Volume 3, Number 2

Denise O’Shaughnessy DPhil FRCP FRCPath Consultant Haematologist, Southampton General Hospital, Martin Thomas FRCS Consultant Vascular Surgeon, St Peter’s Hospital, Chertsey

DVT cannot be diagnosed by clinical means alone; it is well recognised that legs exhibiting signs of swelling and tenderness may be free of thrombus and apparently normal legs may contain extensive clot.

Hugh Antrobus FRCA Consultant, Acute Pain Service, Warwick Hospital

Bleeding in the vertebral canal can follow central nerve block. If a drug that impairs haemostasis is given at or about the same time it may make a haematoma more likely or bigger. Fortunately, serious consequences are rare. The combination of epidural analgesia and heparin thromboprophylaxis is becoming more common as Acute Pain Services expand, because the strongest indication for epidural analgesia often occurs in patients with the highest risk of thromboembolism. The risks and benefits of epidural analgesia were debated at the 6th National Pain Management Conference in Leicester on 1 March 1999.

Lindsey Murray RGN Clinical Nurse Practitioner, Acute Medical Services, Western General Hospital, Edinburgh

DVT is an increasingly common condition with potentially serious complications. Traditionally, all patients with confirmed DVT were admitted to hospital for inpatient care. However, recent advances in drug treatment now allow patients to be treated on an outpatient basis.

Caroline Shiach BSc MD FRCP FRCPath Consultant Haematologist; Jeanne Birchenhall RGN DMS Anticoagulant Nurse Specialist, Manchester Royal Infirmary

The problem of ever-expanding anticoagulant clinics has occurred in Manchester in much the same way as it has around the rest of the country. In 1996, the Local Health Authority called together a group representing the three main hospital trusts in the city to look at possible developments that would accommodate the increasing demands of an anticoagulant service. After lengthy discussions it was agreed that each of the three trusts would be given £10,000 to run a pilot project. The projects would be audited and further developments would depend upon the outcome of these. Each hospital trust elected to use the money in different ways.

Peter Rose, Editor

DVT management continues to be a hot topic. In this issue of Thrombus the Editor, Peter Rose, sets out the case for secondary care management. David Fitzmaurice will counter with the argument for primary care in the autumn issue.

Premini Mahendra MD MRCP MRCPath Consultant Haematologist, Bone Marrow Transplant Unit, University Hospital Birmingham NHS Trust

The syndrome of hepatic veno-occlusive disease (VOD) is one of the many regimen-related toxicities of high-dose chemo/radiotherapy and stem cell transplantation. VOD causes damage of zone 3 of the liver acinus resulting in hyperbilirubinaemia, jaundice and fluid retention. It usually presents within the first 30 days of the transplant. The reported incidence varies from between 5% and 50%; this wide variation is probably due to diverse diagnostic criteria and sample sizes used in different studies. It varies in severity from mild to severe, with multi-organ failure.