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Treating Multiple Myeloma in North Africa, the Middle East, and Europe - Global Multiple Myeloma Academy Treating Multiple Myeloma in North Africa, the Middle East, and Europe Emerging and Practical Concepts in Multiple Myeloma Register Now Overview In recent years, progress in the understanding of multiple myeloma has led to novel therapies that are rapidly changing treatment paradigms. Aptitude Healt...

Another UK lockdown, but we'll be using it make the site even better. Expect plenty more questions, with essays (+ comprehensive model answers and explanations) coming in the new year. We can't wait to relaunch https://t.co/AZBN8rx3Zd next month.

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We've been busy uploading our questions into the new site today. It's looking great and we can't wait to share it with you. Here's a sample, we'll share the answer tomorrow.

Regarding the efficacy of treatment with Caplacizumab for thrombotic thrombocytopaenic purpura, which of these statements is not true?

A) Caplacizumab shortens the time for platelets to improve

B) Caplacizumab shortens the time for ADAMTS13 levels to improve

C) Caplacizumab decreases the plasma exchange requirement

D) Caplacizumab reduces length of stay

E) Caplacizumab increases the risk of bleeding

Another question from www.pathquestionbank.com launching 1st August with a ridiculous launch offer!

A 71-year old woman who was referred to haematology for investigation of polycythaemia returns for clinic review. At her initial appointment, there were no clear secondary causes and his Hb was
191g/l, HCT 0.56, and platelets 348 x 10^9/l. JAK2 V617F mutation analysis is negative.

Which of the following investigations is unlikely to be helpful in this situation?

A) CALR gene mutation analysis
B) JAK2 exon 12 mutation analysis
C) Abdominal ultrasound
D) Serum erythropoietin level
E) Red cell mass measurement

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Answer to yesterday's question. Plenty of activity on Twitter. Like and share our page to be in with a chance of winning a free 12 month subscription to our site.

A 72-year old man with advanced liver cirrhosis is admitted with a history of melaena over the past
week. He is haemodynamically stable: BP 115/80 and HR 85. His haemoglobin is 79 g/l, platelets 78,
INR 2.5, and aPTTR 2.3. He weighs 60kg. An urgent gastroenterology opinion is sought, and the team
ask you for advice regarding transfusion support, especially given his deranged clotting tests. What is
the most appropriate advice based on the current parameters?

A) No transfusion indicated
B) 3 units FFP, 1 unit of platelets
C) 1 unit packed red cells, 2 units FFP
D) 2 units packed red cells, 3 units FFP
E) 3 units of FFP

Answer: A

This man with a GI bleed does not need any transfusion. Let’s deal with this stepwise:

1) Correction of coagulopathy

The use of FFP in this situation is controversial. Whilst many patients are transfused with FFP in this
situation, or are transfused prophylactically prior to invasive procedures, there is no good evidence
of benefit and plenty of scope for harm.

In upper GI bleeding due to varices, transfusing FFP will in fact increase portal venous pressure and
could worsen the bleeding. There is evidence from observational studies that derangements in
coagulation tests is not necessarily indicative of bleeding risk, particularly in variceal haemorrhage.

https://pubmed.ncbi.nlm.nih.gov/26228370/
https://pubmed.ncbi.nlm.nih.gov/17316874/

A 2020 study that looked at thrombin generation in patients with liver disease found that FFP only
enhanced thrombin generation by 5%. In 94% of patients, thrombin generation was normal or high
indicating adequate thrombin generation in the majority of patients with an INR >1.5.

https://www.ncbi.nlm.nih.gov/pubmed/31536747

The BSH guideline struggles to give concrete answers but falls more towards the side of no transfusion.
However, looking at the main recommendations in the BSH guidelines it is not clear what we should be doing!

The guidelines state:

• PT and aPTT are not reflective of true haemostatic status in liver disease. Interpret with caution.

• No good evidence for FFP for correction of abnormal coagulation tests in patients who are not bleeding prior to interventions such as elective variceal banding

• FFP or cryoprecipitate not recommended for low bleeding risk procedures such as paracentesis

• No good evidence for FFP for correction of abnormal coagulation tests prior to percutaneous liver biopsy – advise use transjugular approach instead.

(https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.15167)

PT bore no relevance to bleeding risk in a study of acutely ill cirrhotic patients on intensive care. A fibrinogen level

PubMed The derangement of hemostasis in patients with chronic liver disease has long been thought to be causally related to the bleeding events seen in these patients. However, the relatively poor correlation between bleeding and the peripheral indices of hemostasis together with the recent findings of the...

We are launching August 1st and can't wait to help you revise for FRCPath Part 1 in haematology. Here's one of over 500 high quality questions to start you off. Answer tomorrow.

More where this came from at www.pathquestionbank.com. Sign up today for an awesome launch offer. Like and share our page to be in with a chance of winning a year's free access.

A 72-year old man with advanced liver cirrhosis is admitted with a history of melaena over the past week. He is haemodynamically stable: BP 115/80 and HR 85. His haemoglobin is 79 g/l, platelets 78, INR 2.5, and aPTTR 2.3. He weighs 60kg. An urgent gastroenterology opinion is sought, and the team ask you for advice regarding transfusion support, especially given his deranged clotting tests. What is the most appropriate advice based on the current parameters?

A) No transfusion indicated
B) 3 units FFP, 1 unit of platelets
C) 1 unit packed red cells, 2 units FFP
D) 2 units packed red cells, 3 units FFP
E) 3 units of FFP

Path Question Bank is coming soon We are doing some maintenance on our site. Please come back later.