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Category: Immune Thrombocytopenia (ITP)

Multiple Sclerosis FAQ




Multiple Sclerosis FAQ

  1. What is Multiple Sclerosis (MS): MS is a chronic, autoimmune disease that affects the central nervous system (CNS), including the brain and spinal cord. It occurs when the immune system mistakenly attacks the protective covering of nerve fibers (myelin), leading to communication problems between the brain and the rest of the body.
  2. What are the Symptoms of MS: Common symptoms include fatigue, difficulty walking, numbness or tingling, muscle weakness, problems with coordination and balance, vision problems, and cognitive impairment.
  3. How is MS Diagnosed: Diagnosis often involves a combination of medical history, neurological exams, magnetic resonance imaging (MRI) scans, and sometimes lumbar puncture (spinal tap) to analyze cerebrospinal fluid.
  4. What Causes MS: The exact cause is unknown, but it is believed to involve a combination of genetic and environmental factors. There may be a link to viral infections and other triggers that lead to an abnormal immune response.
  5. Is MS Hereditary: While there is a genetic component, MS is not directly inherited. Having a family member with MS may increase the risk, but the majority of people with MS have no family history of the disease.
  6. Can MS be Cured: There is no cure for MS, but there are various treatments available to manage symptoms, slow disease progression, and improve quality of life. Treatment plans are individualized based on the type and severity of MS.
  7. What are the Different Types of MS: MS can be categorized into relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS), and progressive-relapsing MS (PRMS). RRMS is the most common form.
  8. How does MS Progress Over Time: MS progression varies among individuals. Some people may experience periodic relapses followed by periods of remission, while others may have a gradual progression of symptoms without distinct relapses.
  9. Can MS Affect Pregnancy: Many women with MS experience a reduction in symptoms during pregnancy, but there may be an increased risk of relapse in the postpartum period. Most disease-modifying treatments are not recommended during pregnancy.
  10. What Lifestyle Changes Can Help Manage MS: Regular exercise, a balanced diet, stress management, and adequate rest can contribute to overall well-being for individuals with MS. Avoiding smoking and excessive alcohol consumption is also advisable.
  11. Are There Support Groups for People with MS: Yes, there are numerous support groups and organizations that provide resources, information, and emotional support for individuals with MS and their families.
  12. Can MS Cause Mental Health Issues: MS can be associated with depression, anxiety, and other mental health issues. Individuals with MS need to discuss any mental health concerns with their healthcare team.
  13. How Does MS Affect Vision: Optic neuritis, inflammation of the optic nerve, is a common symptom of MS that can cause blurred vision, eye pain, and even temporary vision loss. Visual disturbances often improve over time.
  14. Is MS Fatal: MS itself is usually not fatal, and most individuals with MS have a normal life expectancy. However, complications and secondary conditions can impact overall health.
  15. What Research is Being Done for MS: Ongoing research is focused on understanding the causes of MS, developing new treatments, and improving the quality of life for individuals with the disease. Advances in immunology and neurology continue to inform MS research.
  16. What is the Definition of a Relapse: A relapse, also known as an exacerbation, flare-up, or attack, in the context of multiple sclerosis (MS), refers to the sudden appearance of new symptoms or the worsening of existing symptoms. These episodes are typically temporary and can last for varying durations, ranging from days to weeks. A relapse is indicative of an inflammatory process occurring in the central nervous system (CNS), which includes the brain and spinal cord.
  17. What is an MS Hug: An “MS hug” is a term used in the multiple sclerosis (MS) community to describe a sensory symptom that feels like a tight band or girdle around the chest or torso. This sensation is caused by spasms or contractions of the muscles between the ribs, which can result from the impact of demyelination on nerve signals. The MS hug can vary in intensity, from a mild squeezing sensation to more severe discomfort. While the name may sound benign, the experience can be distressing for individuals with MS. Treatments for the MS hug may include muscle relaxants or other medications aimed at managing neuropathic pain. As with any symptom of MS, individuals need to discuss their experiences with healthcare professionals to determine the most appropriate management strategies for their specific situation.
  18. Can MS Sufferers Work and Maintain Employment: The ability to work with MS varies widely among individuals and depends on factors such as the type and severity of symptoms, the nature of the job, and the individual’s overall health and wellness. Some people with MS experience periods of relapse and remission, and during periods of remission, they may be fully capable of working.
  19. Can an MS Sufferer Have a Caregiver and Be Able To Go To Work: Individuals with multiple sclerosis (MS) can have a caregiver and still be able to work. The ability to work with MS varies greatly among individuals, and having a caregiver can provide valuable support in managing daily activities and tasks. Caregivers may assist with various aspects of daily living, such as transportation, meal preparation, and personal care, allowing the person with MS to focus on work. Individuals with MS and their caregivers need to work closely with healthcare professionals and, if applicable, human resources departments to create a supportive environment that allows for both employment and caregiving responsibilities.
  20. Is Numbness in the Toes and Thighs Classed as a Relapse? Numbness in the toes and thighs can be a symptom of multiple sclerosis (MS), and it may or may not indicate a relapse. A relapse, also known as an exacerbation or flare-up, is typically defined as the appearance of new symptoms or the worsening of existing symptoms lasting for at least 24 hours and occurring in the absence of fever or other identifiable causes. If the numbness in the toes and thighs is a new or worsening symptom that lasts for a significant period and meets the criteria for a relapse, it may be considered as such.
  21. Can You Suffer From Incontinence If You Have MS: Yes, urinary incontinence can be a symptom of multiple sclerosis (MS). MS can affect the nerves that control the bladder and the muscles involved in urinary function. As a result, individuals with MS may experience various urinary issues, including incontinence.
  22. Can You Suffer From Cognitive Impairment, If You Suffer From MS: Yes, cognitive impairment is a common symptom of multiple sclerosis (MS). While MS is often associated with physical symptoms such as numbness, weakness, and difficulty walking, it can also affect cognitive functions. Cognitive impairment in MS can manifest as difficulties with memory, attention, information processing speed, problem-solving, and other aspects of cognitive function.
  23. Is OCD Associated With MS: The relationship between MS and psychiatric conditions is complex and may involve various factors, including the impact of neurological changes, the stress of coping with a chronic illness, and the influence of immune system dysfunction. MS can affect the central nervous system, leading to both physical and psychological symptoms. Some studies suggest that individuals with MS may be at an increased risk of developing anxiety disorders, including OCD-like symptoms. However, the exact nature of this relationship is still an area of ongoing research, and not everyone with MS will experience psychiatric symptoms. Frequency of obsessive-compulsive disorder in patients with multiple sclerosis: A cross-sectional study – PMC (nih.gov)

The specific criteria for defining an MS relapse include:

  1. Duration: Symptoms must persist for at least 24 hours, and there should be a noticeable change in neurological function.
  2. Absence of Fever: The symptoms should not be associated with a fever or any other illness that could mimic an MS relapse.
  3. Exclusion of Other Causes: Other potential causes of symptoms, such as infections or medication side effects, should be ruled out.

Relapses can vary widely in terms of severity and the specific symptoms experienced. Common symptoms during a relapse may include increased fatigue, difficulty walking, numbness or tingling, muscle weakness, vision problems, and problems with coordination.

Individuals with MS need to communicate any new or worsening symptoms to their healthcare team promptly. The management of relapses often involves treatment with corticosteroids to reduce inflammation and speed up recovery. Additionally, disease-modifying therapies may be prescribed to help prevent future relapses and slow the progression of the disease.

Factors such as stress, fatigue, and other health conditions can contribute to temporary symptom exacerbations. Regular communication with a healthcare team is crucial for individuals with MS to monitor and manage their symptoms effectively. If you experience new or worsening symptoms, it’s recommended to discuss them with your healthcare provider to determine the appropriate course of action.

Incontinence

Different types of urinary incontinence can occur in people with MS:

  1. Stress incontinence: This occurs when there is increased pressure on the bladder, such as during coughing, sneezing, or laughing.
  2. Urge incontinence: This involves a sudden, strong urge to urinate that is difficult to control.
  3. Overflow incontinence: In this type, the bladder doesn’t empty properly, leading to constant dribbling or leakage.
  4. Mixed incontinence: Some individuals may experience a combination of stress and urge incontinence.

It’s important for individuals with MS who are experiencing urinary symptoms, including incontinence, to discuss these issues with their healthcare provider. There are various management strategies and treatments available to help address urinary symptoms in people with MS, including medications, pelvic floor exercises, and lifestyle modifications. A healthcare professional can provide guidance and tailor interventions to the specific needs of the individual.

Cognitive Impairment

The severity and specific cognitive challenges can vary widely among individuals with MS. Some people may experience mild cognitive changes that do not significantly impact their daily lives, while others may face more pronounced difficulties that affect work, relationships, and overall quality of life.

Cognitive impairment in MS is thought to be related to the impact of demyelination and damage to nerve fibers in the central nervous system, particularly in areas of the brain responsible for cognitive functions.

Individuals with MS need to communicate any cognitive changes they experience to their healthcare team. Neuropsychological assessments may be used to evaluate cognitive function, and interventions such as cognitive rehabilitation, medications, and lifestyle modifications may be recommended to help manage cognitive symptoms. Early detection and intervention can contribute to better outcomes in managing cognitive challenges associated with MS.

Conclusion

In such cases, it’s important to contact a healthcare professional, such as a neurologist, who can assess the situation, conduct appropriate tests, and determine whether intervention, such as corticosteroid treatment, is necessary.

Further Reading


#ms #multiplesclerosis #autoimmunedisorder #mssupport #msfaq #neurologist #neurology #msrelapse #corticosteroids #modifyingtherapy #lemtrada #listeriadiet #immunesuppress


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The Struggle for MS Support

Support



The Struggle for Support: Cardiff NHS and the Neglected Calls for Multiple Sclerosis Patients

Living with Multiple Sclerosis (MS) is challenging enough without having to navigate a healthcare system that seems unresponsive and neglectful. Unfortunately, this appears to be the experience of some MS patients in Cardiff, where reports suggest, limited or a lack of support from the National Health Service (NHS). The failure to answer calls, initiate callbacks, and respond to emails raises serious concerns about the quality of care and support for individuals facing the complexities of MS.

Patients should have an emergency number they should be able to call or chat (chat should be with a human) where there is an MS nurse on standby. There should also be a link to frequently asked questions and a resources page, describing in-depth what a patient should do if they believe they are relapsing. There should be an email autoresponder to reassure patients that they will be dealt with promptly.

The Impact of MS Relapses:

For those living with MS, relapses are a common occurrence, marked by the sudden onset or worsening of symptoms. These relapses can be frightening and debilitating, requiring prompt attention and intervention from healthcare professionals. The reported lack of support exacerbates the challenges that MS patients already face, potentially leading to delayed treatment and prolonged suffering.

What to Do If You Suspect an MS Relapse:

  1. Document Your Symptoms: Keep a detailed record of your symptoms, noting their onset, duration, and severity. This information can be crucial when communicating with healthcare providers.
  2. Contact Your Neurologist or MS Nurse: If you suspect you are experiencing an MS relapse, reach out to your neurologist or MS nurse as soon as possible. Provide them with documented information about your symptoms and emphasize the urgency of the situation.
  3. Persist with Communication: In cases where calls go unanswered, callbacks are not initiated, or emails remain unresponded to, persist with your attempts to communicate. Escalate your concerns to higher levels of authority within the healthcare system if necessary.
  4. Seek Alternative Channels: Explore alternative channels of communication, such as contacting your GP or visiting urgent care if the situation warrants immediate attention. Advocate for yourself and make it clear that you need prompt assistance.
  5. Engage Patient Advocacy Groups: Connect with MS patient advocacy groups that may have resources and guidance for navigating healthcare challenges. They can offer support, share experiences, and potentially assist in resolving communication issues with healthcare providers.

Accountability and Advocacy:

The reported lack of support for MS patients is a matter of great concern, raising questions about accountability within the healthcare system. Patients have a right to timely and responsive care, especially when dealing with conditions as complex as MS.

  1. Raise Official Complaints: If you have experienced difficulties in obtaining support, consider raising an official complaint with the healthcare provider. This can help bring attention to systemic issues and contribute to improvements in the delivery of care.
  2. Contact Health Ombudsman: If your concerns are not adequately addressed, you have the option to contact the Health Ombudsman. They can independently investigate complaints about public services, including those related to healthcare.
  3. Advocate for Systemic Change: Collaborate with patient advocacy groups and engage in efforts to bring about systemic change. Advocate for increased resources, better training for healthcare staff, and improved communication processes within the NHS.

Conclusion:

Living with Multiple Sclerosis is undoubtedly challenging, and patients rely on a responsive and supportive healthcare system to manage their condition effectively. The reported lack of support for MS patients is a cause for serious concern. Individuals need to advocate for themselves, document their experiences, and engage with advocacy groups to bring attention to systemic issues that may be compromising the quality of care. Accountability within the healthcare system is crucial to ensuring that MS patients receive the timely and effective support they need.

It used to be that the NHS had a dedicated MS team to answer calls but with all the public spending cuts this has been abolished and according to the MS Cardiff Website MS (Multiple Sclerosis) – Cardiff and Vale University Health Board (nhs.wales) the only way to contact them is as follows:

  1. For prescription/MRI inquiries: please ring either Lesley at 029 20748161, Gaynor at 029 21847104, or Hadiza at 029 20745735
  2. Day Unit admission or infusions/treatments: please contact our Day Unit on 029 20743280;   
  3. Other queries: please ring your Consultant’s Secretary who can either help with your query or speak to one of the Clinical Team:
  4. Carole (Dr Tallantyre / Dr Pickersgill) on 029 20745564
  5. Relina (Secretary for Professor Robertson) on 029 20745403 (works limited hours and passes you on to other people, as cited by a patient)
  6. Kate (Dr Willis) on 029 21847624

Every patient has a consultant and MS team and if the said people are out of the office who do you call?


** Disclaimer: Since publishing this article on 29th December 2023 there has been an update on the CAVUHB website and they have reinstated the MS Support Team, coincidence or what?

Please search the NHS website or your local hospital for other regions.


UPDATED CARDIFF MS SUPPORT

If you have a prescription/MRI inquiry, please ring either Lesley at 029 20748161, Gaynor at 029 21847104, or Hadiza (MS Nurse) at 029 20745735

If you have a query relating to Day Unit admission or infusions/treatments, please contact our Day Unit on 029 20743280;   

If you have any other queries, please ring your Consultant’s Secretary who can either help with your query or speak to one of the Clinical Team:

  • Carole (Dr Tallantyre / Dr Pickersgill) on 029 20745564
  • Relina (Professor Robertson) on 029 20745403
  •  Kate (Dr Willis) on 029 21847624

Citation: https://cavuhb.nhs.wales/our-services/ms-multiple-sclerosis/


Note From The Editor:

In my opinion, they should have an autoresponder email message telling you what to do if they are out of the office. Simply stonewalling does nothing for someone’s mental health. https://disabledentrepreneur.uk/what-if-your-gp-stonewalls-you/ They should have someone to answer calls 24/7 who could be on standby and pay the person by the length of time the call takes to get resolved. A patient who worries is at risk of having an MS relapse from stress. There should be someone on call even through the holidays, yet this was not the case when we tried reaching out today.


#multiplesclerosis #ms #msrelapse #neurologist #msteam #cardiffnhs #nhs #cav #uhw ##mssupport #msteam #autoimmune #autoimmunedisorder


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A Trainee Phlebotomist Caused a Hematoma

A Trainee Phlebotomist Caused a Hematoma

Hematoma: Understanding the Bruising Beneath the Skin

From the smallest bump to the most severe trauma, our bodies are remarkably adept at healing themselves. One of the body’s remarkable defense mechanisms against injury is the formation of a hematoma. But what exactly is a hematoma, and how does it play a vital role in the healing process?

Defining Hematoma

A hematoma is a localized collection of blood that pools outside the blood vessels, usually within the soft tissues of the body, such as muscles or skin. Essentially, it is a bruise beneath the skin’s surface. Hematomas can range in size from small and inconspicuous to large and painful. They typically occur as a result of trauma, injury, or surgery but can also develop spontaneously in some medical conditions.

The Mechanism of Hematoma Formation

When a blood vessel, such as an artery, vein, or capillary, is damaged due to injury, the body activates a series of processes to stop bleeding and repair the vessel. This process is known as hemostasis.

  1. Vasoconstriction: The initial response to vessel damage is vasoconstriction, where the blood vessel narrows to reduce blood flow to the injured area. This helps minimize blood loss.
  2. Platelet Activation: Platelets, small cell fragments in the bloodstream, play a crucial role in forming blood clots. They quickly adhere to the damaged vessel wall, creating a temporary plug to stop bleeding.
  3. Coagulation Cascade: A complex sequence of events known as the coagulation cascade is initiated. This process involves the activation of various clotting factors in the blood, eventually leading to the formation of a stable blood clot or thrombus.
  4. Clot Retraction: After the initial clot forms, it begins to contract or retract, pulling the edges of the damaged blood vessel together. This helps seal the vessel and prevent further bleeding.
  5. Fibrin Formation: Fibrin, a protein, forms a meshwork within the clot, further strengthening it.

Despite these intricate mechanisms, in some cases, blood can still leak out of the damaged vessel and accumulate in the surrounding tissues, leading to the formation of a hematoma.

Types of Hematomas

Hematomas can be classified into several types based on their location and the underlying cause:

  1. Subcutaneous Hematoma: These occur beneath the skin and are often visible as a bruise or discoloration. They are commonly caused by blunt trauma.
  2. Intramuscular Hematoma: These form within muscles and are typically associated with muscle injuries or strenuous physical activity.
  3. Subdural Hematoma: These are located between the brain and the protective covering (the dura) and often result from head injuries.
  4. Epidural Hematoma: These occur between the skull and the outermost layer of the brain’s protective covering (the dura) and are usually caused by severe head trauma.
  5. Intracranial Hematoma: These hematomas form within the brain tissue and can result from various causes, including head injuries or blood vessel abnormalities.

Treatment and Management

The management of a hematoma depends on its location, size, and the underlying cause. In many cases, small hematomas resolve on their own as the body reabsorbs the trapped blood. However, larger or more severe hematomas may require medical intervention.

Treatment options may include:

  1. Rest and Elevation: Elevating the affected area and resting can help reduce swelling and improve blood circulation.
  2. Cold Compresses: Applying cold compresses or ice packs to the area can help reduce pain and inflammation.
  3. Compression: In some cases, compression bandages may be recommended to prevent further bleeding and reduce swelling.
  4. Surgical Drainage: For large or deep hematomas, surgical drainage may be necessary to remove the accumulated blood and relieve pressure on surrounding tissues.
  5. Medications: In cases where blood clotting is impaired, or to prevent complications like infection, medication may be prescribed.

Medical Negligence: A Trainee Phlebotomist Caused A Hematoma

A hematoma is a common occurrence in the field of phlebotomy, and it can sometimes be an unintended outcome of the blood collection process. A trainee phlebotomist, while learning and perfecting their skills, may inadvertently cause a hematoma. Let’s explore how this can happen and what steps can be taken to minimize the risk of hematoma formation during blood collection.

  1. Needle Insertion Technique: One of the key factors in preventing hematomas is the proper technique for needle insertion. A trainee phlebotomist may sometimes insert the needle too deeply, causing damage to not only the vein but also the surrounding tissues. This can lead to blood leaking out of the vein and into the surrounding tissue, resulting in a hematoma.
  2. Vein Selection: Choosing the right vein is crucial. A trainee phlebotomist might select a vein that is too small, fragile, or prone to rolling. This can make it more challenging to successfully access the vein and increase the risk of hematoma formation.
  3. Needle Positioning: The angle at which the needle is inserted matters. If the needle is not inserted at the correct angle, it can increase the likelihood of vein puncture and hematoma.
  4. Failure to Release Tourniquet: Leaving the tourniquet on for an extended period can cause blood to pool in the vein, increasing the risk of hematoma when the tourniquet is finally released.
  5. Improper Pressure Application: After withdrawing the needle, it’s essential to apply adequate pressure to the puncture site to help prevent blood from leaking into the surrounding tissue. A trainee phlebotomist may not apply sufficient pressure, leading to hematoma formation.
  6. Inadequate Observation: Monitoring the patient for signs of hematoma during and after the procedure is crucial. A trainee phlebotomist may not be experienced enough to recognize the early signs of a hematoma developing.

Minimizing the Risk of Hematomas in Phlebotomy:

To reduce the risk of hematoma formation during blood collection, trainee phlebotomists should follow these best practices:

  1. Proper Training: Thorough training and supervised practice are essential for phlebotomy students. This includes learning proper techniques for needle insertion, vein selection, and patient care.
  2. Vein Assessment: Before attempting venipuncture, assess the patient’s veins carefully. Choose a suitable vein that is visible, palpable, and less likely to roll.
  3. Correct Needle Angle: Ensure that the needle is inserted at the appropriate angle (usually around 15-30 degrees) to minimize the risk of vein damage.
  4. Tourniquet Control: Use the tourniquet judiciously, and release it promptly once the vein is accessed and blood begins to flow.
  5. Proper Pressure Application: After needle removal, apply gentle pressure to the puncture site with gauze or a cotton ball, holding it in place for a sufficient amount of time to allow the vein to seal.
  6. Patient Education: Communicate with the patient throughout the process, explaining what is happening and what they can expect. Reducing anxiety can help minimize patient movement, which can contribute to hematoma formation.
  7. Post-Procedure Observation: After blood collection, monitor the puncture site for any signs of hematoma formation and take appropriate action if necessary.

Understanding the Risks of Thrombotic Thrombocytopenic Purpura (TTP) and Hematoma

Thrombotic Thrombocytopenic Purpura (TTP) and hematoma are distinct medical conditions, each with its own set of risks and implications. However, they can be interconnected in certain scenarios, especially when TTP affects the blood’s ability to clot properly. Let’s explore these two conditions and their associated risks.

Thrombotic Thrombocytopenic Purpura (TTP):

TTP is a rare and potentially life-threatening blood disorder characterized by the formation of small blood clots throughout the body. It primarily affects the smallest blood vessels, leading to a cascade of health issues. TTP is caused by a deficiency of a specific enzyme called ADAMTS13, which is responsible for breaking down a large protein called von Willebrand factor (vWF). Without sufficient ADAMTS13, vWF accumulates, leading to abnormal blood clot formation.

Risks of TTP:

  1. Clot Formation: The hallmark of TTP is the formation of microclots in small blood vessels throughout the body. This can lead to organ damage and dysfunction, as the clots impede blood flow to vital organs like the brain, kidneys, and heart.
  2. Bleeding Tendency: Paradoxically, even though TTP is characterized by clot formation, it can also cause a decrease in platelet count (thrombocytopenia), leading to an increased risk of bleeding. This dual risk of clotting and bleeding makes TTP a challenging condition to manage.
  3. Organ Damage: When clots disrupt blood flow to organs, it can result in damage and failure. For example, TTP-induced clots in the brain can cause strokes, while those in the kidneys can lead to kidney dysfunction.
  4. Neurological Complications: TTP can lead to neurological symptoms, including confusion, weakness, and even coma, due to the impact of clots on the brain.

Risks of Hematoma:

  1. Pain and Swelling: Hematomas can cause significant pain and swelling at the site of the injury. This can interfere with the function of the affected body part and disrupt daily activities.
  2. Infection: There is a risk of infection if the hematoma breaks through the skin or if the injury that caused the hematoma is contaminated.
  3. Compartment Syndrome: In severe cases, a hematoma can cause increased pressure within the affected area, known as compartment syndrome. This can lead to tissue damage and impaired blood flow, necessitating immediate medical attention.
  4. Secondary Complications: Depending on the location and size of the hematoma, it can lead to secondary complications. For example, a hematoma near a joint may result in limited mobility.

The Connection Between TTP and Hematoma:

While TTP primarily involves abnormal clot formation within the bloodstream, it can impact the body’s overall ability to regulate clotting and bleeding. In some cases, individuals with TTP may be at an increased risk of both bleeding and clotting disorders. This dual risk might predispose them to the formation of hematomas, particularly if they experience trauma or injury.

Managing TTP typically involves therapies to suppress abnormal clot formation, such as plasma exchange and medication. In individuals with TTP, healthcare providers must carefully assess and address the risks of both bleeding and clotting to provide effective treatment.

Immune Thrombocytopenia (ITP)

ITP, or Immune Thrombocytopenia, is a medical condition characterized by a low platelet count in the blood. Platelets are a type of blood cell that plays a crucial role in blood clotting, and a low platelet count can lead to bleeding and easy bruising.

In ITP, the immune system mistakenly targets and destroys platelets as if they were foreign invaders. This is typically due to an autoimmune response, where the body’s immune system attacks its own healthy cells and tissues. In the case of ITP, it is believed that antibodies produced by the immune system bind to platelets, marking them for destruction by the spleen or other immune cells.

The exact cause of ITP is not always clear, but it is often considered an autoimmune disorder. It can occur in isolation, known as primary or idiopathic ITP, where there is no underlying cause, or it can be secondary to other autoimmune disorders or conditions such as lupus, rheumatoid arthritis, or certain infections.

The symptoms of ITP can vary from mild to severe and may include:

  1. Easy bruising.
  2. Prolonged bleeding from small cuts.
  3. Petechiae (small red or purple spots on the skin).
  4. Nosebleeds.
  5. Blood in the urine or stools.
  6. Heavy menstrual periods.
  7. In severe cases, internal bleeding can be life-threatening.

Treatment for ITP may vary depending on the severity of the condition. Some individuals with mild ITP may not require treatment and can be managed through regular monitoring. In more severe cases or when bleeding symptoms are significant, treatment options may include:

  1. Corticosteroids to suppress the immune response.
  2. Intravenous immunoglobulin (IVIG) to temporarily raise platelet counts.
  3. Platelet transfusions in cases of severe bleeding.
  4. Medications that affect the immune system, such as rituximab or thrombopoietin receptor agonists.
  5. In extreme cases, surgery to remove the spleen (splenectomy) may be considered.

Managing ITP with an underlying autoimmune disorder may involve treating the primary autoimmune condition as well. It’s essential for individuals with ITP to work closely with their healthcare team to determine the most appropriate treatment plan based on their specific circumstances and symptoms.

Both ITP (Immune Thrombocytopenia) and hematomas involve issues related to blood clotting and can carry certain risks:

Risks of ITP (Immune Thrombocytopenia):

  1. Bleeding: The primary risk associated with ITP is bleeding due to a low platelet count. Platelets are essential for normal blood clotting, and when their numbers are low in ITP, there’s an increased risk of spontaneous bleeding, such as nosebleeds, gum bleeding, easy bruising, and, in severe cases, internal bleeding.
  2. Severe Bleeding Episodes: In severe cases of ITP, there is a risk of life-threatening bleeding, such as gastrointestinal bleeding or intracranial hemorrhage. These are medical emergencies and require immediate attention.
  3. Chronic Disease: ITP can become a chronic condition for some individuals, which means they may experience ongoing issues with low platelet counts and the associated risk of bleeding over an extended period.
  4. Impact on Quality of Life: Living with ITP can be challenging due to the need for frequent medical monitoring, potential treatment side effects, and lifestyle adjustments to reduce the risk of bleeding.

The risks associated with ITP and hematomas can vary depending on the severity of the condition, the individual’s overall health, and the location and size of the hematoma. It’s essential to seek medical attention and follow medical advice for both conditions to manage and reduce these risks effectively. For ITP, this may involve treatments to increase platelet counts or manage bleeding, while for hematomas, treatment may include drainage, wound care, or surgical intervention if necessary.

Personal Experience

As a multiple sclerosis sufferer who has had Alemtuzumab Treatment with regular blood tests required by law, upon visiting the hospital on Wednesday 20th September 2023 I was greeted by a trainee phlebotomist whom may I add was supervised. I did not take either of their names. I explained I have problems with my veins being too thin, The trained phlebotomist looked at my arm and told the trainee phlebotomist to try the fatter vein, after a bit of poking and prodding the needle the trainee nurse took out the needle after several times going in a different direction and with a bit of perseverance she managed to draw blood. When she finally took the needle out this resulted in my arm bruising and swelling to the point it was extremely painful.

If the test tube is not removed when the needle comes out, it can cause a number of issues. For instance, the blood sample may clot inside the tube, making it difficult to extract the required amount of blood for testing. In some cases, if the needle is withdrawn too quickly, it can cause a hematoma. Hematomas can be painful and may require medical attention if they are large or do not resolve on their own.

I did have an independent nurse and pharmacist look at it afterward (not from the hospital) and both agreed it was really bad.

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I realize the hospital (UHW) is a teaching hospital but the departments should get the patient’s permission first before letting trainee doctors/nurses and phlebotomists train on a patient. I was never informed until after the fact and by that time it was too late. Had I known from the start a trainee phlebotomist would be taking my blood I would have refused. This is not the first time I have had a hematoma.

My arm a week later is still bruised and swollen. This is a lesson learned. I would like to add I do not hold a grievance to the trainee phlebotomist but with my history of blood tests proving difficult, I would expect a professional fully trained nurse to take my blood.

Conclusion

Hematomas are a natural part of the body’s response to injury and play a crucial role in the healing process. While they can be painful and concerning, most hematomas resolve with time and appropriate care. However, it is essential to seek medical attention if you suspect a severe hematoma, especially if it is associated with head trauma, as prompt treatment may be necessary to prevent complications. Understanding how hematomas form and the importance of their role in the healing process can help individuals make informed decisions about their care when faced with these common injuries.

It’s important to remember that hematoma formation is a potential risk in phlebotomy, even for experienced practitioners. Trainee phlebotomists should focus on learning and consistently applying proper techniques to minimize this risk and ensure safe and adequate blood collection procedures. Supervision and feedback from experienced phlebotomists are valuable tools in the learning process.

TTP and hematoma are distinct medical conditions, each associated with its own set of risks and complications. However, in some cases, individuals with TTP may be more susceptible to hematoma formation due to disruptions in their blood clotting and bleeding mechanisms. It is essential for healthcare professionals to consider these risks when managing patients with TTP and tailor treatment accordingly.

What should a patient do if a trainee phlebotomist causes a hematoma in high-risk patients who are susceptible to ITP having blood tests because of Lemtrada alemtuzumab treatment?

If a trainee phlebotomist causes a hematoma in a high-risk patient who is susceptible to ITP (Immune Thrombocytopenia) due to Lemtrada (alemtuzumab) treatment, it is crucial for the patient to take the following steps:

  1. Notify the Phlebotomist: Immediately inform the phlebotomist about the hematoma and any discomfort or pain you may be experiencing. They need to be aware of the issue to provide assistance and documentation.
  2. Apply Pressure: If the hematoma is actively bleeding or swelling, gently apply pressure to the area with a clean cloth or sterile gauze to help control bleeding and minimize the size of the hematoma. Do not press too hard, as this could exacerbate the issue.
  3. Elevate the Affected Area: If possible, keep the affected limb elevated. Elevating the area can help reduce swelling and minimize further blood accumulation in the hematoma.
  4. Seek Medical Attention: Given the patient’s susceptibility to ITP and the potential complications associated with hematoma, it is advisable to seek immediate medical attention. This is especially important because ITP is a condition characterized by abnormal clot formation and bleeding tendencies, and it could be exacerbated by a hematoma.
  5. Notify Healthcare Provider: Contact the healthcare provider responsible for managing your Lemtrada treatment. Inform them of the situation, including details about the hematoma and any symptoms you are experiencing. They may need to adjust your treatment plan or monitor your condition closely.
  6. Follow Medical Advice: Follow the guidance provided by your healthcare provider regarding the management of the hematoma and any potential treatment adjustments necessary to mitigate the risk of ITP.
  7. Document the Incident: Keep detailed records of the hematoma incident, including the date, time, and name of the phlebotomist involved. This documentation may be valuable for future reference, especially if it leads to complications related to your ITP susceptibility or Lemtrada treatment.
  8. Consider Future Precautions: Discuss with your healthcare provider and the phlebotomy department whether any additional precautions or modifications to the blood collection process are necessary to minimize the risk of hematoma formation during future blood tests. This could include using experienced phlebotomists or employing alternative blood collection methods.

It is essential to prioritize your health and safety in this situation, especially if you are a high-risk patient with ITP susceptibility due to Lemtrada treatment. Prompt and effective communication with healthcare providers is critical to ensure that any potential complications are addressed promptly, and your treatment plan is adjusted as needed.

Photographic Evidence

Further Reading

Lemtrada (alemtuzumab) | MS Trust

Relapsing MS Infusion Treatment: LEMTRADAÂź (alemtuzumab)

Immune Thrombocytopenic Purpura (ITP) | Patient

Thrombotic Thrombocytopenic Purpura (also known as ‘TTP’) | CUH

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