Haematology

Iain and Simon review May 2020 on St Emlyn's, including COVID-19 research discussions and venous thromboembolism resources. The written episode notes also connect global health, race and inequality with reflections on privilege and the perspectives emergency clinicians bring to their work.

Dan Horner examines the difficulties of diagnosing and treating venous thromboembolism in COVID-19 in May 2020. The review considers D-dimer, imaging, screening effects and possible immunothrombosis, weighing uncertain treatment benefits against bleeding risks while randomised trial results were still awaited.

Dan Horner reviews the 2020 NICE guidance on diagnosing and managing venous thromboembolism. The article discusses PERC, age-adjusted D-dimer, outpatient pulmonary embolism care and anticoagulant choices, including cancer-associated VTE, with attention to patient selection, bleeding risk and questions outside the guideline's scope.

An April 2020 critical appraisal of early reports linking COVID-19 with thrombosis and raised D-dimer. Dan Horner questions incidence estimates, composite outcomes and claims about heparin, explaining why observational associations alone could not settle the benefits and harms of intensified anticoagulation.

Could arginine vasopressin reduce blood-product requirements after major traumatic haemorrhage? This appraisal reviews a small single-centre randomised trial, examining reduced transfusion use alongside the lack of a demonstrated mortality benefit and the limits of applying its findings to a broader trauma population.

Can clinical probability guide D-dimer thresholds and reduce imaging for suspected pulmonary embolism? Dan Horner appraises the PEGeD management study, examining follow-up outcomes, assay units, possible selection bias and the limited evidence for moderate-risk patients, with a perspective on applying the findings in different settings.