Afleveringen
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All that glitters isnāt gold, and all that paraproteins isnāt myeloma. But if weāre not going to blame myeloma, then what else might be responsible? Hold on to your M-Spikes as we the Bloody Minded Team dive into the weird and wonderful world of paraproteins causing havoc in patients without myeloma. This episode isnāt for the faint of blood so get ready for an advanced look at paraproteins and take a bit of the U out of MGUS.
2:12 - The Problem with "Unknown" Significance
8:45 - Waldenstrƶm's macroglobulinemia/Lymphoplasmacytic Lymphoma
11:17 - Marginal zone lymphoma
12:42 - Cold Agglutinin Disease
15:09 - Heavy chain disease
16:27 - POEMS Syndrome
23:10 - Other Paraproteinemic Neuropathies
25:55 - TEMPI
27:03 - CANOMAD
29:16 - Schnitzler Syndrome
31:34 - Scleromyxedema
34:06 - The āparaprotein AND...ā approachCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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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 - SummaryCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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Zijn er afleveringen die ontbreken?
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Canāt get enough of obscure haematological lab chat, can you? Well weāve 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 didnāt 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 pointsCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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Thought you were free of myeloma acronyms? Donāt be ridiculous - this is the haematology lab! We were born in the acronyms, moulded by them. We didnāt see a complete word until advanced training and even then it was nothing but BLINDING. Your lab tests betray you because they belong to usā¦ but in this episode weāll 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(nāt).
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 MessagesCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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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 MessagesCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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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 careCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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==
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 - PrognosisCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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Ordered something you shouldnāt 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 MMCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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A is for Antibody. B is for B-cell. C is for Cryoglobulā¦ wait no weāve covered that already. If you struggle to tell your thymus from an isthmus, canāt 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 finishCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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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.ā 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 haemCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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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 outroCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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Have you been spending too much time outside of the lab lately? So have we! Come with us on a whirlwind tour through the high altitudes of thermal amplitudes, the chilly depths of cold agg titres, the bright lights of EMA testing, the flocculated wetlands of unstable haemoglobins (donāt ask) and more! All from the safety of the lab, of course. We donāt go outside.
Timestamps
2:14 - Cold agglutinin testing
8:05 - PCH (Pretty Cool Haem)/Donath-Landsteiner testing
14:52 - G6PD testing
23:25 - Unstable Haemoglobin testing
28:55 - Take homesCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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Do you have a FLAER for the exotic? All at sea without your GPI-anchor? Come on a deep dive into the world of paroxysmal nocturnal haemoglobinuria - which isnāt really a disease of haemolysis at all but hey we're putting it here anyway and you can't stop us
Timestamps
1:46 - What is PNH? Baby don't hurt me...
4:48 - Signs and Symptoms
7:27 - Pathophysiology
11:27 - Diagnosis
17:04 - Managing Pretty Not Happy BloodCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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MAHA TMA Gandhi once said a cell for a cell makes the whole body anaemic, or something along those lines. Thereās so much more to DAT negative haemolysis than just DIC. Get out those buckets and put your sorting hats on - itās time to go where detective Coombs never dared to and look over the DAT negative haemolytic processes.
Timestamps
2:42 - Approach to DAT negatives - main categories
4:53 - Intrinsic Bucket 1: Membrane disorders
16:16 - Intrinsic Bucket 2: Enzyme disorders
18:51 - Intrinsic Bucket 3: Haemoglobin disorders
24:05 - Extrinsic Bucket 1: Microangiopathies
26:54 - Extrinsic Bucket 2: Infections
28:07 - Extrinsic Bucket 3: "Macroangiopathies"
30:58 - Extrinsic Bucket 4: Liver stuff
34:07 - Take home messagesCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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Grab your hot beverage of choice and come out of the cold as we give you a warm welcome to the world of cold-dependent antibodies! No need to cry(o) as we unpack CAD vs CAS, get personal with PCH and gaze without alliteration at whatever the hell cryoglobulins are. If you're desperate for a medical reason to move to the tropics, this is the episode for you.
00:58 - Deliberately inflammatory pop-culture discussions
02:45 - Clearing up nomenclature
6:12 - How cold is cold?
8:40 - Clinical case and problems with the FBC
13:27 - Testing for Cold Agglutinins & What are they binding?
16:14 - CAD, CAS and Causes
21:41 - Management - Stay toasty
28:07 - Cold Agg Summary
29:40 - Cryoglobulins
36:45 - Cryglobulinaemia Summary
NB We actually ran out of time to talk about PCH so apologies - keep an eye out in future episodesCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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Is there a glow surrounding your red cells? Things feeling heated in your reticuloendothelial system? An antibody to keep your bed warm at night? We donāt know where this is going either but grab a coconut and hop in the pool because we are excited to welcome you back with a chat about warm autoimmune haemolysis!
Timestamps
00:57 - Introduction & Case
05:08 - wAIHA - What is it?
07:04 - Reminder about the RES
08:35 - Surface Targets & Drugs
11:45 - Brief Mid-Ep Summary
13:05 - Causes
22:30 - Treatment
26:20 - Misc Points & Episode SummaryCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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Feel your knowledge fragmenting? A MAHA doesn't make you haha? I mean, that's probably a good thing - they're quite serious. Time to unpack the troublesome schistocytes. Hope you brought your helmets as we teach you the bare minimum about fragments so you can save lives on the ward.
Timestamps
02:26 - What is a red cell fragment?
06:09 - How are schistocytes born?
09:40 - DIC. The haem one, we mean.
13:32 - TTP or not TTP
16:15 - Sorry, he's not single
19:02 - HUS - a harsh renality
20:19 - aHUS - complements incoming
23:14 Take home messagesCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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āItās Test. Coombs Test. And I like my erythrocytes shaken, not stirred.ā Return the lab (where some of the Bloody Minded Crew truly belong) and uncover the secrets of the most important test in haemolysis - the Direct Antiglobulin Test. Learn to whisper its secrets and it can guide you to identifying the true culprit behind these broken red cells.
Timestamps:
0:57 - Coombs Noir
2:05 - Naming History
4:32 - DAT in the Lab
11:52 - Doing a DAT - Exam Version
14:35 - Eluates (Briefly)
15:45 - False Positives & Negatives
18:24 - When to DAT?
21:55 - Distilling the DAT - Interpretation
25:38 - DAT-Vanced Topics
29:24 - Takehome PointsCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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Haemolysis? Do I really hapto send off more tests? This is reticulous! Now you know what a red cell is - lets learn about how they can break down. Join us as we explore what your boss actually wanted you to do when they asked for a haemolysis screen, and about Cale's deep seated distrust of hepatologists.
Timestamps
2:30 - Haemolysis - what is it (good for?)
7:58 - Reticulocytes? What a reticulous name for a cell
9:36 - LDH - Nick will talk about biochemistry here, I'm SORRY okay?
11:36 - Bilirubin feat. Gilbert - winner of the 2015 Triple J's Hottest 100
16:10 - Haptoglobin (with apologies to my anaesthetist friends)
20:32 - Who is DAT?
23:49 - Haemolysis screen recap - click here when med reg is impatient
27:35 - Take home messages!Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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What is blood (Baby don't hurt me)? Rejoice as we escape the land of coagulation and look at some of the questions we have all asked during our medical training- what is blood? Does everybody have blood? Why is there so much of it on this floor? Who are you and how did you get in here? Join us as we we answer all these questions and more this episode with a focus on red cells.
Timestamps
1:33 - Blood - What is it (good for)?
3:49 - Differentiation of blood cells (my progenitors would be proud)
6:29 - Where did blood come from? Where did blood go? Where did you come from cotton blood Joe?
07:47- White cell summary is here. Basophils still a mystery.
10:30 - Finally the red cell talk I've been waiting for
12:07 - Four ingredients to make a red cell. Prep time 5 min, cleanup 120 days
13:26 - Iron (in more detail than anyone could possibly want)
16:34 - B12 and folate. Don't do nangs, kids (despite this bit here)
21:28 - MCV - Why haematologists care about cell size (I mean it's more about how you use it)
25:18 - Take home messages, predominantly nang basedCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au
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