The newly classified entity of vaccine induced thrombocytopenia and thrombosis (VITT) following AstraZeneca Vaccination is an area of ongoing investigation. The underlying pathophysiology is considered to have pathological similarities to heparin induced thrombocytopenia (HIT). It is unclear which cohorts may be particularly susceptible to developing VITT. In view of the underlying mechanism of action we undertook a retrospective analysis of patients with a history of HIT to assess whether they had been vaccinated and to assess whether any patients had experienced adverse reactions to the AstraZeneca vaccination. 20 out of 60 patients with a confirmed history of HIT received the AstraZeneca vaccination and none of these reported any features suggestive of VITT.

Philadelphia chromosome negative myeloproliferative neoplasms (MPN) are clonal haematopoietic stem cell disorders. Of the MPNs, polycythaemia vera (PV) and essential thrombocythaemia (ET) confer a high thrombotic risk which may be the presenting feature of the disease. Thrombotic complications consist of both arterial and venous events and the presence of the JAK2 V617F mutation is associated with higher risk. Patients presenting with an unprovoked thrombus, particularly at an unusual site, e.g., splanchnic circulation, should be screened for the presence of this mutation. Historically, warfarin has been the only option for oral anticoagulation; however, there is now increasing evidence and practise to use direct oral anticoagulants (DOACs) in cancer. The seminal randomised control trials have demonstrated non-inferiority compared to low molecular weight heparin (LMWH) with a preferable bleeding profile. DOACs are now the first line treatment for atrial fibrillation and venous thromboembolic disease, as recommended by NICE, and therefore there is increasing familiarity with these agents. Furthermore, there are now targeted antidotes available. This paper reviews evidence for efficacy and safety of DOACs in MPN. Whilst no randomised control trials have been performed, several retrospective studies and reviews of registry data have reproducibly demonstrated that, alongside cytoreduction, DOACs represent an effective modality of anticoagulation for treatment of venous thromboembolism in MPN. Furthermore, dosing regimens provide the option for longer term secondary prophylaxis. Use of DOACs in arterial thrombosis is an area for future development and there is already some evidence for utility in peripheral vascular disease.

A case report of a young, healthy female who presented as an emergency with large bowel obstruction secondary to a rectosigmoid tumour. Acute presentation was preceded by a progressive history of change in bowel habit managed medically in the community with laxative treatment. The family history of note included breast cancer of an identical triplet aged 41 years. An emergency Hartman's procedure was successfully performed the same day as presentation due to the high risk of perforation. The patient was discharged home within a week. Histology confirmed adenocarcinoma, Dukes’ Stage C and oncologists have now taken over care of the patient. Discussion points explore whether it is appropriate to refer a young healthy patient presenting with a change in bowel habit if she is resistant to medical management in the community and in the absence of other red flag symptoms. The family history of malignancy and genetic associations are also considered.