Volume 4, Number 2

Beverley J Hunt MD FRCP FRCPath Consultant, Hon Senior Lecturer, Departments of Haematology and Rheumatology, Guy’s and St Thomas’ Trust, London

Antiphospholipid or Hughes’ syndrome is the association between antiphospholipid antibodies (aPL), venous and arterial thromboses and pregnancy morbidity.1 Antiphospholipid syndrome (APS) commonly coexists with autoimmune diseases, usually systemic lupus erythematosus (SLE), when it is known as secondary APS. When present in isolation it is known as primary APS.2

John Lanham FRCP Consultant Physician and Rheumatologist, Rheumatology Department, Whipps Cross Hospital, London

A swollen painful lower leg is a common presentation for admission. Once cellulitis has been excluded on clinical grounds, the diagnosis is invariably that of a deep vein thrombosis (DVT). The principal alternative diagnosis – a ruptured Baker’s cyst is often overlooked. Failing to recognise this diagnosis can have far reaching consequences.

David Keeling BSc MD MRCP MRCPath Consultant Haematologist, John Radcliffe Hospitals, Oxford

Which D-dimer test? The diagnosis of venous thromboembolism (VTE), whether as deep vein thrombosis (DVT) or pulmonary embolism (PE), can be difficult, time consuming, and expensive. There is increasing interest in the use of D-dimer tests to improve the diagnostic procedure by reducing the need for expensive, invasive testing.

Edward Bibby, Patient at Shipston Health Centre

Having recently retired at 71 after 55 years of working life, my wife and I were anxious to catch up on our travels and were immediately co-opted by one of our daughters and her husband who were embarking on a round-the-world cycling trip. As the trip was to take some years, they wanted us to meet them in various places bringing along the necessary tyres, spares and appropriate clothing for the weather in that area.

David Warwick MD FRCS FRCS(Orth) Consultant Orthopaedic Surgeon, Southampton University Hospitals NHS Trust

While the plethora of randomised trials and review articles suggest that chemical prophylaxis is mandatory in orthopaedic surgery1,2 some orthopaedic surgeons have their doubts. Consequently thromboprophylaxis is not universally used in the UK. This article discusses these doubts in a provocative but hopefully informative way.

Peter Rose, Editor

The optimal method of prevention of venous thromoboembolism (VTE) following orthopaedic surgery continues to provide debate among orthopaedic surgeons and haematologists, often without agreement. What is clear however, is that every trust will be required to have guidelines in place for thromboprophylaxis and be able to provide evidence to support their practice.

Denise O’Shaughnessy MRCP MRCPath Consultant Haematologist, Southampton University Hospitals Trust

At the recent International Society of Thrombosis and Haemostasis meeting in Washington DC, the most interesting symposium was undoubtedly on the role of Von Willebrand factor (VWF) in the aetiology of thrombotic thrombocytopenia purpura (TTP).