A PE is usually diagnosed by special x-rays (CT scan) that identify the blood clot blocking the blood vessel in the blood vessels of the lungs. Other techniques use special radioactive dye to look at the blood flow of the lungs. Additional tests that may be helpful include blood tests and tracings of the rhythm of the heart (ECG).

Usually people get PE for the same reason blood clots occur in other parts of the body. Some factors for getting a blood clot in the body include:

• Hospitalisation for a medical illness
• Recent major surgery or injury
• Previous history of DVT / PE
• Known personal history or a family history of a clotting disorder
• History of active cancer and concurrent cancer therapy
• Pregnancy and first 6 weeks after delivery
• Smoking
• Hormone replacement therapy or high dose combined oral contraceptive pill
• Being overweight or obese
• Prolonged sitting (greater than 6 to 8 hours)

A PE is treated with blood thinning (anticoagulation).

Anticoagulation is important to prevent any further blood clots from developing and may also assist in reducing the size of blood clots that have already formed. If the blood clot is particularly large and blocking a lot of blood flow to the lung, a special medication given by the intravenous drip can be given to dissolve the blood clot. This medication (called lytic therapy) needs to be given in hospital and is associated with a significant risk of bleeding.

Often blood thinning can be started and continued to be given as an outpatient with injections under the skin (low molecular weight heparin – Clexane). Patients will usually then need to start on tablets (Warfarin) XXXX and continue anticoagulation treatment.

This will depend on why you develop the blood clot in the first place. If the blood clot occurred in the setting of surgery or a known risk factor that is no longer present you may need six months blood thinning.

If a risk factor is not identified and your doctor thinks you may be at risk of developing further PE, a longer period of blood thinning may be needed.

Some people stay on blood thinning for a very long time because of they have a high risk of developing further PE. It is important for you to discuss this with your doctor.

HS is relatively common – around 1 person in every 5000 people has HS (around 800 people in Melbourne; population 4 million).

There are three main common problems associated with having HS:

There is another uncommon potential problem for people who have Hereditary Spherocytosis associated with a viral infection called “Slapped cheek”. Slapped cheek is caused by a virus called Parvovirus which can infect bone marrow cells and put the red cell producing cells “to sleep”. Because patients with HS need the bone marrow to be rapidly replacing the fragile red cells, this infection can cause a severe anaemia; patients can become very pale and sometimes even require blood transfusions. Fortunately this problem is uncommon.

HS is now diagnosed with a simple blood test. It is also important for a doctor to examine patients with HS to see if they are jaundiced or have an increase in the size of the spleen.

Most patients with HS do not need to do much about their condition at all. The bone marrow has the capacity to increase the number of red cells it produces many fold and is able to keep up replacing the fragile cells.

A few things may be helpful:

Removing the spleen (splenectomy) has been used a lot in the past in the treatment and management of patients with HS; it stops the red cells from breaking down and solves the problems of HS.

Removing the spleen has problems however – the spleen is an important organ in the immune system and patients who do not have a spleen may be prone to getting serious infections. This risk is higher in younger children but may be less than previously expected because of newer vaccinations. It is now generally recommended to avoid splenectomy in children younger than 6 years and to ensure that children who may need a splenectomy have all the appropriate vaccinations.

Another approach for some of these young patients is to remove only a small part of the spleen – partial splenectomy. This is done in a few hospitals and there is some experience to say this may be very helpful for some patients.