13 June 2023
In this month's spotlight blog, we delved into the world of hemophagocytic lymphohistiocytosis, also known as HLH.
We spoke to Mariam Maliak, an acting consultant in rheumatology and general internal medicine, and Mostafa Meshaal Ahmad, a specialty trainee doctor in rheumatology and general internal medicine, who touched on the HLH material and the podcast
Why do you think it is important to have a spotlight on HLH?
Mostafa: HLH is an under-recognised condition. I remember the first case that I dealt with was puzzling, and no one had a clue what was happening. I didn’t have previous knowledge of this case, but trying to connect the dots, I came across this diagnosis and found the case ticked all the boxes, and this was a revelation. It was so rewarding to see the case responding to treatment and turning the corner.
HLH has become something I always keep in my mind when dealing with acutely unwell patients with unexplained fever, deranged liver functions, and falling counts. This helped me to pick up more cases and start treatment early.
Mariam: HLH is an interesting topic and a potentially life-threatening condition. Early detection and treatment is important, and the spotlight helps to highlight this and understand the condition.
What does the HLH spotlight cover?
Mariam: The HLH spotlight covers the basics of HLH, risk factors, and causes, investigations, and management – particularly for rheumatological causes.
In the podcast, the expert speaker Dr Jessica Manson, talks about the National HLH MDT in London and shares her tips in the diagnosis and management of HLH. The spotlight also includes an interesting e-learning case, webinars, and links to journal articles that all help understand the complex condition.
Mostafa: I am delighted to say that we have a variety of high-quality content, including fantastic webinars, a very practical podcast, an interesting interactive case, and an infographic. So, watch this space!
Can you summarise some key findings on the spotlight podcast for HLH?
Mariam: Think about HLH! Early detection and treatment is key! Remember to check ferritin in acutely unwell patients with fever and look for falling cell counts. Calculate the H score. There are several causes.
Don’t forget the role of MDT, ask for help if needed, London HLH MDT can be contacted if support is needed.
Mostafa: HLH should be kept in your mind when dealing with acutely unwell patients presenting with unexplained fever, deranged liver functions, and falling blood counts.
Get urgent ferritin and calculate the H Score. Be aware that ferritin may not be initially as high as expected.
Furthermore, remember to switch off the inflammation while simultaneously searching for and treating the underlying cause.
Finally, when you get the satisfying feeling of picking up the diagnosis and saving lives, remember to share the learning points and raise awareness!
Did you enjoy working on the HLH spotlight?
Mariam: Absolutely! I love working for the digital learning board and enjoy my role. Podcasts are great and I really enjoy working on the spotlights. I found the process very straightforward. I have had help from the BSR team regarding setting up the link for the podcasts which is helpful. The team is great!
Mostafa: Certainly! Getting involved in this spotlight was a great way to have a deeper understanding of the subject. I am so glad that I am participating in producing teaching materials and raising awareness about this potentially life-threatening condition.
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Listen to the HLH podcast below: