Browsing by Subject "Haematology"

Now showing 1 - 6 of 6
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    Clinical conundrum: managing iron overload after renal transplantation
    (BMJ, 2021-02-05) Upadhyay, Binayak; Green, Steven D.; Khanal, Nabin; Antony, Aśok C.; Medicine, School of Medicine
    Iatrogenic iron overload, which is not uncommon in patients undergoing long-term haemodialysis, arises from a combination of multiple red cell transfusions and parenteral iron infusions that are administered to maintain a haemoglobin concentration of approximately 10 g/dL. Although iron overload due to genetic haemochromatosis is conventionally managed by phlebotomy, patients with haemoglobinopathies and chronic transfusion-induced iron overload are treated with iron-chelation therapy. However, the management of iron overload in our patient who presented with hepatic dysfunction and immunosuppressive drug-induced mild anaemia in the post-renal transplant setting posed unique challenges. We report on the decision-making process used in such a case that led to a successful clinical resolution of hepatic iron overload through the combined use of phlebotomy and erythropoiesis stimulating agents, while avoiding use of iron-chelating agents that could potentially compromise both hepatic and renal function.
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    Hereditary haemochromatosis discovered after COVID-19 hospitalisation
    (BMJ, 2023-09-12) Hall, Zachary; Manlove, Emily; Medicine, School of Medicine
    COVID-19 infection and hereditary haemochromatosis (HH) have something in common; the disease course can be monitored with ferritin levels. Throughout the pandemic, physicians have looked for markers to help predict disease severity. Ferritin levels are commonly used to predict and monitor disease severity in hospitalised patients with COVID-19. While ferritin is elevated as part of the acute-phase reaction in response to infection, it can also be elevated due to iron overload. We report a case of undiagnosed, asymptomatic HH that was unveiled after COVID-19 infection via monitoring for resolution of ferritin levels that were found to be extremely elevated during a moderate COVID-19 infection. This diagnosis allowed the patient to initiate phlebotomy treatment before symptoms of HH arose.
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    Multifocal Myeloid Sarcomas: A Rare Presentation of AML
    (BMJ Publishing Group, 2017-10-04) Angsubhakorn, Natthapon; Suvannasankha, Attaya; Medicine, School of Medicine
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    Multiple ‘doughnut’ granulomas in a liver transplant patient with CMV reactivation
    (BMJ, 2018-12-22) Dejhansathit, Siroj; Miller, Adam Michael; Suvannasankha, Attaya; Medicine, School of Medicine
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    Seizures, renal failure and acute respiratory failure: not your typical case of Henoch-Schonlein purpura
    (BMJ, 2019-07-17) Bose, Subhasish; Pathireddy, Samata; Baradhi, Krishna M.; Aeddula, Narothama Reddy; Medicine, School of Medicine
    A 30-year-old Caucasian woman with no prior medical history presented with pedal oedema, arthralgias and abdominal pain with diarrhoea, following a respiratory infection. She had mild abdominal tenderness along with a purpuric rash on the extremities and was anaemic. Following initial workup for anaemia and rash, her condition deteriorated with renal impairment, respiratory failure and seizures necessitating ventilatory support, dialysis and steroids. Serologies were negative, and skin biopsy showed leucocytoclastic vasculitis without vascular IgA deposition, and renal biopsy showed subendothelial, mesangial deposits of IgA with C3 indicative of Henoch-Schonlein purpura (HSP). She was treated with steroids, haemodialysis and on 6-month follow-up recovered renal function. We present the case to illustrate that HSP, though rare in adults, can present with multiorgan failure, with renal, pulmonary and central nervous system involvement, and the need for early diagnosis and prompt treatment for rapid clinical recovery.
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    Severe FGF23-based hypophosphataemic osteomalacia due to ferric carboxymaltose administration
    (BMJ Publishing Group, 2018-01-03) Klein, Klara; Asaad, Shonda; Econs, Michael; Rubin, Janet E.; Biochemistry and Molecular Biology, School of Medicine
    Ferric carboxymaltose (FCM) is a novel iron formulation increasingly prescribed due to its effectiveness and fast infusion time. FCM administration can cause an asymptomatic hypophosphataemia secondary to fibroblast growth factor 23 (FGF23) dysregulation. In patients with chronic iron needs, however, a severe, long-lasting hypophosphataemia can lead to osteomalacia with associated bone pain. Lack of awareness of this complication results in delayed time to diagnosis and significant morbidity. We report a case of a patient with Crohn’s disease and chronic iron-deficiency anaemia receiving multiple doses of FCM who developed severe hypophosphataemic osteomalacia with urinary phosphate loss and increased FGF23. FGF23 excess and osteomalacia resolved only months after FCM discontinuation and aggressive phosphate repletion. Potential mechanisms of FGF23 dysregulation are discussed, with the aim of raising awareness of this significant side effect for prescribers of chronic intravenous iron supplementation, and to help guide future studies to determine the safety of FCM in all patient populations.