{"title":"Venous thromboembolism and thrombophilia testing","authors":"Beverley J Hunt, Caroline Dix","doi":"10.1016/j.mpmed.2025.02.002","DOIUrl":"10.1016/j.mpmed.2025.02.002","url":null,"abstract":"<div><div>Thrombophilia testing detects individuals with hereditary or acquired prothrombotic states that predispose to venous thromboembolism. If one considers Virchow's triad, thrombophilia describes the changes in blood constituents that predispose to venous thromboembolism. Inherited and acquired risk factors for thrombosis are discussed, and an algorithm for the management of acute deep venous thrombosis and pulmonary embolism is presented.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 229-234"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acquired disorder of thrombosis","authors":"Micky KH Tsui","doi":"10.1016/j.mpmed.2025.02.001","DOIUrl":"10.1016/j.mpmed.2025.02.001","url":null,"abstract":"<div><div>The UK incidence of venous thromboembolism is approximately 1–2 in 1000 per year, with most instances having no identifiable triggers. Usual acquired physiological conditions and other common pathological states can increase the baseline risk of thromboembolism. These include pregnancy, malignancy, drugs, autoimmune disease, obesity, smoking and infection. However, rare acquired causes should be appropriately and promptly investigated in the context of atypical presentations, thrombocytopenia, multiorgan failure and atypical sites of thrombosis. For acquired thrombotic disorders with a chronic course, continuing optimization of modifiable cardiovascular risk factors is important for long-term outcomes.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 235-239"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Blood transfusion","authors":"Catherine Booth, Shubha Allard, Susan Robinson","doi":"10.1016/j.mpmed.2025.01.012","DOIUrl":"10.1016/j.mpmed.2025.01.012","url":null,"abstract":"<div><div>The term ‘blood transfusion’ refers to the therapeutic use of whole blood or its components (red cells, platelets, fresh frozen plasma, cryoprecipitate). Careful donor selection and stringent testing by the Blood Service is required to ensure a safe blood supply. Blood transfusion can be life-saving. However, donated blood is a limited resource, and hospital blood transfusion practice must focus on ensuring safe and appropriate use. Patient blood management is an evidence-based multidisciplinary approach aimed at optimizing the care of patients who might need transfusion, to reduce avoidable use of blood components. Clinical transfusion guidelines are essential, supported by education and training with regular practice audits. To minimize errors, particular emphasis must be placed on accurate patient identification from the initial blood sample, through laboratory testing and transfer of blood to clinical areas, to the final bedside check before transfusion. The reporting and monitoring of adverse events via national haemovigilance schemes has highlighted key areas for action and improved transfusion safety. Transfusion medicine must be practised within a strict regulatory framework; the Blood Safety and Quality Regulations 2005 based on European Union blood directives have had particularly far-reaching implications for UK Blood Services and hospital transfusion laboratories.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 246-252"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Blood in systemic disease","authors":"Isabel Farmer, Deepti H Radia","doi":"10.1016/j.mpmed.2025.01.009","DOIUrl":"10.1016/j.mpmed.2025.01.009","url":null,"abstract":"<div><div>The bone marrow is highly influenced by external factors, making abnormalities of full blood count (FBC) extremely common in systemic disease. This knowledge is important as correction of the laboratory abnormality often occurs with treatment of the underlying disease. Here we discuss some commonly encountered FBC abnormalities and their association with systemic disease.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 263-266"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment/CPD answers","authors":"","doi":"10.1016/j.mpmed.2025.02.004","DOIUrl":"10.1016/j.mpmed.2025.02.004","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 267-272"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acquired disorders of coagulation","authors":"Vickie McDonald","doi":"10.1016/j.mpmed.2025.01.002","DOIUrl":"10.1016/j.mpmed.2025.01.002","url":null,"abstract":"<div><div>Normal coagulation is a delicate balance between pro- and antithrombotic mechanisms. Haemorrhage results from dysfunctional/absent procoagulant mechanisms and can be caused by inherited or acquired factors. The most common acquired abnormalities seen in clinical settings are covered in this article, including vitamin K deficiency, warfarin therapy, liver disease, direct oral anticoagulants, disseminated intravascular coagulation, platelet disorders and vascular disorders. Patients with new-onset abnormal bruising or bleeding require a full history and examination to allow targeted investigations. Most interventions target the underlying cause but other specific measures such as reversal of warfarin, vitamin K replacement, clotting factor replacement or blood product transfusion can be required. Liver disease results in complex haemostatic changes, and the management of bleeding depends on its site and severity. Disseminated intravascular coagulation can complicate many clinical situations and needs prompt action when patients are bleeding. Acquired dysfunction of platelets is commonly encountered in clinical practice, often in association with drug therapy (e.g. aspirin), but also with more widespread medical conditions such as renal failure or after procedures such as cardiopulmonary bypass.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 220-224"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Thrombocytopenia","authors":"Gulnaz Shah, Deepti H Radia","doi":"10.1016/j.mpmed.2025.01.010","DOIUrl":"10.1016/j.mpmed.2025.01.010","url":null,"abstract":"<div><div>Thrombocytopenia (low platelet count) is caused by a number of different factors that either reduce the production of platelets or increase the destruction of platelets. Broadly speaking, these can be divided into immune and non-immune causes. Non-immune causes include inherited causes of abnormalities of megakaryocyte development, infiltration of the bone marrow, liver disease and infection-related and drug-induced causes. Immune thrombocytopenia (ITP) is caused by antibody- or cell-mediated destruction and can be primary (where a cause is not identified) or secondary to infections, autoimmunity or lymphoproliferative disorders. This article discusses the causes of thrombocytopenia with a focus on ITP.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 214-219"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anticoagulation treatment","authors":"Karen A Breen","doi":"10.1016/j.mpmed.2025.01.005","DOIUrl":"10.1016/j.mpmed.2025.01.005","url":null,"abstract":"<div><div>Anticoagulant therapy has been used effectively for the prevention and treatment of thromboembolic events for many years. However, anticoagulant therapy is also associated with a significant risk of haemorrhagic complications, warranting careful consideration of the need for anticoagulation. There are now many choices of anticoagulant available, including direct oral anticoagulants (rivaroxaban, apixaban, edoxaban, dabigatran), which provide a stable predictable form of anticoagulant therapy compared with traditional agents – heparin and vitamin K antagonists, these having recognized drawbacks of unpredictable pharmacokinetics and the need for laboratory monitoring.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 240-245"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Haematology of pregnancy","authors":"Catherine Prodger, Sue Pavord","doi":"10.1016/j.mpmed.2025.01.008","DOIUrl":"10.1016/j.mpmed.2025.01.008","url":null,"abstract":"<div><div>Obstetric haematology has expanded as a specialism over the past 20 years in recognition of the growing understanding that pregnancy outcomes can be significantly impacted by haematological disease, and that pregnancy can trigger new diseases. Physiological changes that occur during pregnancy to meet the needs of the developing fetus can lead to complications in vulnerable women, including those with pre-existing haematological conditions. For example, the massive increase in uterine blood flow and vascular compliance necessary to maintain the blood supply to the developing fetus can lead to significant haemorrhage at the time of placental separation. Increasing hypercoagulability helps prevent this but raises the potential for systemic thromboembolic events. Despite increased understanding of these risks, haemorrhage and thrombosis remain leading causes of maternal death. The most common medical disorders in pregnancy are also haematological, being anaemia and thrombocytopenia, affecting around 25% and 10% of pregnant women, respectively. Fetal anaemia and thrombocytopenia may also occur, due to fetal-maternal alloimmunization. Obstetric haematology is a high-stakes area of practice that requires specialist knowledge and collaboration across disciplines.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 257-262"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Structure and function of red and white blood cells and platelets","authors":"Barbara J Bain","doi":"10.1016/j.mpmed.2025.01.003","DOIUrl":"10.1016/j.mpmed.2025.01.003","url":null,"abstract":"<div><div>Red cells have a major function in transport of oxygen, and minor functions in regulation of local blood flow and transport of carbon dioxide. Neutrophils and monocytes are phagocytic cells that are part of the innate and also the adaptive immune response. Eosinophils have their major function in protecting against multicellular parasites, and basophils participate in this process. Dendritic cells participate in regulation of T cell function. B cells are part of the adaptive immune response, specifically differentiating to plasma cells, which are responsible for humoral immunity. Some T cell subsets and natural killer (NK) cells mediate cellular immunity, both innate and adaptive, while other T cell subsets suppress the activity of B cells, helper T cells and cytotoxic T cells. NK cells and cytotoxic T cells are important in defence against tumours. Platelets function in primary haemostasis and, on activation, provide phospholipid that is essential for the activation of coagulation factors.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 175-180"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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