factors for PE
8:55 - Signs & Symptoms ft. ECGs
12:15 - Investigations
21:49 - Vibe Augmenting - Decision Scores
25:59 - Brief Recap
26:44 - Treatment
39:15 - Pregnancy
44:35 - Take Homes

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Calves, thighs, arms and more, 
Clots can form inside them all!

Join your hosts Cale, Bashar and Nick as they take a deep (hah) dive into the nitty-gritty things you should know about managing DVTs of the extremities

TIMESTAMPS

0:54 - Intro to Extremity Clots
3:49 - Veins of the Lower Limb
5:54 - History & Exam Lower Limb
10:54 - Phlegmasias
15:52 - Investigations
21:27 - Below Knee DVTs
26:41 - Proximal Lower Limb
29:40 - May-Thurner
33:04 - PTS
34:33 - Upper Limb
41:15 - How long to anticoagulate?
45:28 - Take Homes

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Rudolf the red nosed physician
Wrote a very cool triad
And if you ever saw it
you would even say ‘Egad!’

All of the other physicians
used to laugh and call him dumb
They never let poor Rudolf 
join in the MDT fun

Then one foggy clinic day
a patient came to say
 “Rudolf with your triad so smart
won’t you describe to me the pathophysiology of clotting in a way that both makes sense and fits inside the metre of this children's song”

But he couldn’t, so welcome back to our next batch of episodes on the pod as we tackle the wonderful world of venous thromboembolism. How do I ask a patient about clots? Is a provoked thromboembolism when you call it names? Join Nick, Cale and Bashar jumping into the wild world of clots...

TIMESTAMPS

0:58 - Episode Intro
2:51 - Crafting a Clot Redux - Haemostasis
7:21 - Turbo Coag Cascade
8:34 - Thrombosis History
12:17 - Why we bother with history
16:39 - Risk factors for VTE
21:41 - Major vs Minor risk factors
23:54 - Thinking about risk factors
26:04 - The Thrombosis History
32:53 - Management Overview
37:40 - Summary and Takehomes

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Philip K. Dick once wrote, “Perhaps if you know you are insane then you are not insane. Or you are becoming sane, finally. Waking up.” Waking up, that is, not to the alternative history universe where the Axis won WWII but rather, to a new bonus episode on Castleman disease! Join Cale, Bashar and Nick as we explore one of Haem’s most zebra diagnoses, and do whatever we can to put off Nick’s clot season for just a bit longer.

TIMESTAMPS:

00:53 - Holiday to Bavaria
04:12 - Basics of Castleman Disease
07:41 - Histological Subtypes
10:57 - Clinical Subtypes - Unicentric
13:05 - Clinical Subtypes - Multicentric
16:08 - Brief Recap
18:00 - Pathophysiology of Castleman
21:38 - Historical Diversions
23:54 - Investigations
25:30 - Treatment - UCD
26:44 - Treatment - MCD
31:02 - Rarer than a Zebra (POEMS/TAFRO)
37:23 - Summary and Takehomes

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Have you stumbled onto the haematology ward only to discover patients on bizarrely named BiTE & CART therapy? Why are we giving patients CARTs? Do they come with a horse?  Why does everyone freak out when these patients are febrile? Why is everyone so hung up about handwriting? What are these weird drugs? 

It's OK – we are here once more to demystify the acronyms – and help you know what we are giving, why we are giving it and how to manage complications of Bi-Specific and CAR-T therapy! 

TIMESTAMPS

3:48 - Intro to BiTEs  
5:26 - Intro to CAR-T  
8:27 - Examples of BiTEs  
16:36 - CAR-T Collection + Production  
18:44 - Examples of CAR-T Products  
19:35 - Similarities and Differences between BiTEs and CAR-T  
23:24 - Cytokine Release Syndrome (CRS)  
30:23 - Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS)  
39:29 - Treatments for CRS  
45:52 - Treatments for ICANS  
50:01 - Take Home Messages  

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Bamboozled by basophils bountiful booty of granules? Let’s begin brilliantly with a basophil based bonanza. Buckets and buckets of brazenly basophil related bonus banter. You beauty! But, beware the bawdy, boisterous boys babbling brobdignagian-ly about BASOPHILS. It sounds better if you read it in Hugo Weaving’s voice and it’s the 5th of November I swear. 

TIMESTAMPS

3:07 - What are basophils?  
6:54 - Snapping turtle trivia  
7:55 - Role of basophils  
9:42 - Basopenia  
10:41 - Cutoffs (arbitrary as usual)  
11:14 - Artefactual basophilia  
12:29 - Reactive basophilia  
14:27 - Haem Causes = MPNs Galore  
16:14 - CML (Again)  
19:17 - Zebras have hoofbeats too  
23:20 - Take Home Messages  

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Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au