{"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}
{"title":"Haemostasis","authors":"Jack Taylor-Stuart, Chin Neoh","doi":"10.1016/j.mpmed.2025.01.015","DOIUrl":"10.1016/j.mpmed.2025.01.015","url":null,"abstract":"<div><div>Haemostasis is a vital bodily function to prevent excessive bleeding or formation of unnecessary thrombus. Blood vessel injury instigates a complex interplay between four major components: endothelial cells, platelets, clotting factors and their regulators, and the fibrinolytic pathway. Problems within each component can lead to an increased clotting or bleeding risk. A thorough bleeding and family history is important as routine laboratory clotting tests do not always detect a haemostatic defect.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 186-190"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792704","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":"Haemolytic anaemia","authors":"James Masters, Julia Sikorska","doi":"10.1016/j.mpmed.2025.01.014","DOIUrl":"10.1016/j.mpmed.2025.01.014","url":null,"abstract":"<div><div>Haemolytic anaemia is characterized by the premature destruction of red blood cells. There are multiple pathological mechanisms including immune, infection, congenital, mechanical and microangiopathic. A direct antiglobulin test can help to differentiate between immune and non-immune mediated haemolysis. Autoimmune haemolytic anaemia can be further divided into cold and warm haemolysis depending on the type of antibody responsible for the red cell destruction. Management depends on the type identified and includes supportive measures, such as transfusion and folic acid supplementation, and immunosuppression.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 200-203"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792121","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":"Inherited anaemias: sickle cell and thalassaemia","authors":"Dale Seviar, Rachel Kesse-Adu","doi":"10.1016/j.mpmed.2025.01.013","DOIUrl":"10.1016/j.mpmed.2025.01.013","url":null,"abstract":"<div><div>Inherited haemolytic anaemias are caused by genetic mutations that result in an abnormality within the red cell, leading to its early destruction. This abnormality can affect the cell membrane (e.g. hereditary spherocytosis), result from an absence or abnormality of a red cell enzyme (e.g. glucose-6-phosphate dehydrogenase deficiency) or affect haemoglobin, leading to a haemoglobinopathy such as sickle cell disease or thalassaemia.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 204-213"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792122","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":"Investigation and management of anaemia","authors":"Alison Thomas","doi":"10.1016/j.mpmed.2025.01.006","DOIUrl":"10.1016/j.mpmed.2025.01.006","url":null,"abstract":"<div><div>The average lifespan of an erythrocyte is 120 days, and maintenance of a normal haemoglobin concentration requires the rate of production of erythroid cells to match the rate of loss from the circulation. Where this is insufficient, anaemia ensues. Deficiency of haematinics (iron, vitamin B<sub>12</sub>, folate), bone marrow infiltration or chronic inflammation and organ dysfunction can result in impaired erythropoiesis. Abnormalities of the erythroid membrane, globin chains or intracellular enzymes shorten red cell lifespan, resulting in a congenital haemolytic anaemia. Acquired haemolysis is commonly immune or microangiopathic in aetiology. A detailed history including dietary, drug and family history, followed by interpretation of the full blood count, examination of the blood film and appropriate interpretation of simple tests (e.g. vitamin B<sub>12</sub>, folate, ferritin) often identifies the cause of the anaemia. Multiple factors can contribute in patients who are older or have complex co-morbidities. Management of anaemia focuses primarily on treating the underlying cause. Blood transfusion is reserved for cases of acute-onset symptomatic anaemia and anaemia with no remedial cause.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 4","pages":"Pages 195-199"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792120","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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