Its time to hit the hot girl summer of haematology (we're in Australia after all) but also the hot boy winter and Autumn and Spring. Because our patients are hot all year round and sadly all night shift and possibly all throughout your ward round.   

Welcome to our next On The Wards episode looking at fevers in the haematology patient with a focus on the management of febrile neutropenia. There's a lot to cover in this jumbo sized episode and we're super happy that Dr Alison Chandler agreed to return after last time. 

Timestamps
2:08 - Episode Overview
4:47 - What is Febrile Neutropenia?
8:59 - Reminder: What are neutrophils
13:08 - Where did the neutrophils go?
18:24 - Why is FN a big deal?
20:00 - Assessing the neutropenic patient
30:15 - Antibiotics: Get them in
33:29 - Bugs: What grows?
36:15 - That fever isn't going away
41:01 - After the fever
42:24 - Can we make the neutrophils go up?
48:00 - Prophylaxis
52:50 - Summary

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Can’t get enough of obscure haematological lab chat, can you? Well we’ve got good news for you! Join us today as we delve even deeper into the arcane depths of flow cytometry, mass spectrometry and cytogenetics as they apply to myeloma. We promise we didn’t just make these words up.

02:23 - Flow cytometry: overview
04:01 - The flow cytometer: practical aspects
09:01 - How we interpret flow
11:44 - Myeloma flow markers
14:32 - Quality in flow
21:26 - Mass spectrometry
25:59 - Cytogenetics
27:46 - Cytogenetics assay principles
30:30 - Karyotype abnormalities
31:44 - FISH and SNP arrays
33:05 - Cytogenetics and prognostication in MM
39:59 - Take home points

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Thought you were free of myeloma acronyms? Don’t be ridiculous - this is the haematology lab! We were born in the acronyms, moulded by them. We didn’t see a complete word until advanced training and even then it was nothing but BLINDING. Your lab tests betray you because they belong to us… but in this episode we’ll let you in on some secrets. Join Nick, Cale and Bashar in the haematology (and closely adjacent immunology) lab as they chat about just how we do that electrophoresis, why an iEPG is different to an EPG and just how useful Bence-Jones proteins are(n’t).

Timestamps
3:15 - Bone marrows - not as bad as they sound?
4:25 - What even do we do with the marrow?
10:57 - Eponymous plasma cells with weird morphology
13:04 - EPG - Electrophoresis
22:23 - IEPG - Immunoelectrophoresis
29:09 - What's the deal with Bence Jones proteins
33:27 - SFLC Measurements
37:07 - The Hook/Prozone Effect
40:55 - Light chain measurement in renal dysfunction
44:32 - Take Home Messages

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MGUS and Myeloma too simple for your tastes? Do you like vague presentations and biopsying many tissues in a sometimes wild goose chase? Why does Congo have all the birefringent apples? Go 'AAaah' as we TTRy to unpack ALl the problems that come with that most protean of disease - Systemic Amyloidosis!

Timestamps
3:04 - Pathophysiology of Amyloid
6:52 - All The Subtypes of Amyloid
7:56 - AA Amyloid
10:08 - ABeta2M Amyloid
11:04 - Age-Related Amyloidosis = wtATTR = WTTA = SSA
14:38 - AL Amyloidosis
16:24 - Diagnosis of Amyloid
22:25 - Clinical Presentation of Amyloid
27:10 - Prognosis
32:17 - Take Home Messages

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RVd, KTd, CyBorD, DVd, EloRd - Looks like the cat got on the keyboard. Oh wait, this is just the myeloma regimens in day therapy today. 

Come on a journey as we attempt (mostly successfully) to avoid drug trade names! Let go of your proteasome inhibitions, phenotype your red cells and let us modulate your understanding of what it is to treat myeloma with an alphabet soups worth of drugs. We sincerely apologise to our endocrinology colleagues for how much dexamethasone we use in this episode but also generally. 

Timestamps
4:00 - Overview of the treatment journey
9:49 - Steroids - not the bulking kind
13:54 - Immunomodulators - the IMiDs
19:46 - Proteasome inhibitors - Bortezomib, Carflizomib
24:45 - Monoclonal antibodies - Daratumumab, Elotuzumab
28:31 - SINE Inhibitor - Selinexor
29:27 - Antibody-drug conjugates - Belantamab mafodotin
30:27 - CELMoDs - Iberdomide, mezigdomide
31:06 - Standard chemotherapy
33:15 - Autologous stem cell transplant
38:21 - T-cell directed therapy - BiTes, CAR-T
40:57 - Supportive care

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

==
I do not like blue eggs and ham,
I do not like them, Sam I Am.
They crowd and clump, they grow too fast,
Causing troubles that can last.
They make my bones feel weak and sore,
And through my kidneys they gnaw!
I do not like blue eggs, you see,
They're signs of something wrong with me.
==
Timestamps
3:35 - Recap of MGUS + smouldering myeloma
4:42 - Clinical case - Mr. Peter Rotein
8:15 - What is rouleaux?
10:30 - Bone marrow biopsies - what, how, how much ow?
15:29 - Multiple myeloma
16:41 - CRAB Criteria
18:26 - SLiM Criteria
19:24 - Clinical presentations of myeloma
21:48 - Plasmacytomas
22:56 - Causes of myeloma?
24:45 - Prognosis

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Ordered something you shouldn’t have and accidentally found a paraprotein again? Shame on you, but now you have to do something with it. Maybe you were genuinely suspicious for myeloma. If incidentally discovered lab findings are leaving you smouldering, this is the episode for you! 

Join Nick, Cale and Bashar as they chat about the spectrum of plasma cell dyscrasias, and cover the precursor conditions MGUS and Smouldering Myeloma.

Timestamps
2:53 - What is a paraprotein?
5:56 - The heavy chain component
9:40 - The spectrum of plasma cell disorders
10:12 - MGUS
11:33 - How common is MGUS?
15:24 - You've found a paraprotein - what next?
17:38 - IMWG MGUS Criteria
19:47 - Mayo Score for Risk Stratification
22:25 - Serum free light chain ratio
24:25 - Bence Jones proteins
26:21 - Smouldering myeloma
27:30 - IMWG Smouldering myeloma criteria
29:16 - Risk of progression to MM

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A is for Antibody. B is for B-cell. C is for Cryoglobul… wait no we’ve covered that already. If you struggle to tell your thymus from an isthmus, can’t see the humour in humoural immunity and think a bursa is just some fancy elbow cushion then THIS is the episode for you. Join the Bloody Minded Crew as they dust off their undergraduate immunology degrees, get back to the classroom and cover the foundations of the immune system in preparation for tackling our upcoming malignant diseases. 

Timestamps
3:43 - The Immune System
4:50 - The Spleen
5:36 - The Thymus
6:19 - The Lymph Nodes
8:19 - The Innate Immune System
13:16 - The Adaptive Immune System
16:56 - VDJ recombination
21:21 - MHC/HLA
24:54 - Antibodies!
27:42 - Class switching
28:58 - The purpose of Plasma Cells
30:33 - An immune response - start to finish

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Help! After a disastrous 3 way ward swap you now have to cover the haem ward as an intern in... 45 minutes time. If only there were some way you could get a crash course on everything you might need to know. Well are you in luck today! Join our new guest host Dr Alison Chandler for a whole new subtype of episodes, our new "On the Wards" series.“ These are for those new interns and residents who have been drafted to cover the dreaded haem wards and need to prepare all the practical day to day things.

On this inaugural On The Wards episode we'll cover the haematology ward round, how to read a haematology note and plan for some planned admissions. Keep an eye out for these every so often in between our conventional topics. 

Timestamps
1:09 - Who is Dr Alison Chandler?
3:43 - What makes haem scary?
8:20 - Three top tips for haem JMOs
14:34 - The haem ward round - letters and numbers!
27:50 - Always look at the blood count
34:08 - Planned admissions
38:02 - Extra things to do on haem

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Tired of listening to the three of us? Why not listen to an actual expert!? Today we're joined by Dr Danny Hsu, consultant haematologist, clinical lead of Immune Haematology & Therapeutic Apheresis at Liverpool Hospital, THANZ council member and all around top bloke to dig down into the nitty gritty of TTP and PNH. 

Any question you might have about these conditions Dr Hsu is your go to. Sadly we didn't ask him every question you might have, but he certainly came up with incredible answers to the ones we asked of him. 

Timestamps
1:15 - Intro to Dr Danny Hsu!
7:19 - Getting into nonmalignant haem
9:55 - TTP in practice
14:03 - Intricacies of TTP diagnosis
25:15 - Managing TTP in the the longer term
28:55 - PNH chat!
38:57 - Final words and outro

Support the show

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