A 64-year-old woman with a medical history of alcoholic cirrhosis(diagnosed 7 months prior), monoclonal gammopathy, and hemochromatosis presented to the emergency department with abdominaldiscomfort, general weakness and loss of appetite. On admission,laboratory analysis revealed a mild macrocytic anaemia (haemoglobin10.2 g/dL), high total bilirubin (4.9 mg/dL), and normal lactate dehydrogenase (193 U/L) levels. During the consecutive days, an ongoingdecline in haemoglobin levels (nadir on day 7: 7.4 g/dL) was notedin parallel with a rise in reticulocyte counts (day 7: 38/103 RBC),total bilirubin (day 7: 9.3 mg/dL) and lactate dehydrogenase (day7: 329 U/L) levels.

The COVID-19 pandemic has disturbed medical training. Haematology registrars were surveyed using SurveyMonkey. Eighty-nine out of 269 (24.9%) responded. Reported stressors included concerns about transmitting the infection, disruption of leave, inferior patient outcomes, survivors’ guilt and interruption of career progression. Only 31.2% felt ready to progress to the next training stage. Reported causes of lack of training were disruption of clinics and training days and utilisation of telephone consultations. Several stressors negatively impacted haematology registrars’ well-being, training and progression. More emphasis on psychological support, outpatient clinic work and e-learning is needed.

Multiple myeloma is characterized by chromosomal abnormalities and genetic variation, which may inform prognosis and guide treatment. This pilot study sought to examine the feasibility of incorporating Whole Genome Sequencing (WGS) alongside the routine laboratory evaluation of 14 patients with newly diagnosed multiple myeloma who had enrolled in the 100,000 Genomes Project. In all 14 cases, WGS data could be obtained in a timely fashion within existing clinical frameworks in a tertiary hospital setting. The data not only replicated standard-of-care FISH analysis of chromosomal abnormalities but also provided further chromosomal and molecular genetic insights that may influence patient management.

A 61-year-old man diagnosed with primary central nervous systemlymphoma (PCNSL) was admitted to our hospital for the second cycleof rituximab, methotrexate, procarbazine, and vincristine (R-MPV)treatment. On day 6 of the second cycle of R-MPV, erythema nodosumlesions emerged at his left leg and right wrist joint, and then disappeared after initiation of loxoprofen sodium hydrate. No fever wasobserved in the first or second cycle of R-MPV. On day 1 of the thirdcycle of R-MPV, erythema appeared on the left hip and left arm. Thearm lesions disappeared rapidly after initiation of topical betamethasone, whereas the hip lesions remained.

A 70-year-old man found to have leukocytosis of 44 × 109/L withabsolute lymphocytosis (9.37 × 109/L) on routine peripheral blood(PB) testing with no B symptoms. CT chest/abdomen imaging showedsplenomegaly and mild lymphadenopathy. Peripheral blood smear illustrated medium to large sized lymphocytes (90%, 8.5 × 109/L) withscant agranular cytoplasm, ovoid nuclei with condensed chromatinand prominent nucleoli (panel A and B; hematoxylin and eosin stain,× 40 and × 100 objective respectively). Bone marrow (BM) examination identified an extensive infiltration of neoplastic prolymphocytes.

CANOMAD is a rare syndrome encompassing chronic ataxic neuropathy, ophthalmoplegia, IgM paraprotein, cold agglutinins and disialosylantibodies [1,2]. We present a case of acute craniobulbar palsy associated with COVID-19 in which the combination of an established IgMparaprotein and the later emergence of a typical and persistent ganglioside antibody profile ultimately revealed a diagnosis of CANOMADsyndrome.We review the clinical presentation, diagnostic work-up andcurrent treatment.