Monday, February 01, 2016

Acute Myeloid Leukaemia

This is my discharge notice from King's College Hospital on January 29:

Lord Avebury was admitted as an emergency on 19th January 2016. Following outpatient blood tests which showed an acutely raised creatinine of 250, he was admitted for IV fluids which resulted in the sum improvement in his renal function. He was due to have an outpatient renal artery angiogram +/- stent on 21st January to treat the underlying cause of the acute kidney injury, so this was performed as an inpatient. Due to his low platelet count, (due to the underlying diagnosis of myeloproliferative disorder) and deranged clotting results Lord Avebury was given platelet transfusions and Fresh Frozen Plasma to minimise the risk of bleeding during or post the procedure. Following this, Lord Avebury suffered from chest tightness, shortness of breath and his oxygen saturations deteriorated. He also spiked a temperature. He was treated for sepsis with IV Meropenem and for fluid overload with diuretics. ITU outreach team reviewed him regularly. Lord Avebury had a very high troponin during the above events and though this was thought at first to be secondary to an acute myocardial infarction, it is more likely to be related to acute heart strain post-stenting of the renal arteries and fluid overload. An echocardiogram showed no new regional wall motion abnormalities, moderate tricuspid and normal left ventricular systolic function. Lord Avebury also had some haemoptysis so the clopidogrel was discontinued (aspirin continued due to the new indwelling stents) and a course of vitamin K was given to correct his clotting. His haemoptysis settled. His oxygen requirements were gradually weaned from Optiflow. However, he still required some oxygen to maintain saturations above 94% (he had no evidence of CO2 retention during admission). As he was still spiking temperatures, antibiotics Clarithromycin and Teicoplanin were added in. Blood films taken during admission were suggestive that the myeloproliferative disorder has transformed to acute myeloid Leukaemia. This will be managed supportively. As Lord Avebury was clinically stable, he was discharged from Davidson ward. He is already known to St Christopher’s Hospice who will kindly review his needs in the community. He will be seen regularly in HOP for blood transfusions as required.

Main diagnosis: acute kidney injury, transfusion associated cardiac overload, sepsis (likely chest source) transformation of myelofibrosis to acute myeloid leukaemia.

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