Bloody Minded

We’ve had one difficult coagulation topic yes, but what about second difficult coagulation topic? We are joined by the fantastic Dr Caroline Dix today to take us through not one but TWO challenging scenarios in thrombosis. First we’ll be revisiting Cerebral Venous Sinus Thrombosis but this time with someone who knows what they are doing. After that we’ll cover anticoagulating people when some very fundamental parts of the system are broken - the management of antithrombin deficiency. This episode wraps up our journey through clots… for now. Timestamps:2:08 - Introducing Dr Caroline Dix8:03 - CVST - Risks11:15 - CVST - Clinical18:08 - CVST - Duration21:05 - Antithrombin Deficiency25:12 - Antithrombin Deficiency - Diagnosis29:43 - Antithrombin Deficiency - Management37:34 - WrapupSupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Sometimes something comes along that puts a chill down the spine of every doctor. Any conversation that starts with "Oh hey do you remember that patient you saw...?". Mystery meat day in the cafeteria. Dealing with hospital executives. For these times in life you need a guide. Today we'll be covering one of those spine-chilling clinical scenarios with our very apt guide consultant haematologist Dr Sara Ng. Over forty minutes Sara will un-chill your spine with her practical approach to managing thrombosis when there just aren't that many platelets to go around, as well as talking about conditions where clots and thrombocytopenia are intimately linked.Timestamps: 2:11 - Introducing Dr Sara Ng7:18 - Case 1: Acute PE and Thrombocytopenia14:55 - Case 1.5: Subacute PE and Thrombocytopenia18:20 - Case 2: Line Thrombus during Chemotherapy22:09 - Thrombosis in ITP26:15 - Oh no a STEMI27:44 - Two sides of the same coin31:58 - How 2 4T Score - HITS35:15 - Other PF4 Antibodies38:33 - Wrap up & TakehomesSupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Come one come all to see the thinnest extended reference in the universe. Draped over not one but TWO episodes, the Bloody Minded Crew continue to make vaguely topical references to popular recent films. Look - we go outside and experience the full gamut of popular culture. Oh and we finish up our discussion of thrombophilia testing in the lab - looking this week at activated protein C resistance testing, molecular Factor V Leiden assessment and Prothrombin gene mutations.TIMESTAMPS1:06 - Pay no attention to the man behind the curtain3:10 - Activated Protein C resistance testing10:27 - Testing in Australia for APCR17:17 - FvL Testing18:51 - PCR - Polymerase Chain Reactions22:52 - Melt curve analysis27:39 - Prothrombin G20210A Testing28:44 - Take Home MessagesSupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Lions and tigers and… thrombosis? Oh my! Join the Bloody Minded Crew on the yellow brick road to visit the emerald laboratory and see the wonderful wizard of clots - your friendly laboratory coagulation scientist! Put on your blood red ruby slippers and join us for this bumper lab episode as we learn about how exactly we test for Protein C, S and antithrombin deficiencies as well as lupus anticoagulants. By the end of it you’ll have a brain for coags, a heart full of of love for thrombosis and the courage to peer behind the laboratory curtain Support the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

“HATE. LET ME TELL YOU HOW MUCH I'VE COME TO HATE YOU SINCE I BEGAN AS A HAEM REG. IF THE WORD HATE WAS ENGRAVED ON EACH NANO-ANGSTROM OF THE HUNDREDS OF MILLIONS OF CONSULT NOTES I HAVE WRITTEN IT WOULD NOT EQUAL ONE BILLIONTH OF THE HATE I FEEL FOR YOU ORDERING THROMBOPHILIA TESTING INAPPROPRIATELY.” Woah - Let’s calm down, that's a bit much. Cale and Bashar are exposed to Nick’s inner monologue as the Bloody Minded Crew learn about the what, when and when not of thrombophilia testing. TIMESTAMPS0:52 - Nick gets stuck in an anger loop  2:19 - Intro to thrombophilia testing  4:25 - Inherited thrombophilias  5:38 - Surprise historical diversion on antithrombin  8:14 - Proteins C and S  9:31 - Factor V Leiden  10:56 - Prothrombin gene mutation  11:52 - Risk profiles in inherited thrombophilia  18:49 - Acquired thrombophilias  18:56 - Antiphospholipid syndrome  19:46 - PNH  20:22 - JAK2  21:08 - Mid-ep summary  22:28 - The world's biggest soapbox: what not to do  23:25 - Soapbox: no MTHFR pls  25:19 - Soapbox: bad times to test  26:46 - Soapbox: don't test the obvious provoked clots  27:30 - Bonus soapbox: factor V levels vs Leiden  28:54 - When SHOULD we test?  30:41 - Benefits of testing  32:33 - Clinical scenario: spoiler, no real answer  33:26 - Scenarios where you might test  37:49 - Take home messages  Support the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au