Bethan Myers

Bethan Myers
University Hospitals Of Leicester NHS Trust | UHL · Department of Haematology

MB BCh MA FRCP FRCPath

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97
Publications
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Publications

Publications (97)
Article
Full-text available
Familial Platelet Disorder with associated Myeloid Malignancy (FPDMM) is a rare inherited disorder confirmed with the presence of a pathogenic germline RUNX1 variant and is thought to be heavily underdiagnosed. RUNX1 has also been found to be mutated in up to 10% of adult AML cases and other cell malignancies. We performed targeted next-generation...
Article
Bleeding diatheses due to platelet-related disorders can present challenges to treating clinicians, especially in the context of peri- and post-partum patients in the obstetric setting. Thrombocytopenia and Absent-Radii syndrome (TARS) is an inherited disorder characterized by reduced bone marrow platelet production, skeletal deformities affecting...
Article
Eosinophilic gastrointestinal disease (EGID) encompasses several conditions including eosinophilic oesophagitis, gastritis, colitis and gastroenteritis (EG)(¹). An increase in eosinophils in the gastrointestinal mucosa is a core diagnostic criterion. The symptoms of EGID (other than eosinophilic oesophagitis), are nausea and vomiting, bloating, alt...
Article
Full-text available
Background As pregnancy is a physiological prothrombotic state, pregnant women may be at increased risk of developing coagulopathic and/or thromboembolic complications associated with COVID-19. Methods Two biomedical databases were searched between September 2019 and June 2020 for case reports and series of pregnant women with a diagnosis of COVID...
Article
Full-text available
Background Hereditary Alpha-Tryptasemia (HAT) is a genetic trait caused by an increased alpha-tryptase TPSAB1 gene copy number. Basal serum mast cell tryptase is typically ≥8.0ng/ml. Objectives To study the clinical disease spectrum of HAT and determine its UK prevalence. Methods Droplet digital PCR was used to determine TPSAB1 copy number in 432...
Article
Background The currently published population pharmacokinetic (PK) models used for PK-guided dosing in hemophilia patients are based on clinical trial data and usually not externally validated in clinical practice. The aim of this study was to validate a published model for recombinant factor VIII-Fc fusion protein (rFVIII-Fc) concentrate and to de...
Poster
Full-text available
Extended half-life coagulation factor concentrates (EHL-CFC) were introduced into routine clinical care in the UK in the last quarter of 2016. Thus far, data on patients switched to EHL-CFCs have only been collected through participants in clinical trials. The UK EHL Outcomes Registry was established to systematically collect real-world data on all...
Article
Full-text available
Heavy menstrual bleeding (HMB) is often undiagnosed in women and can cause discomfort and distress. A haemostatic cause for excessive bleeding is often not routinely investigated and can lead to hysterectomy at an early age. A prospective cohort study was carried out to determine whether certain patients with unexplained HMB have an underlying plat...
Chapter
Factor XI (FXI) is a glycoprotein that circulates as two identical subunits. Factor XI deficiency is a bleeding disorder with a complex autosomal inheritance pattern, with both recessive and dominant forms. As the genitourinary system is an area of high fibrinolytic activity, menstruation is an inherent challenge to women with FXI deficiency. Women...
Article
Full-text available
Background Inherited thrombocytopenias (ITs) are a heterogeneous group of disorders characterized by low platelet counts and often disproportionate bleeding with over 30 genes currently implicated. Previously the UK‐GAPP study using whole exome sequencing (WES) identified a pathogenic variant in 19 of 47 (40%) patients of which 71% had variants in...
Article
Women of child‐bearing potential are increasingly treated with direct oral anticoagulants (DOACs) for venous thrombo‐embolism, and so the impact on abnormal vaginal bleeding is an important topic to consider. This adverse event in women taking anticoagulants may result in discontinuation, leading to recurrent venous thrombosis. This issue includes...
Article
Full-text available
Antithrombin deficiency is identified as one of the most potent risk factors for venous thromboembolism during pregnancy. Therapeutic low molecular weight heparin is recommended, but it can be difficult to attain sufficient anticoagulation since low molecular weight heparin requires antithrombin to exert its anticoagulant effect. We carried out a m...
Article
Abstract watch Direct oral anticoagulants: impact on young women A review of three articles on this topic
Article
Full-text available
Direct oral anticoagulants (DOACs or NOACs -non-vitamin K oral anticoagulants), as the name suggests, are oral anticoagulants with a direct inhibitory action either against factor X or factor II (thrombin). Pregnant women were excluded from participating in all the large trials of the DOACs and they are considered contra-indicated in pregnancy and...
Article
Introduction Since the introduction of a venous thromboembolism (VTE) risk assessment tool in 2011 there has been an increase in the workload of the combined Obstetric-Haematology clinic. In view of this increase a retrospective review of the size and composition of clinics during the first 12 weeks of 2011 and 2012 was carried out. Method Clinic l...
Article
Full-text available
Background: Iron-deficiency anaemia is common in pregnancy, with well-described maternal morbidities. When oral iron therapy has failed, intravenous (IV) preparations are considered. Ferric carboxymaltose (ferinject) is a new IV preparation which can be given quickly. There are no published data on Ferinject use in pregnancy. This study analyses h...
Article
Thrombocytopenia is a common finding in pregnancy, occurring in approximately 710% of pregnancies. It may be a diagnostic and management problem, and has many causes, some of which are specific to pregnancy. Although most cases of thrombocytopenia in pregnancy are mild, and have no adverse outcome for either mother or baby, occasionally a low plate...
Article
Neonatal alloimmune thrombocytopenia (NAIT) is caused by maternal alloantibodies directed against fetal paternally derived platelet-specific antigens destroying fetal platelets. We present a patient (HPA-1a negative platelets with genotype 1b/1b) with NAIT complicated by significant obstetric and psychiatric history. A 32-year-old woman with a hist...
Article
Full-text available
Iron deficiency is the most common deficiency state in the world, affecting more than 2 billion people globally. Although it is particularly prevalent in less-developed countries, it remains a significant problem in the developed world, even where other forms of malnutrition have already been almost eliminated. Effective management is needed to pre...
Article
Key content: • All the major heritable thrombophilias have been found to be significantly associated with increased risk of venous thromboembolism, but the absolute risk remains low. • The association of heritable thrombophilias with adverse pregnancy outcomes remains controversial. • Testing for thrombophilias should only be performed when this ma...
Article
With the rising prevalence of kidney disease, clinicians are increasingly faced with concerns about potential thrombotic and bleeding complications. Thrombotic risk, both arterial and venous, predominates with all severities of kidney disease but bleeding manifestations become an additional concern particularly with uraemia. This article reviews th...
Article
Full-text available
Thrombocytopenia is a common finding in pregnancy, occurring in approximately 7–10% of pregnancies. It may be a diagnostic and management problem, and has many causes, some of which are specific to pregnancy. Although most cases of thrombocytopenia in pregnancy are mild, and have no adverse outcome for either mother or baby, occasionally a low plat...
Article
• Thrombocytopenia occurs in 8–10% of all pregnancies.• In pregnancy it is usually mild and benign.• Rare causes can be associated with severe complications for mother and baby.• Cases thought to be due to immune thrombocytopenic purpura or microangiopathic processes should be managed in a specialist centre.Learning objectives: • To learn about the...
Article
The aim of this study was to evaluate the maternal platelet count in women diagnosed antenatally with thrombocytopenia (platelet count < 100) from any cause, neonatal outcome, and, where available, the corresponding neonatal platelet count. The authors wanted the information in our population to guide us in the following: (1) for antenatal counsell...
Article
Full-text available
Anaemia is a common problem in surgical patients. Patients with critical limb ischaemia (CLI) suffer chronic inflammation, repeated infection, require intervention, and can have a protracted hospital stay. The aims of this study were to assess anaemia and nutritional status in patients presenting with CLI. Two observational studies were undertaken,...
Chapter
IntroductionHeparinsOther agentsThromboprophylaxis of VTETreatment of VTEManagement of APSPrevention of pregnancy complications associated with thrombophiliasManagement of anticoagulant therapy in patients with prosthetic heart valvesConclusion References
Article
Full-text available
We observed previously that the extent of ADP-induced platelet aggregation in blood from patients with leucocytosis is markedly reduced. We obtained evidence that this is via enhanced ADP metabolism consequent to the high leucocyte count, and speculated that ecto-NTPDase CD39 on leucocytes may be involved. Here we have investigated the association...
Article
Although efficacy of thalidomide (thal) monotherapy in relapsed/refractory Multiple Myeloma (MM) is proven, the optimal duration of treatment is unknown. Here, we analysed individual patient data of 852 patients (pts.) with relapsed/refractory MM from 21 centres who received thal monotherapy in a trial or in a compassionate use program. To assess t...
Article
Pregnancy complications in women with Factor XI deficiency were assessed in this retrospective analysis. All nonnulliparous women registered with Factor XI deficiency in the East Midlands region were included. Each woman was classified into 'bleeder' or 'nonbleeder'. Rates of antenatal and postnatal bleeding and miscarriage rate were recorded. A to...
Article
Full-text available
We evaluated the combination of thalidomide, pulsed dexamethasone and weekly cyclophosphamide (CTD) for the treatment of patients with newly diagnosed, relapsed or VAD-refractory multiple myeloma. We found that this combination was highly effective in inducing responses in all treatment groups with an overall response rate of 83.8%. CTD was well to...
Article
Systemic mastocytosis is characterised by proliferation of mast cells and infiltration of organs. Severe bony pain may result from release of chemical mediators from mast cells and affected patients are at an increased risk of anaphylaxis. Traditional analgesics such as non-steroidal anti-inflammatory agents and opioids are contraindicated. Diagnos...
Article
We report on three cases of Guillain-Barré syndrome (GBS) occurring in patients with myelodysplasia, two with autoimmune manifestations. In two cases the myelodysplasia was diagnosed during the treatment of the GBS, while in the third case the myelodysplasia preceded its diagnosis. We discuss possible underlying mechanisms for the previously unrepo...
Article
A 31-year-old man developed a widespread, non-pruritic rash. Ten years later, he saw his general practitioner with multiple symptoms, including weight loss of 12 kg, back pain, episodic bronchospasm and intermittent vomiting. Gastroscopy demonstrated antral gastritis. He was subsequently referred for haematological assessment. His rash, urticaria p...
Article
We describe a case where danaparoid was used prophylactically in a high-risk twin pregnancy following the development of heparin-allergy while on prophylactic dalteparin. Danaparoid was substituted for dalteparin at 20 weeks of pregnancy following the development of a severe skin reaction while on the low molecular weight heparin. Although there wa...
Article
A4-year old girl was transferred from a local district general hospital with a presumptive diagnosis of acute lymphoblastic leukaemia. She had been referred with coryzal symptoms and recurrent epistaxes for 6 months. Her parents had noticed pallor, lethargy and anorexia.
Article
beta 2 glycoprotein 1 (beta2GP1) is a phospholipid-binding protein implicated in the development of antiphospholipid antibodies, associated with thromboembolic complications and fetal morbidity and death, and is thought to corrrelate better than anticardiolipin (aCL) assays. We analysed the role of beta2GP1 in assessing 86 patients being investigat...
Article
We present an unusual case of post-renal transplant 'erythrocytosis' in a patient with sickle-cell anaemia, who had developed renal failure following the effects of a phaeochromocytoma. Prior to transplantation, the patient had experienced only occasional crises. However, post-transplant, he experienced multiple and varied crises, associated with a...
Article
We report a case of strongyloides infection in a 72-year-old man presenting with acute angio-oedema and urticaria. He was also found to have natural killer cell (NK) large granular lymphocytosis (LGL). We discuss the possible relationship between the strongyloides infection and the NK-LGL lymphocytosis.
Article
Relapsing polychondritis (RP) is a rare multisystem disorder. We describe two case reports of patients with RP, one of whom developed myelodysplasia subtype refractory anaemia (RA) and the other, refractory anaemia with ringed sideroblasts (RARS). We also review the literature of association between RP and haematological disorders.
Article
A 14-year-old boy, with acquired haemolytic anaemia secondary to paravalvular leak from a prosthetic aortic valve, presented with severe pancytopenia. Subsequent investigation showed serological evidence of recent parvovirus B19 infection. The patient required transfusion and subsequently improved rapidly, with maintenance of pre-infective haemoglo...
Article
Transmission of hepatitis C virus (HCV) is an important hazard of blood transfusion and may result in chronic liver disease. 98 children from Nottingham and Sheffield with haematological malignancies were studied to determine the prevalence of HCV infection by enzyme immunoassay and RT/PCR techniques. The children had been exposed to up to 184 dono...
Article
Men with indwelling catheters and men and women with suprapubic catheters were studied in their homes. Urine and blood were cultured and body temperature recorded after every catheter change. Nearly all patients had infected urine after 4 weeks of catheterisation, and all had bacteriuria after longer periods, usually with a mixture of organisms. Cu...
Article
Full-text available
In six healthy subjects serum concentrations of 5 amino salicylic acid (5ASA) and acetyl 5ASA were measured for up to 24 hours, and urinary excretion over 48 hours. After an intravenous injection of 3.26 mmol 5ASA serum concentrations fell rapidly with a distribution half-life of 17 +/- 2 min and an elimination half-life of 42 +/- 5 min. After 45 m...
Article
A patient with nephritic factor in the serum following an attack of disseminated herpes is described. In the majority of cases, the factor is associated with mesangio-capillary glomerulonephritis, with or without partial lipodystrophy. It has, however, been described in cases of partial lipodystrophy alone, in one patient with recurrent pyogenic in...
Article
A retrospective study was carried out on 119 Caucasians who were admitted to the Hospital for Tropical Diseases, London, for investigation of eosinophilia on return from the tropics. In 46 patients (38.7%) a definite parasitological diagnosis was made, and in all those followed up eosinophilia decreased with appropriate chemotherapy. In those patie...
Article
The effect of pretreatment with topical prostaglandin E2, prednisolone and sulphasalazine in experimental colitis has been examined in the rat colon. Only prostaglandin E2 treatment significantly reduced mucosal ulceration. Long-term exposure of the rat colon to topical ethanol produced some of the histological changes seen in human colitis.